Truths about Cholesterol.

The news media, your doctor and your mother are always talking about your cholesterol. How high it it? How high is too high? While you’re at it, what is cholesterol?

What is commonly called “cholesterol” is really a fatty, waxy-like substance that is found in all cells of the body. Without cholesterol, you cannot live. It is needed to make your skin; to make the hormones like testosterone, estrogen and Vitamin D that circulate in your blood; for the protective coating of your nerves; and to help you digest your food.

Where does cholesterol come from? Your liver makes the vast majority of the cholesterol in your body. About 80% of the cholesterol in your body is made this way. The other 20% comes from the food you eat.

When your doctor measures your cholesterol level, what is actually being measured are proteins that carry cholesterol around in your blood. These proteins are necessary because cholesterol, like cooking oil, doesn’t mix with water. So these proteins allow the cholesterol to be carried in your blood. There are several different types of these proteins, but the main ones are HDL and LDL.

HDL is commonly called “good” cholesterol. This is because it carries cholesterol from other parts of your body back to your liver. Once at the liver, the cholesterol is either recycled back out to the body, or it is lost in your intestines. People with higher levels of HDL seem to be protected from diseases like heart attacks and strokes. About 20-25% of the cholesterol in your blood is carried by HDL.

LDL is commonly called “bad” cholesterol. That is because it carries cholesterol from your liver out to the rest of your body, where it could possible build up in your arteries and cause a heart attack. LDL makes up about 70-75% of the cholesterol in your blood.

What is high cholesterol? High cholesterol is a condition in which the amount of cholesterol circulating through your blood is higher than average. High cholesterol by itself usually has no signs or symptoms; that’s why your doctor recommends having your cholesterol tested from time to time.

Why should you worry about high cholesterol? Well, people that have high cholesterol seem to be at increased risk of developing Coronary Heart Disease (commonly called a heart attack), strokes and peripheral arterial disease (a condition in which the blood vessels in your legs get blocked).

What can you do if you have high cholesterol? The most effective way to control high cholesterol is through lifestyle changes centered on proper diet, maintaining your ideal weight, exercise, and stopping smoking if you do smoke. Another way to control your cholesterol is by the use of nutritional supplements and medication. There are several different types of medication and supplements your doctor may prescribe. Some may be more effective than others. By working with your doctor and other professionals like dieticians and nutritionists, you can help keep your cholesterol at safe levels. Have you had your cholesterol checked lately?

Oral health and you

When was the last time you went to the dentist? Last month? Six months ago? A year? Why is a physician asking me when I last went to the dentist?

It turns out that having healthy teeth is important for more than just your smile. It’s good for your overall health, good for your new baby, and it just might save you money in the long run.

Did you know that patients with periodontal disease (unhealthy teeth and gums) are twice as likely to develop diabetes? And that poorly controlled diabetes is associated with worsening dental disease? Which, of course worsens your blood sugars, which worsens your gums… like a snowball rolling down a hill. Studies have shown that by having your periodontal disease treated by a dentist, you can improve your diabetic control by up to 20%!

Periodontal disease is also associated with heart attacks and strokes. A definite relationship between your teeth and gums and your cardiovascular system isn’t yet proven. We do know that dental disease causes chronic inflammation, and inflammation is implicated in both heart attacks and strokes. However, unlike with diabetes, treatment of periodontal disease has not yet been shown to reduce cardiovascular risk; studies are ongoing.

Maybe you don’t think you can see the dentist because you are pregnant. Only 1 out of 3 pregnant women visit the dentist during their pregnancy. You might not know this, but bacteria in your mouth cause most cavities. The main bacteria (strep mutans) that causes problems is transmitted from mother to child by pre-tasting food, kissing and other close contact. The more bacteria in mom’s mouth, the more likely the child will acquire the bacteria. Studies have shown that if you can delay the buildup of strep mutans until after your child is 2 years old, your child will have fewer cavities. Fathers and other family members can also pass on the bacteria, but that is less common. Also, most antibiotics used for dental diseases are appropriate to use during pregnancy. So are many of the numbing agents and pain medications used.

Cost is a concern for everybody. One of the reasons you may not have gone to the dentist is the expense. Maybe you don’t have dental insurance, or maybe you just don’t have the money to see the dentist. United Concordia (a large dental insurance group) published a study in June, 2014, that showed that patients who had their gum disease treated had significant annual medical cost savings, as much as $5,681 less. They also had up to 39% fewer hospitalizations.

There are other reasons besides cost that keep people from going to the dentist. Are you on blood thinners and are afraid that you will bleed too much from dental work? Routine cleanings, fillings and simple extractions can be performed without stopping your blood thinning medication. Just be sure you tell your dentist or dental hygienist that you are on the medication.

Besides keeping your teeth and gums clean and healthy, there are other reasons to get a regular check up. Many common medications can cause problems with your teeth and gums. Medications like prednisone can cause thrush, some seizure and blood pressure medications can cause gum abnormalities, and many medications can cause chronic dry mouth, which leads to cavities and gum disease. And your dentist is trained to recognize early signs of oral cancer.

As you can see, having regular dental checkups is important for several reasons. By working with your dentist and your doctor, you have the best chance of living a longer, healthier and happier life.

Changing jobs

Doctor: from the Latin word "docere", meaning teacher. After working in the specialty of Urgent Care medicine for a lucky number 13 years, a new opportunity dropped into my lap.

Four months ago, I just happened to notice that my former residency program, where I trained to be a Family Medicine specialist, was looking to add new faculty. So I sent the program director an email inquiry. I didn't hear back from him for 2 months, so I just assumed that they already filled the position.

Then, 2 months ago, I got a reply from the program director, Dr Gregg Mitchell, telling me that they were indeed looking for new attending physicians to teach the doctors. We met for lunch a couple of times and had a great time catching up with each other. Dr Mitchell was a resident at the University of Tennessee College of Medicine, Family Medicine department, when I did a 3 month rotation with them. He became faculty in the program during my last 6 months of training

After much thought, prayer and discussion with my wife, I decided to make a more formal inquiry. So I met with Dr Mitchell again, but this time he was accompanied by Dr David Maness, chairman of the Medical school Department of Family Medicine. After talking with Drs Mitchell and Maness, I told them I was very interested in the position.

Three weeks ago, I was offered the job. After a couple more weeks of thought and prayer, I accepted their offer. I will be an official Assistant Professor in the Department of Family Medicine for The University of Tennessee Health Science Center Department of Family Medicine, Jackson, Tennessee.

I will still have a few days of my own clinic every week, but my primary responsibility will be teaching newly graduated physicians how to become Family Docs. I'll give lectures; see, examine, and discuss treatment plans for patients with the residents. I'll also occasionally round at the hospital with the residents, teaching them how to manage everything from newborn baby exams, to managing acute myocardial infarctions (heart attacks, to administering comfort measures to patients dying in the Intensive Care Unit.

I always thought I would enjoy teaching at the college or post-graduate level. This will be exciting, intellectually stimulating and scary at the same time! A lot has changed in the 13 years since I admitted hospital patients.

I will deeply miss my current partners. They are the best group of physicians I've ever met, and are more like family than colleagues. Hopefully, before too long, my new colleagues will seem the same!