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Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Is plavix really a life saver?

Jul 09, 2009 - 11 comments
Tags:

aspirin

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atrial fibrillation

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Plavix

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Chest Pain

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Heart Attack

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Stroke



Below is an exerpt from a direct to consumer advertisement on clopidogrel----

If you have been diagnosed with P.A.D., you need to learn how to lower your risk of heart attack or stroke. Individuals with P.A.D. have more than double the risk of heart attack or stroke compared to people who don't have P.A.D. Now is the time to explore all your treatment options to help reduce that risk, including P.A.D. medications like Plavix® (clopidogrel bisulfate).

PLAVIX is the only antiplatelet therapy FDA-approved for patients with established P.A.D. to help reduce the risk of heart attack and stroke. Medical guidelines recommend antiplatelet therapy, like PLAVIX, in addition to other risk-reducing medications for P.A.D. patients. Together, you and your doctor can design a plan that's right for you and may include P.A.D. medication, diet and exercise.

PLAVIX is prescribed to lower the risk of future heart attack or stroke in patients with established Peripheral Artery Disease.

________________

I frequently have patients on fixed incomes that ask me if they should be on plavix because they have seen a commercial, print advertisement or direct mail.  The company has done a great job of convincing people that if they are not on plavix, they should be. There is no doubt that plavix is a good medication and is essential in some patients. However, there are some patients who would best be served by a single aspirin per day at several cents per tablet as opposed to clopidogrel/plavix at $1-2 per pill. Another example of pharmaceuticals fleecing of America


Is the Benefit of exercise overblown!!

Jun 20, 2009 - 5 comments
Tags:

Weight Loss

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Exercise

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Diabetes

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Heart Disease

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vitamin



I recently came across this article in the NY Times. It raises the question about the benefits of exercise. It reminds me of a comment that I heard from a patient. I asked him if he was exercising to better his health and control his weight. He told me "I believe that God has given me a set number of steps that I will walk on this earth. No more, no less. Why should I waste those predetermined number of steps walking on a treadmill". Of cource the man was being facetious, but there are always questions about the true benefits derived purely from exercise.

The gist of this short article, is that exercise certainly has significant benefits over a sedentary life. How much exercise and how intense is unclear. Also, why its beneficial is multifactorial. People who make a committment to exercise generally commit to living a healthier life by eating well, visiting a doctor and adhering to a safe and prevention driven existence. Furthermore, many of the illnesses that we suffer are related to obesity and as we age falls and bone fractures become a large concern. It is clear that active seniors have less falls and are less likely to become obese.

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Your Guide to Optimal Health by Dr Lee Kirksey and Dr Seema Patel
www.personalwellnesswheel.com

Bottom line. Although we cant answer the question completely...moderate exercise is safe and effective. Read On....

Source
Kevin Moloney for The New York Times

Kaoko Obata, a Japanese marathoner, runs at the Boulder Reservoir in Colorado.

In Brief:

While exercise can boost mood, its health benefits have been oversold.

Moderate exercise can reduce the risk of diabetes in people at risk. Exercise may reduce the risk of heart disease and breast and colon cancers.

Though the evidence is mixed, exercise may also provide benefits for people with osteoporosis.

Physical activity alone will not lead to sustained weight loss or reduce blood pressure or cholesterol.

Exercise has long been touted as the panacea for everything that ails you. For better health, simply walk for 20 or 30 minutes a day, boosters say — and you don’t even have to do it all at once. Count a few minutes here and a few there, and just add them up. Or wear a pedometer and keep track of your steps. However you manage it, you will lose weight, get your blood pressure under control and reduce your risk of osteoporosis.

If only it were so simple. While exercise has undeniable benefits, many, if not most, of its powers have been oversold. Sure, it can be fun. It can make you feel energized. And it may lift your mood. But before you turn to a fitness program as the solution to your particular health or weight concern, consider what science has found.

Moderate exercise, such as walking, can reduce the risk of diabetes in obese and sedentary people whose blood sugar is starting to rise. That outcome was shown in a large federal study in which participants were randomly assigned either to an exercise and diet program, to take a diabetes drug or to serve as controls. Despite trying hard, those who dieted and worked out lost very little weight. But they did manage to maintain a regular walking program, and fewer of them went on to develop diabetes.

Exercise also may reduce the risk of heart disease, though the evidence is surprisingly mixed. There seems to be a threshold effect: Most of the heart protection appears to be realized by people who go from being sedentary to being moderately active, usually by walking regularly. More intense exercise has been shown to provide only slightly greater benefits. Yet the data from several large studies have not always been clear, because those who exercise tend to be very different from those who do not.

Active people are much less likely to smoke; they’re thinner and they eat differently than their sedentary peers. They also tend to be more educated, and education is one of the strongest predictors of good health in general and a longer life. As a result, it is impossible to know with confidence whether exercise prevents heart disease or whether people who are less likely to get heart disease are also more likely to be exercising.

Scientists have much the same problem evaluating exercise and cancer. The same sort of studies that were done for heart disease find that people who exercised had lower rates of colon and breast cancer. But whether that result is cause or effect is not well established.

Exercise is often said to stave off osteoporosis. Yet even weight-bearing activities like walking, running or lifting weights has not been shown to have that effect. Still, in rigorous studies in which elderly people were randomly assigned either to exercise or maintain their normal routine, the exercisers were less likely to fall, perhaps because they got stronger or developed better balance. Since falls can lead to fractures in people with osteoporosis, exercise may prevent broken bones — but only indirectly.

And what about weight loss? Lifting weights builds muscles but will not make you burn more calories. The muscle you gain is minuscule compared with the total amount of skeletal muscle in the body. And muscle has a very low metabolic rate when it’s at rest. (You can’t flex your biceps all the time.)

Jack Wilmore, an exercise physiologist at Texas A & M University, calculated that the average amount of muscle that men gained after a serious 12-week weight-lifting program was 2 kilograms, or 4.4 pounds. That added muscle would increase the metabolic rate by only 24 calories a day.

Exercise alone, in the absence of weight loss, has not been shown to reduce blood pressure. Nor does it make much difference in cholesterol levels. Weight loss can lower blood pressure and cholesterol levels, but if you want to lose weight, you have to diet as well as exercise. Exercise alone has not been shown to bring sustained weight loss.Just ask Steven Blair, an exercise researcher at the University of South Carolina. He runs every day and even runs marathons. But, he adds, “I was short, fat and bald when I started running, and I’m still short, fat and bald. Weight control is difficult for me. I fight the losing battle.”

The difficulty, Dr. Blair says, is that it’s much easier to eat 1,000 calories than to burn off 1,000 calories with exercise. As he relates, “An old football coach used to say, ‘I have all my assistants running five miles a day, but they eat 10 miles a day.’”



An Over Medicated Nation!!!

May 16, 2009 - 13 comments
Tags:

your guide to optimal health

,

Lee Kirksey

,

medication errors

,

medication

,

Diabetes

,

hypertension



A situation that happened in my practice this week motivated me to look up some information about American's use of prescription drugs for chronic disorders. The results of my search (below) are consistent with what everyone already knows. We are a heavily medicated country. There's a medication for every disorder. And the most frightening part of the whole equation is the rapidly increasing inclusion of children. Statistics show that up to 25% of insured children are on some medication (asthma, attention deficit and diabetes are the most common condition)

Medication Usage
51% of all insured Americans (including children) take at least one prescription drug
20% of insured Americans take three or more Rx drugs
75% of older adults take one or more Rx drugs
25% of older adults take five or more meds on a regular basis (28% of women and 22% of
men)

The fact that many older Americans are on long term medications is startling because of the know consequences and side affects of these medication. And unfortunately, the monitoring of these medications over times is sometimes inadequate

Older adults are seven times more likely to be hospitalized for an adverse drug event than
younger individuals.

Warfarin, insulin, and digoxin together account for over one-third of emergency department
visits for adverse drug events among older adults.—Budnitz DS, Pollock, DA, Weidenbach KN, et al. National
Surveillance of Emergency Department Visits for Outpatient Adverse Drug Events. JAMA. 2006;296:1858-1866.

“About one in three older persons taking at least five medications will experience an adverse
drug event each year, and about two thirds of these patients will require medical attention.”—
Hanlon JT, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:945-8.

“If the findings of the present study are generalized to the population of all Medicare enrollees,
then more than 1,900,000 adverse drug events—more than a quarter of which are preventable—
occur each year among 38 million Medicare enrollees; furthermore, estimates based on our
study suggest that there are in excess of 180,000 life threatening or fatal adverse drug events
per year, of which more than 50% may be preventable.”—Gurwitz JH, Field TS, Harrold LR, et al. Incidence
and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289:1107-16.


The situation that prompted this blog was an elderly woman who recently had surgery. II saw her in the office to verify that she had healed her incision completely. As I was discharging her from my office, she asked if I could writer her a couple of refills on prescriptions. Her politely told her that I was not comfortable with that because I think, unless its an emergency, one physician should manage a patients medications. Well that lead to a discussion about how doctors are fleecing America

From Medco Drug Trends Report 2008, May 2008 (data from 2007)
Percent of prescriptions filled with brand name drugs declined from 45.9% in 2003 to 30.6% in
May 2008.—WSJ July 16, 2008 “Patients Curb Prescription Spending”New research reveals that one-third (34%) of seniors are taking medications prescribed by two or more physicians and that seven out of ten (72%) seniors reported taking medications that were first prescribed for them more than six months ago. Commissioned by the American Society of Health-System Pharmacists (ASHP), the survey of 275 Americans, age 65 and older, questioned seniors on their medication use as well as their knowledge and concerns about potentially harmful drug interactions.

Suffice to say that I encourage all of us who are on medications or who have family members on them to monitor the meds closely and ask for periodic reviews about how effective they are, what medications can be decreased or eliminated. We have to be our own advocates.

To learn more about Optimal Health, visit www.personalwellnesswheel.com and pick up Your Guide to Optimal Health: Creating Your Personal Wellness Wheel. Stay tuned for a teleseminar which myself and my co-author will be conducting on Medhelp.org.-your source for helpful medical information

Your Waist Size Predicts Heart Attack Risk

Apr 25, 2009 - 6 comments
Tags:

Obesity

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Weight gain

,

Heart Attack

,

palpitations

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Diabetes

,

Stroke

,

Amputation

,

Thyroid problem

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Polycystic Ovarian syndrome

,

insulin resistance



83362?1248812051
I was reviewing a recent paper on the associations of BMI, waist size and hip to waist ration as predictors of heart attack risk. It turns out that your hip size may have the closest correlation. Currently in the US, 70% of men and 65% of women are obese (BMI) >25.5. As we look to give people simpler ways of self-assessing their heart attack and stroke risk, waist circumference is one simple way to do this. Read on to learn why abdominal fat is a bad thing. As it turns out, those love handles may be cute...but they may also be deadly

According to several recent studies, both waist size and the waist to hip ratio may be better indicators of heart disease risk than the traditional Body Mass Index (BMI).

The American Heart Association (AHA) recommends that people aim for a BMI of between 18.5 and 24.9 however most Americans have a BMI well above this range. Approximately 70% of American men and 60% of American women have a BMI greater than 25 and around 35% of Americans have a BMI greater than 30 (these individuals fall into the obese category). The proportion of Americans with a BMI over 25 has more than doubled over the last 30 years.

The major drawback of BMI is that it does not take into account a persons body composition. An athlete or body builder for example may have little body fat and yet have a BMI well over 25 due to the large amount of muscle they carry.

Waist size on the other hand gives a good indication of the amount of fat a person is carrying, particularly around the stomach area. Abdominal fat is considered an important risk factor for cardiovascular diseases such as coronary heart disease and stroke. Abdominal fat is also a risk factor for diabetes because it leads to a reduction in the body’s response to insulin which results in larger amounts of insulin needing to be secreted by the pancreas to control blood sugar levels. This eventually leads to insulin resistance and the onset of type-2 diabetes.

Most doctors recommend a waist size of under 37 inches (84 cm) for men and 32 inches (81 cm) for women. As of 2008, the average American man has a waist size of around 40 inches, an increase of 5 inches compared to 40 years ago. The average American woman has a waist size of 37 inches, an increase of 7 inches over the last 40 years.

One study, presented at the annual conference of the American College of Cardiology in Atlanta, found that a 14 cm increase in waist size correlated to around a 30% increase in heart disease risk. The data was collected from over 160,000 individuals in 63 countries and represents one of the largest studies on the effects of waist size on heart disease.

A study of post-menopausal women conducted at the Washington University School of Medicine also found that the correlation between waist size and three different heart disease risk factors: insulin sensitivity, HDL-cholesterol, and triglyceride levels was stronger than the correlation between BMI and the three risk factors. The authors of the study concluded that waist circumference was a better measure of heart disease risk than BMI in middle aged and older women.

Recently, it has been suggested that the waist to hip ratio is a better predictor of heart disease than either BMI or waist size alone. The waist to hip ratio is calculated by dividing the circumference of the waist at its smallest point by the circumference of the hips at their widest point. An optimal waist to hip ratio is less than 0.8 in women and 0.9 in men.

A study, published in the American Journal of Epidemiology in 1998, found the waist to hip ratio to be a far better predictor of heart disease than BMI.