Health Connection - September 2019

Cholesterol: The Good, the Bad, the Healthy

Your cholesterol level is an important indicator of your general health, but how much do you really know about it? Cholesterol is a waxy substance made in the liver and used by the body to build cells. While your body makes all the cholesterol you need, your cholesterol levels are supplemented by the foods you eat.

Cholesterol is carried through your bloodstream by proteins known as “lipoproteins.” When you go in for a check up, your doctor may order a test called a Lipid Panel, or Lipid Profile. This test measures the amount of different lipoproteins in your blood:

• Low-density lipoprotein (LDL), transports cholesterol particles throughout your body. LDL is known as “bad” cholesterol because it builds up in the arteries, forming plaque.
• High-density lipoprotein (HDL), or "good" cholesterol, picks up excess cholesterol and takes it back to your liver.
• Triglycerides, a type of fat in the blood, stores unused calories and helps provide your body with energy. A high level of triglycerides in the blood means you are taking more calories than your body can use. Combined with high LDL and low HDL, a high triglyceride level is a risk factor for heart disease.

The Dangers of Atherosclerosis

When plaque accumulates on your artery walls, it leads to a condition called atherosclerosis, commonly referred to as hardening of the arteries. This reduces the blood flow through the arteries, so your heart might not get enough oxygen. Or if plague tears or ruptures, it can form dangerous blood clots that can block the flow of blood or break free and plug an artery elsewhere in the body. If a clot blocks blood flow to the heart, you'll have a heart attack. If a blood clot blocks blood flow to your brain, a stroke occurs.

Risk Factors for “Bad” Cholesterol

• Diet. Foods high in saturated fats and cholesterol, such as red meat and full-fat dairy products, can increase your cholesterol. Trans fats, found in tropical oils such as palm oil, palm kernel oil and coconut oil, can also raise your cholesterol levels. These are common ingredients in many processed foods so make sure to read nutrition labels!
• Obesity. A body mass index (BMI) of 30 or more puts you at risk for high cholesterol.
• A Sedentary Lifestyle. Being inactive increases your LDL (bad) cholesterol; conversely, exercise can boost your body’s HDL (good) cholesterol.
• Smoking. Cigarette smoking damages the blood vessel walls, making them more prone to accumulating fatty deposits.
• Age. As you age, your liver becomes less able to remove LDL cholesterol.
• Diabetes. High blood sugar damages the blood vessel walls. It also raises the levels of very-low-density lipoprotein (VLDL), a dangerous form of cholesterol, while lowering HDL levels.

Getting Your Cholesterol Under Control

If you have high cholesterol, you can take steps to lower it with the the heart-healthy tips below. Better yet, if your cholesterol isn’t currently elevated, these tips can help keep your cholesterol levels in the healthy range:

• Eat a healthy, low-salt diet that includes plenty of fruits, vegetables and whole grains
• Limit the amount of animal fats you consume and use good fats in moderation
• Lose weight if needed
• Quit smoking
• Exercise for at least 30 minutes a day, at least 5 days a week
• Use alcohol moderately, if at all
• Manage stress

To learn more about how the right diet—such as Dr. Ornish’s Program for Reversing Heart Disease—can help you manage your cholesterol and improve your heart health, listen to MarinHealth’s Healing Podcast featuring cardiologist, Mark P. Wexman, MD, FACC.

Can You Prevent Painful Kidney Stones?

by Patrick M. Bennett, MD, MarinHealth Urology | A UCSF Health Clinic

According to the National Kidney Foundation, the lifetime risk for developing kidney stones is about 19% for men and 9% for women. Kidney stones account for more than a million visits to the Emergency Room each year. The pain they cause can be excruciating – female sufferers often compare it to childbirth in its intensity and unpredictability.

Kidney stones develop from crystals that collect on the inner surface of the kidney during urine production. These deposits eventually become large enough to break off from the kidney walls, forming a stone. Some rest harmlessly within the kidney. Others may fall into the ureter, the tube that carries urine from the kidney to the bladder. The resulting blockage of urine causes “renal colic,” a severe lower back or abdominal pain, often radiating to the groin, and usually accompanied by nausea and vomiting. For many patients, relief is achieved only with medications provided at an emergency room, and many require more advanced treatment.

Most stones are small enough to pass into the bladder without any further intervention. Stones larger than 5 millimeters, however, are less likely to pass on their own. To treat these, urologists frequently recommend lithotripsy, a non-invasive procedure that uses shock waves to break up a stone so it can pass through the urinary track more easily. This is usually performed on an outpatient basis.

Kidney stones are most common in adults between 30 and 60 years of age. The risk increases if you have a family history of kidney stones or have previously developed a stone. About half of patients who have had a kidney stone will experience a recurrence within 10 to 15 years. Obesity and diabetes are also risk factors.

Patients can usually make dietary or lifestyle changes that will reduce the risk of stone recurrence. In nearly all instances, increasing fluid intake to more than 2.5 liters a day and lowering sodium intake will reduce stone formation. Some people are more prone to kidney stones due to their particular intestinal or kidney function. In such cases, a urologist can recommend diets or medication to reduce risks.

Most stones are comprised of calcium and a carbohydrate molecule called oxalate. Our bodies make oxalate, which is also found in high concentrations in green leafy vegetables and tree nuts such as almonds. Because foods containing calcium and oxalate have significant nutritional benefits, most urologists and nutritionists will not recommend dietary restrictions without doing a few simple tests to determine what might be best for a given patient.

Medication to prevent stones could be as simple as baking soda, citric acid, or a gentle diuretic. Specific recommendations are based on stone composition results from analysis of urine collected over a 24-hour period. Kidney stones usually cause no permanent damage, and to pass one you may need only time, pain medications and lots of liquids.

Learn more about kidney stones and the treatment programs available at MarinHealth.

Is Your Child Being Bullied? Know the Signs.

We want to believe our children tell us everything. But think back to your own childhood. Weren’t there some things you just couldn’t bring yourself to share with your parents? Bullying is one of those things. Some children hesitate to speak up. In fact, according to the National Center for Education Statistics, children tell an adult about bullying incidents just 40% of the time.

There are a variety of reasons children don’t tell adults they are being victimized by other children. They may fear being labeled a tattle tale and losing their friends. They may fear that parental interference will make the bullying worse. They may not want their parents to be worried about them. Some parents urge their children to fight the bully and shame them for being “weak” if they don’t, so the child is embarrassed to disclose the problem. In some cases, children are embarrassed to know what the bully is saying about them or their parents. Saddest of all, some bullied children feel so socially isolated, they conclude that no one, including mom and dad, really understands or cares about what is happening to them.

As a parent, you need to be able to detect signs that your child is being bullied. Initiate a serious conversation if your child:

• Becomes aggressive and starts getting in to fights at school
  (This can also be a sign that your child is bullying others)
• Has unexplained cuts, scratches, or bruises
• Has missing or damaged clothes or belongings
• Has failing grades
• Has few or no friends and does not get invited to parties
• Refuses to talk about what’s wrong
• Doesn’t want to get out of bed in the morning
• Doesn’t want to go to school
• Is afraid of walking to school or wants to change their route
• Is prone to crying, anger, anxiety, or mood swings
• Has a lot of stomach aches or unexplained pains
• Asks for extra pocket money or food, or comes home from school hungry
• Won’t discuss their online communication

Could your child be involved in bullying others? If your child is a bully or a “mean girl”, it doesn’t mean you’re a bad parent. But it’s essential to step in early. Find out what’s going on if your child:

• Becomes increasingly aggressive and gets into physical or verbal fights
• Has friends who bully others
• Get repeatedly sent to detention of the principal’s office
• Brings home unexplained money or belongings
• Has a tendency to always blame others for their problems

If your child shows signs of being bullied or bullying others, you need to take immediate action. If they seem reluctant to talk about issues, try asking them questions about their day, such as “What do you do at lunchtime? Who do you sit with? What do you like to talk about?” These types of questions can start a conversation, and help them know they can open up to you if there is a problem. Talk to your child’s teacher, school counselor, or principal, and make sure that the situation is thoroughly investigated and appropriate action is taken. Learn more about California’s anti-bullying laws and policies. Finally, if your child shows behavioral or emotional changes, talk to your pediatrician, as these could be signs of depression. If you don’t have a pediatrician, find one here.

Pain Management: The Responsible Use of Opioids

By Ramana Naidu, MD, Anesthesiologist, Pain Physician, and Medical Director of Pain Management at MarinHealth Medical Center

More than 100 million Americans suffer from chronic pain. Beyond its obvious impact on quality of life, chronic pain can also disrupt sleep and reduce productivity both at work and at home. Some of those suffering from chronic pain have been helped by prescription opioids without any ill effects. But for one out of four people, taking opioids for long-term, chronic pain leads to dependence and even addiction. The statistics are sobering. According to the Centers for Disease Control and Prevention (CDC):

• More than 130 Americans die each day as a result of opioid overdose
• Roughly 68% of the more than 70,200 drug overdose deaths in 2017 involved an opioid

Over-the-counter drugs, such as aspirin, ibuprofen, naproxen or acetaminophen work well for mild to moderate pain. However, these drugs have a threshold beyond which they are ineffective. With opioids, physicians can keep raising the dose until relief is achieved. This is what makes these drugs appealing for patients recovering from surgery or a broken bone. However, opioids have many side effects and actually make you more sensitive to pain over time (hyperalgesia). This is what makes them deleterious in non-cancer chronic pain. In essence, there is a short-term gain, for a long-term loss.

Medically, dependence and addiction are two different issues. In dependence, the opioid receptors in the brain learn to “expect” the next dose of medication. When that dose doesn’t come, the person experiences physical withdrawal symptoms. In addiction there is a psychological dependence described by use despite consequences, loss of control, cravings and compulsion.

Opioids have a place in pain management, but there are many other new alternatives that are growing in pain medicine, such as novel, minimally-invasive spine procedures and neurostimulation. If your doctor does prescribe opioids, there are steps you can take to minimize your risk for addiction:

• Never take an opioid (or any prescription medication) that wasn’t prescribed for you
• Don’t take opioids in higher doses, or more frequently, than as prescribed by your doctor
• Avoid alcohol and/or benzodiazepines while taking opioids
• Tell your doctor if you have a personal history, or family history, of substance abuse
• Ask your doctor about alternatives for pain relief
• Tell your doctor if you experience withdrawal symptoms, such as anxiety, insomnia, nausea, or diarrhea, when you stop taking the opioids
• Engage in an opioid agreement with your provider
• Have naloxone available in your home to reverse an overdose of opioids in your home and community.
• Lock your opioids so others, including children, do not misuse these controlled substances.

People with a family history of substance abuse or alcoholism are more at-risk for addiction. Addiction may be diagnosed based on the following troubling indicators:

• Taking opioids in greater quantities and over a longer period of time than medically indicated
• Unsuccessful efforts to cut down or control opioid use
• Spending a lot of time obtaining, using, or recovering from the effects of opioids
• Strong cravings to use opioids
• Problems fulfilling obligations at work, home, or school
• Social or interpersonal problems stemming from opioid use
• Using opioids instead of engaging in activities you used to enjoy
• Using opioids in physically hazardous situations such as driving or operating machinery
• Developing a tolerance so that increasing amounts of the drug are necessary to get the same effect
• Experiencing opioid withdrawal symptoms
• Turning to alcohol or street drugs to relieve or avoid withdrawal symptoms

The parallel “sister” epidemic to the opioid epidemic is the benzodiazepine epidemic. When these drugs are used in combination with opioids or other sedatives, there is an increased risk of respiratory depression leading to death.

Managing pain safely and effectively is possible and is an important part of recovery and rehabilitation for a variety of injuries and procedures. To learn more, listen to this podcast featuring Ramana Naidu, MD.

If you think you may be suffering from addiction, contact your primary care provider or call the SAMHSA National Helpline at 1-800-662-HELP (4357).

What’s New on MyMarinHealth.org

Our new website, www.mymarinhealth.org, combines information and resources previously found on 26 separate sites into one comprehensive site. Now when you need to find a provider or service, all of the expert MarinHealth Medical Network and Medical Center physicians and locations are easily accessible in one place.

Some key features to check out on our new website include:

• Find a Provider Tool
  Looking for a new doctor? Use our provider search tool to find providers by name or specialty. Easily access contact information and more on each provider’s profile page.
• Location Search
  Similar to our Find a Provider tool, our Locations page allows you to search for MarinHealth locations by city, name, service type and more.
• Events Calendar
  As a Health Connection member, you receive advance notice for MarinHealth lectures and events, but you can also check out our robust, new events calendar to find all the details for upcoming events.