26.2 Miles: Accomplishment or Overdose? How Much Is Too Much for Your Heart?

A recent wellness blog on the New York Times website contradicts Mae West’s old adage that too much of a good thing is better.  Specifically, the question is whether excessive exercise can actually be injurious to your heart.  In two separate clinical studies, veteran British and German male marathoners were compared to healthy, but less active, controls and found by sophisticated imaging to have increased scarring in the marathon runners’ hearts.  This was observational only and any relevance to the runners’ health or prognosis would be speculative.  However, other causes for the scarring such as smoking history or cardiovascular disease was excluded.  This correlation between prolonged running and subtle structural cardiac damage found in humans has also been recently noted in laboratory experiments involving male rats.  Interestingly, the scientists also observed that this fibrosis was reversible, disappearing when the animals stopped their “marathoning”.  All of these studies were published in distinguished medical journals and therefore, were subjected to strict, unbiased editorial review before publication.

 

I will take them at face value and believe that excessive marathon running causes cardiac fibrosis.  Obvious the scar did not limit their athletic ability.  And parenthetically, what do you think the orthopedic consequences of excessive mileage are?  What about all those weight-bearing joints, cartilages, menisci, and tendons that have been pulverized for thousands of miles?  Ever hear of ruptured spinal discs?  Is not the frequency of many biological phenomenon represented by a bell-shaped curve?  Is not drug dosage calculated by a dose response curve to determine what is too little to be effective and what too much to be toxic?  Real life scenarios are dieting can be good, but starvation is bad, normal blood pressure is good, but too low causes circulatory shock, blood sugar control is good, but hypoglycemia causes coma and mental focus is good, but obsessive-compulsive is a psychiatric disorder.

 

There may be some scientific curiosity as to the outer limits of mechanical endurance the human heart can safely endure.  But the fitness fanatics studied are curiosities in the laboratory of exercise physiology.  These studies have absolutely no relevance to the 6 million other human beings on this planet that are trying to take control of their lives by sensible physical exertion.  Moderate exercise is undeniably good for you, period.  Before initiating on such a program, patients with heart disease or who are at risk of having undiagnosed cardiac problems should check with their doctors or be monitored.  It seems to me a more productive area of research would be to further define what the optimal amount of exercise is now that we know what is too much and that none is too little.

 

By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton

Cutting Healthcare Spending - Big Data, Hospital Costs, and Outcomes

According to the federal Agency for Healthcare Research and Quality (AHRQ), inpatient hospital costs account for nearly 30% of healthcare spending in the United States and are increasing by about 2% per year over inflation. This cost issue is a focus of the Affordable Care Act, which is accelerating the move away from fee-for-service to a single, diagnosis-related comprehensive payment, similar to Medicare reimbursement. Such payment systems punish unnecessary testing, prolonged hospitalization, and readmissions.

Is Medical Science Dead? - Art, Science, and Quackery

On April 8, 1966, Time Magazine caused a national commotion when the issue’s cover was emblazoned with the question, “Is God Dead?” The Time article was a measured consideration of how society was adapting to the diminishing role of religion in an age of stunning scientific advances. The writer posited that people would no longer believe things out of received doctrine, but faith would steadily succumb to the scientific method as mankind unraveled the truths of the physical world at the expense of the myths of the metaphysical.

IMPACT OF ICD-10 - Increases Billing Accuracy, Headache for MDs and Patients

I strongly suggest that a pledge to read a synopsis of the philosophy of the 13th century Franciscan William of Ockham on a weekly basis be inserted in the oath of office taken by every government employee. Clearly highlighted should be his nominalist doctrine, Ockham’s razor, which avows that the best solution to a problem is usually the simplest. Pare to a minimum the number of confounding variables.

How do we treat pain? - Unrealistic Goals Leading to Opioid Addiction

In the weekend review from ACEP, two articles caught my attention. The first one was on new guidelines from the American Society of Addictive Medicine on the use of prescription medication to treat opioid addiction. These guidelines were created soon after the Centers for Disease Control and Prevention (CDCP) declared opioid use and resultant death as an epidemic. The second article refers to a study showing that pain is underdiagnosed and undertreated in the ED. This is the challenging dichotomy we live and work in.

Drowning in the Fountain of Youth - Genetic Predisposition

Recently I read in a New York Times magazine article that the 130th richest man in the United States wants to match his age with his Forbes magazine wealth ranking. His riches have not bought him a unique, scientifically-formulated elixir for immortality; nor is he a wacky proponent of perpetual hyperbaric oxygen chambers or cryogenics.

Yelp May Not Help

Concomitant with the metamorphosis of the practice of medicine into the business of healthcare delivery, patients have been transformed into customers. Healthcare providers compete not only on the basis of outcomes, best practices, centers of excellence, advanced technology and cost, but also on customer service

Find and Replace: Genetic Engineering in Science and Medicine

Shakespeare’s Hamlet proclaimed, “What a piece of work is a man,” but now, almost half a millennium later, this could be amended to what a set of sequences is man. The nobility, reason, infinite faculty and admirable form can be attributed to the 20,000 or so genes that contain the chemical code for specific protein formation

HIPAA Protects Millions with Unintended Consequences

The Health Insurance Portability and Accountability Act (HIPAA) was endorsed by Congress in 1996 and was the last significant legislative legacy of Senator Ted Kennedy. It is enforced by the Office for Civil Rights and mandates nationally recognized regulations for use and/or disclosure of an individual's health information by a “covered entity”. Such an entity is a health plan, healthcare clearinghouse or healthcare provider.

Studies Prove Communication and Teambuilding Training a MUST for Surgical And Hospital Staff

Although individual judgment and technical dexterity are obviously important, best surgical outcomes, particularly for complex procedures, reflect the performance of many medical providers before, during and after an operation. Professionalism and a competitive business environment both stimulate medical centers to continuously focus on quality assurance programs, and to improve patient safety.

Death Rates Plunge Due to Following Protocols, Not New Technology

We are regaled in the lay press about new medical breakthroughs a novel cholesterol-lowering drug mimics the effects of a genetic mutation and improves lipid profiles when conventional treatment is ineffective; new cancer therapies are tailored medications designed to specifically attack tumor cells without the nonspecific toxicity of conventional chemotherapy; hepatitis C can be cured by short-term oral agents, not prolonged courses of parenteral infusions; mitral valves can be repaired percutaneously without the potential risks of extracorporeal circulation.

How to Grow Your Medical Practice Online

Here at Michigan Physicians Society, we’re dedicated to the financial betterment of physicians by providing continuing education and technology, along with an extensive network of other like-minded professionals in our space....
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