After months of fighting this virus in the hospitals, I cannot tell you how excited I am to see the amazing work our researchers have done since the start of this pandemic. You have to remember, this is a worldwide pandemic. So, we learned from one another across the globe. This experience demonstrates how we all are unified in this vulnerability.
As a physician, I remember feeling the pain the people and the health care workers were feeling in Italy, Brazil, UK, and of course here in the US. We lead the world in the total number of deaths due to COVID-19.
Personally, it has been exhausting. I have never signed so many death certificates in my 13 year career. I have never cried as much as I did while listening to someone's heart and lungs who was infected with COVID-19.
It is so hard to see a chest x-ray or CT chest of an infected patient who initially might be smiling and talking to you but deep down you know that in the next few days you will be battling a virus that will bring all its might against this same patient. So many sleepless nights have passed with worrying about people under my care and crying over those who I lost.
Many people may not know that as a physician who is treating a COVID-19 infected person in the hospital, you get to really know their family members and their stories as these cases require long hospital stays. Hearing the struggles of others whether it is economic, social, or other issues makes the whole situation even harder.
To say the least, it has been very difficult. I smile a lot so people may not ever know the pain or exhaustion I feel as I write this blog. But, I do this work because I am blessed to be in a position to heal. I am blessed with a team of nurses and nurse practitioners at LiveActive and all the team members we have at our assisted living facility, hospitals, and long term acute care hospital. Together, we have lifted each other when we were down, worked extra shifts when we could, and our families took on risks as we fight this virus.
Please thank the spouses of health care workers too! I feel that we do not recognize them. They are the ones who fear daily for their loved ones. It is they who may have had to make us smile, give us a hug when we needed it the most, or put their concerns on hold while they lend us their ear as we share our frustrations and stories.
BUT...we finally are getting close to vaccination! Here are some important points to remember. The CDC website is helpful, but I found it a bit much to navigate through and make sense of so here is my attempt to simplify it for you.
What the heck is a mRNA?
We are all familiar with DNA (deoxyribonucleic acid). This is the molecule that contains the genetic code for organisms. Remember, plants, bacteria, and many other organisms have DNA. So to get from the genetic code to actual protein synthesis, messenger RNA (mRNA) is needed to transcribe the code for production of protein.
So, how does a vaccine take advantage of this process?
COVID-19 mRNA vaccines give instructions for our cells to make a protein called “spike protein.” This protein is found on the surface of the virus that causes COVID-19.
Where do you inject the vaccine and how does it work?
Once it is injected in the upper arm muscle cells, our cells use the mRNA to make the “spike protein”. Our immune system then goes into action! It recognizes the protein as a foreign invader and starts to build an immune response and making antibodies. Not only will our body protect us from the virus this time but also against future infection.
How safe is the COVID-19 vaccine?
To answer this question, you must understand how a vaccine is developed. Here is a simple picture without getting too technical. At each phase, researchers assess safety while increasing the number of subjects involved in the studies.
In addition, the FDA also looks at the manufacturing of the vaccine to assure its safety.
Manufacturing companies must seek permission to market a vaccine for use in the United States. If the FDA approves it, there is continued monitoring for safety and effectiveness. There are various surveillance systems in place that assist in monitoring for safety and effectiveness.
The CDC website has some great information but it can be confusing. Here are some quick facts that is from their website: Facts about COVID-19 Vaccines (cdc.gov)
Which vaccines are currently in PHASE 3 Clinical trials? As of November 24th, here are the current vaccines in progress or being planned:
This sounds great, but how much is it going to cost me?
Per the CDC website, vaccines purchased with US taxpayer dollars will be given to the American people at no cost. Vaccine providers will be able to charge administration fees for giving or administering the shot to someone. This fee can be reimbursed by the patients public or private insurance company. If uninsured, this fee can be reimbursed by the Health Resources and Services Administration’s Provider Relief Fund.
So, should I get it?
In my humble opinion, I think you should. I trust our country and our researchers. I trust the FDA process. I have faith that every study has been and will be conducted with the utmost care and thoroughness. The FDA is notorious for being complete and having a rigorous process when approving new treatments.
Please discuss your concerns with your primary care physician. Review the CDC website. Ask questions. Stay safe. We all have become stronger and more informed as a result of this terrible pandemic.
UPDATED 01/12/2021: With Missouri and Kansas in the initial phases of their vaccine distribution plans, some counties are allowing residents to sign up to be notified when they're eligible. This is a great new article that lists how to get on the Covid-19 vaccine list for certain counties: https://www.kcur.org/health/2021-01-12/kansas-city-heres-how-to-reserve-your-spot-in-line-for-a-covid-19-vaccine?fbclid=IwAR15z4Ni9FLxqrDbn8r_omTqYVUGcfUlFtT1jmz9F6Ec9tunLEO0xnF-Fv4
Did you know that each time you visit an ER, urgent care, or get admitted to the hospital your risk of developing anemia increases?
increased hospital stay = anemia = decrease longevity
So stop running to these places to get accessible care. Primary care prevents this nonsense. Relationships matter! Build one today.
Click HERE to learn more...again, beware as it is very detailed. I am pretty nerdy.
WARNING: This blog is very geeked out, so it is NOT for the casual reader.
The health and fitness industry has grown to become a multi-billion dollar industry. A large part of this growth has been through selling supplements to the “busy” consumer who just does not have time to eat healthy. Or, these products target the average American who has the aspirations to have the body like their favorite athlete. This has led to an explosion of various products confusing the consumer as to what is really necessary to take.
The goals of this post are:
1. Understand basic human physiology of muscle contraction and all the micronutrients that are involved
2. Educate regarding these micronutrients and how supplements aim to help, assist, or replace them
3. Learn about various supplements, including pre-workout drinks, branched chain amino acids (BCAAs), creatine, B vitamins, and much more!
4. Touch on the topic of probiotics and fiber. What's my colon got to do with all this?
5. Touch on "detox" programs, juicing, and fasting. Which is better and do I really need to do this?
Throughout this discussion, there is one proven fact that cannot be dismissed: all the nutrients your body needs already exist in your environment. To eat and live healthy, all we have to do is be willing to learn, make healthy eating a priority, and surround ourselves with people who will support eating healthy. Easy as that. To learn more, check out Dr. Sommer White, a board certified physician who is a great resource for you to learn about how food can heal and facilitate healthy living. http://www.sommerwhitemd.com
Also consider reviewing my previous blog about the 7 essentials to live healthy.
Basic physiology of energy
We all need energy to do anything. This is a law of physics where energy that is kinetic (motion) is dependent on the weight of the object and its speed. So the faster it moves and heavier it is, the more kinetic energy it develops.
Energy = weight (kg) x velocity (m/s2)
In food, we measure energy in calories. Our sources of energy come from proteins and carbohydrates.
1 calorie = 4.1868 Joules (measurement of energy in an object)
There is international debate as to how much calories we should consume. But here is a general recommendation:
Men = 2500 daily calories
Women = 2000 daily calories
Those who are sedentary, certainly these requirements will suffice. But, what about those who are active. Meaning, those who are working out 150 minutes per week or more? Active individuals have a higher demand for micronutrients and calories, especially if they want to maintain their weight and/or muscle mass.
This means, that the more you exercise, the more you expend energy, then the more you need to invest in the recovery phase.
The recovery phase means:
It is the recovery phase where you build muscle, not when you are working out in the gym.
Remember, before a single muscle fiber moves, it needs to get a signal from the nervous system. This is called an action potential. This process involves sodium and potassium channels. This is why micronutrients are so important!
Basic muscle physiology
Our muscles are important structures as they not only give us strength, make us look “buff”, but also strengthen joints and improve our balance as we age. To learn what an action potential is watch this video. I love this guy because this is what I probably would be doing if I didn't become a doctor.
Now that you understand the basic muscle physiology and realize all the micronutrients that are involved in the contraction, the following sections will make more sense.
What about these pre-workout drinks?
There are various drinks on the market. At the gym, I see few people still use Monster energy drinks and the like. More commonly, I see 5-Hour energy. The main component in many of these drinks is caffeine.
*Depending on the brew, an 8oz serving of coffee contains anywhere from 60-120mg of caffeine. Tea averages about 20-90mg per 8oz cup. Soft drinks average 20-40mg per can.
How much caffeine is too much?
According to the Mayo Clinic, up to 400mg of caffeine a day is safe in healthy adults. However, in adolescents and children, they should limit to no more than 100mg of caffeine per day.
So, taking a pre-workout drink will get an adult close to or meet that maximum daily requirement. Remember, these recommendations are for healthy adults. If you have heart disease, high blood pressure, anxiety, high cholesterol, arrythmias, and many other health conditions, then these recommendations DO NOT apply to you.
Here is where having a good primary care doctor can help. Have a good conversation about your workout goals and work together to reach those goals in a healthy way. If your current primary care doctor is not comfortable with this conversation or doesn't even workout…well, then give Dr. Ahmed a call!
Many energy drinks and pre-workout drinks are packed with B vitamins. Ever wonder why?
Check this out:
What about whey protein and branched chain amino acids (BCAAs)? Or, creatine and glutamine so I can look like those fitness models? Because clearly, if I take all those, I will look like them right?
Um, no you will not look like those fitness models just by taking these supplements. It takes a good balanced diet and exercise. More specifically, 80% - 90% is diet and the rest is exercise. You read that right: diet is more important than your exercise regimen.
How about juicing, fasting, and all these “detox” programs?
Majority of these programs are sketchy and very dangerous. Regardless of which program you are following, you need to be followed by a physician. This idea of “detox” should be an ongoing program where you eat foods that help clear any toxins by allowing normal bowel movements, increasing the efficiency of our cellular enzymes and reactions to digest all the toxins we are exposed to in our foods, water, air, etc.
Check out www.sommerwhitemd.com. Watch her videos and her explanation of detoxification approach through food. We had her at our clinic and support what she offers.
Short intervals of fasting are healthy, but must be monitored by a physician. Juicing has similar advantages for detoxification with elimination of inflammatory markers and provide antioxidants. Again, this should not be a one time thing and must be monitored by a physician. The bottom line is, get a doctor to monitor and assure that whatever you choose to do, follow it up with eating a healthy balanced diet and exercising daily. At the end of the day, diet and exercise is what is going to give you the benefits. If a fast or a juice helps you transition or get you to diet and exercise, then do it I guess.
Here is a breakdown of the most popular ingredients the average athlete is curious about?
How much protein do I really need?
The average person needs about 1g/kg of protein per day. Those who are not as active can probably be ok eating a little less than that. However, if you are trying to add muscle mass, then the usual recommendation is 1.5g/kg. Remember, muscle building happens at night when you are sleeping or when you are resting, not at the gym. Balance this with about 30g of fiber to prevent constipation and certainly anyone with kidney disease, high blood pressure, or the medical conditions must be monitored by a physician.
To give you some idea of how much protein some common foods have:
So, the point is, before you run to the store to get containers of whey protein and bottles of BCAAs, think about how much protein you already consume and if there is a deficit, THEN consider possibly supplement. Remember, many if not all supplement products are NOT FDA approved. This means, these supplements are not benign or harm free. We just do not know the long term effects of some of these supplements. That is why I recommend use supplements to help you fill in gaps and hopefully you can replace those supplements with actual food. Long term supplements are not a good idea since we do not have the data to support their absolute need for the average human being. Professionals athletes are a different category in this discussion.
Probiotics and colon health
There has been more enthusiasm about probiotics recently without the support of much scientific evidence. All the trials that are done on probiotics are inconsistent with methodology or are small studies. The intestinal tract is a host to any bacteria and any change in these colonies can affect your health. In a sense our intestine has its own ecosystem with bacteria regulating certain toxin elimination and protecting the intestine from inflammation and other processes that can damage its lining.
By definition, probiotics are microorganisms that have beneficial properties for the human being. Many of the bacteria in these tablets are available in foods, such as non-pasteurized yogurt and milk. Some of the benefits include suppression of growth or epithelial binding/invasion by pathogenic bacteria, improvement of intestinal barrier function, modulation of the immune system, and modulation of pain perception. Reports for benefit have been seen in the following conditions:
1. infectious diarrhea
2. Clostridium deficile infection
3. preventing antibiotic associated diarrhea
4. Possible benefit with IBS
*Again, the data is limited here. As you can see, there are only a few things have shown moderate evidence of benefit
Fiber is a stool bulking agent that helps people stay regular. It is important to have one bowel movement per day. The bulking agent facilitates peristalsis, which is contraction of the intestinal tract to help move stool along to facilitate a bowel movement. You need to take in about 20-25g of Fiber daily. I usually recommend 30g given the poor American diet. You can get fiber in a balanced diet or supplement with any affordable over the counter powders.
Colon health is important to eliminate toxins from our body. If you think about it, our body eliminates waste by sweating through our skin, urination, and stool elimination. The average American does not stay hydrated and nor do they stay regular with their fiber intake. So the body is left with only sweat as a mechanism to eliminate waste. There is something to be said as these toxins accumulate and are not released, this can lead to poor health outcomes. More evidence is needed for this statement to be completely accurate, but the basic physiology suggests this possibility.
What is the bottom line on supplements?
I take supplements to help with muscle development and recovery. However, supplements are there to do just that - supplement your diet! A majority of supplements I think are unnecessary long term. If you are working out for a competition or a sport, then short intervals are reasonable. The more I learn about various vegetables that I had no idea about: daikon, miso, wakame, dried shiitake, and the benefits of brown rice, I am starting to realize how silly supplements seem.
Every supplement, whether they claim to be “all natural” or not, need to be monitored by a physician who is comfortable with these products.
I have tried many supplements and do so with the intent to taste what my patients or future patients are likely trying. I also read about these products, because for me, it is important to have a knowledgable discussion about these products in the right medical setting. Consumers who take these products are likely very in tune with their bodies and would appreciate a physiologic lesson as to why they should continue, adjust their dose, or maybe even stop what they are taking.
So, bottom line, focus on your diet. Get a team together that will help you not only understand but hold you accountable to a good balanced diet. Food should be entertaining, enjoyed with company, and diverse to facilitate curiosity and enjoyment. The supplement industry makes billions off the human behavior of not sticking to a plan or climbing on and off the wagon. Save yourself money and put together a good team for yourself to help you take what you need and stick to a program for life. Finally, combine your healthy diet and supplements with the right exercise program. You do not need to work out 6 days a week and spend hours at the gym.
After 1 hour in the gym of active working out, any more time is just increasing your risk for injury. Athletes are different in that they know how to recover in between training sessions during the day with the right nutrition to allow healing of those injured muscles.
Don’t be swayed by these new years resolution gimmicks. Stick to what you know - great diet with 150 minutes of activity per week is all you need to see results. Finally, be patient and positive. Feed your soul with a good book, meditate, do yoga, and laugh.
Please do no hesitate to ask any questions you may have. Better yet, if you don't have a primary care doctor, please consider joining my practice.
To a great year full of happiness, health, and blessings,
Employer wellness programs have become more popular in the last several years. Its popularity for implementation has its roots in the ever increasing concerns of rising prevalence of obesity, diabetes, heart disease, and many other chronic illnesses. In fact, based on recent surveys, almost 80% of companies offer some type of a wellness program.
Vendors for these wellness programs have enjoyed their growth in the last several years to a point where it has become a $6 billion industry.
So, it is only fair to ask the question: Are employers getting a significant rate of return on their investment?
The rationale for having a wellness program in the workplace is to create a organizational culture of wellness, improve the health of its employees, decrease turnover, increase productivity, reduce health care costs, and on a larger scale - improve the health of our nation. Nearly half of Americans get their health benefits from their employer and we all spend a majority of our time in the workplace. Thus, these goals and rationale make sense.
But, has this $6 billion industry delivered on its promise?
On average, employers spend about $693 per worker and larger companies who have 20,000 workers or more spend nearly $878 per worker. A large survey found that although some biometric markers like BMI, smoking cessation, and exercise had improved, these changes were not large enough to reduce health care costs nor provide the employer with a substantial ROI.
In addition, one of the major challenges in offering a wellness program is employee engagement (industry talk for employee participation). Surveys have shown that even after a wellness program is implemented, employee engagement is low. Studies have shown that the lost productivity from employee disengagement costs between $450 billion and $550 billion annually in the United States. For each employee, disengagement can cost the employer $5,000 to $7,000 per year in lost productivity.
What if a physician led an employee health benefit plan where it included resources like fitness trainers, physical therapists, nutritionist, chiropractor, acupuncture, supplements for healthy eating and weight loss, financial advisors, lawyers for estate planning, massage therapists, counselors, medical specialists, and educators?
What if the physician also had partners in imaging, laboratory, pathology, had wholesale medications in their office, did not charge for any office visits or in clinic procedures like EKG, joint injections, suturing, skin biopsies, wound care, breathing treatments, or spirometry?
What if each employee as part of this physician led wellness plan had 24/7 access to their physician, even during holidays? Certainly a relationship between the employee and the physician is inevitable. So is there value in this relationship where the physician understands the stresses, aspirations, goals, as well as medical condition of the employee?
Finally, what if the cost is only $600 per employee that is fixed annually with no other out of pocket expenses for the employer? While the employee enjoys significantly discounted medications, imaging, laboratory, and other services.
The answer to all these questions is not an ideal nor is it impossible to implement. I do it already with companies right here in Kansas City. Many physicians across the country who share my vision and mission have also aligned their practice with other companies of various sizes.
In a study that reviewed insurance claims data from 2013 to 2014 showed that the employees who belonged to the Direct Primary Care model compared to those who did not saved $679,000 per 1000 employees. In addition, there were close to 20% less claims from the DPC group.
Isn't it time to be innovative and offer a more comprehensive program to your employees? My practice is NOT insurance. So to qualify for the ACA mandate, employers must have a high deductible plan or a self insured plan that can be paired with our practice to give the most value to your employees.
Healthcare is changing. Costs are rising and the physician supply is decreasing. Employers can play an important role in changing this landscape with one decision: partner with a direct primary care practice.
Our mission is to recruit more primary care physicians, retain more physicians in private practice to facilitate patient focused care, and bring back continuity and relationship medicine. We do this simply because the health of our nation depends upon it.
Please contact us today if you would like to learn more about our primary care practice and how we can partner together to truly establish wellness in the workplace.
To your health
- Dr. Ahmed
Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner.
How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols.
What is the cause?
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated
hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease
When should I be concerned?
What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services.
There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States.
Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing.
Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation.
To your health my friends,
- Dr. Ahmed
Unfortunately, we give our cars, clothes, beauty/spa treatments, homes, or entertainment desires more attention than our own health. The realization of this neglect only becomes known when we become ill or injure ourselves.
Therefore, just like anything else, there is tremendous value in prevention and education. One thing I hear a lot is, "I am very healthy and never see a doctor." Is that a good thing? Should we see a doctor only when we are sick and vulnerable? What about seeing the doctor to discuss life's stress, maybe you are traveling and need to learn about important vaccines, learn about any public health concerns, prevent future illness? How about losing weight? Do you really need that supplement and if so is it safe? Isn't it more costly to go to an urgent care for every minor health issue than going to a doctor who knows you and can see you that day or next day? Finally, do you really need a specialist following your chronic condition?
We have new testing modalities that enable us to prevent heart attack or stroke in those who do not have the traditional risk factors, like smoking, high blood pressure, diabetes, or high cholesterol.
Here is a quick chart on how our patients save if you just look at the numbers. These numbers make the following assumptions:
*Single without any dependents
*Minimum use of health care (healthcare.gov estimates)
*Cheapest plans are selected for this comparison
*Average income of $75,000
*No primary care visit costs as some insurances charge $25-50 for each visit
*No specialist vist costs
So, if you are a couple, go to a primary care doctor currently or urgent care for your needs, have dependents, you are female, or make more money, the cost is significantly more.
Remember 2016 Annual HSA Limits per IRS:
Self-only coverage = $3,350
Family coverage = $6,750
What about Medicare you ask? Well, Medicare patients not only save money, but have a physician who can be a true quarterback for your health care. Coordinating with specialists, home care services, preventing falls, making house calls or assisted living/independent living visits are a tremendous value.
This probably goes without saying, but these numbers are estimates. There are so many factors that can affect your final costs. Certainly, if you end up needing surgery or need medications, then the cost will be higher. This is simply illustrated to give you a general idea at the most basic level.
I hope this blog really clears the air a little in how insurance works with our practice. Remember, at Health Suite, you can pick LiveActive Primary Care as your primary care service or KC Family Doc. Check us out or meet us for a free consultation today!
To your health,
- Dr. Ahmed
The American Heart Association strongly promotes "Life's Simple 7" to raise awareness of what it exactly means to live healthy. More importantly, there has been significant research in looking at these 7 goals and how they reduce the chance of developing heart disease and even cardiac death.
The Life's Simple 7 are as follows:
1. Manage blood pressure
2. Control cholesterol
3. Reduce blood sugar
4. Get active
5. Eat better
6. Lose weight
7. Stop smoking
A more detailed discussion into what each of these goals means...
MANAGE BLOOD PRESSURE
High blood pressure goes undiagnosed and many times because of the lack of time with your physician, it may not be treated appropriately. Many organs can be injured from high blood pressure aside from developing a stroke or a heart attack. These include kidneys, liver, your GI tract, eyes, and much more. Goal blood pressure is less than 120/80.
By reducing your cholesterol levels, you give your arteries the best chance of not getting clogged. Plaques form from cholesterol deposits that can lead to strokes or heart attacks.
REDUCE BLOOD SUGAR
We may not realize how much sugar we consume as several foods we eat are full of sugar. The average American, according to the United States Department of Agriculture (USDA), consumes anywhere between 150 to 170 pounds of sugar in 1 year! That is equal to about 30-34 five pound bags of sugar lined up next to one another in a counter! High blood sugar levels affect every organ in our body, including fighting infections and healing wounds. Certainly, Diabetes is a major concern when one consumes a lot of sugar. Diabetes is a multi-system disease and the good news is that it is preventable and treatable. So how much sugar should you eat? As close to zero as you can get.
Here is the skinny on how much activity you truly need:
We know the usual stuff don't we:
What is the ideal weight? We are all inundated with advertisements of what it means to "look fit." So here is the truth and reality of what goals regarding weight actually result in optimal cardiovascular health, longevity, and living well. By focusing on your BMI, you can get a good assessment of where you need to be. It is a simple calculation by knowing your height and weight. Calculate yours today!
This is a no brainer. The days of the Marlboro man are gone and most have tossed the cigarettes. Smoking causes cardiovascular disease, increases risk for stroke, peripheral vascular disease that can lead to amputation of limbs, poor wound healing, emphysema where you may need oxygen to breathe, and many types of deadly cancers. There is strong evidence regarding the risk of second hand smoke and the fact that it can cause similar damage to the body as if the person was a smoker.
To get in-depth information regarding these 7 goals, visit this site
Wishing you a life full of joy, happiness, and good health,
- Dr. Ahmed
"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."