Sodium intake in realtion to high blood pressure

Sodium is a hot topic that is being investigated to determine if its relationship is truely detremental to blood pressure levels which can impact its relationship with cardiac disease. Currently sodium is a major no no for those with high blood pressure and diets have been developed such as the DASH diet to eliminate sodium intake. The first article gives the Center for Disease Control's opinion on sodium based off previous findings. I feel that this could be a more informative than the french fries and heart article. The second link gives an interesting take on sodium from the opposing side aka the salt lovers.

http://www.cdc.gov/bloodpressure/sodium.htm

http://www.naturalnews.com/015820.html

Review: Innate and Adaptive Immunity in Inflammatory Bowel Disease (IBD)

Inflammatory bowel diseases are the results of a dysregulated mucosal immune system. The mucosal immune system have both innate and adapative immunity. This review article presents the cross-regulation between these two immune systems and understanding the cross-regulation can help us to better understand the disease and possibly identify the future therapeutic targets.

IBD is idiopathic disease, but many soursces say that there is a genetic component for the cause. Genome-wide association studies (GWAS) provided a strong evidence for a close link between the innate and the adaptive immune system in regulating the sensitive balance of the mucosal immune system.

In the intestine, innate immunity includes the epithelial barrier and phagocytic cells within the lamina propria. The genetic defects in innate immunity can increase the incidence of IBD according to the paper.

For the adaptive immunity, Th1-mediated immune responses are typically evoked in response to an intracellular pathogen presented by antigen-presenting cell in the presence of IL-12. Then, the consequencial response is to localize the infectious agent and secret other cytokines like IFN-gamma and cytotoxic T cell for apoptosis. Th17 secret IL-12 and IL-22 which are pro-inflammatory and in inflamed Crohn's disease (CD) mucosa, there was an increasing level of IL-17 and IL-22. There are Treg cells which secrete IL-10, a potent anti-inflammatory cytokine and IL-10 deficient mice develop intestinal inflammation. Another form of IBD, Ulcerative Colitis (UC) had increasing levels of IL-13 and IFN-gamma which targets the epithelial cell to become dysfunctional. So, UC is more of superficial epithelial injury disorder.

Under which conditions does dysregulation of innate and adaptive immunity occur? Luminal antigens cross the epithelial barrier, and this process is increased during intestinal inflammation. The antigens reaching the lamina propria will first activate the innate immune system via pattern recognition receptors (PRRs) and antigen presenting cells (APCs) show antigens to T cell to evoke an adaptive immunity.

This article picked two examples to illlustrate the cross-regulation of innate and adaptive immunity. One example is NOD2, a cytoplasmic protein acting as PRR that serves as a bacteria sensor for the proteins on the cell wall of bacteria. Mice lacking NOD2 showed a defect in intestinal innate defense. CD patients with mutant NOD2 were shown to have decreased defensins and an increase of bacterial translocation and thus activating the adaptive immune system. The second example this article gives is IL-12. IL-12 is a key Th1 cytokine and CD is classified as a Th1-mediated disease. IL-12 is produced a lot by macrophages and dendritic cells within the lamina propria after the translocation of the bacteria and it will ultimately lead to the inflammation by Th1-mediated process. A mutation in NOD2 is associated with increase in IL-12, thus linking a receptor of the innate immunity with the effector cascade of the adaptive immunity. So, anti-IL-12 treatment is effective in patients with CD.

Source: Siegmund, Britta, and Martin Zeitz. "Innate and adaptive immunity in inflammatory bowel disease." World Journal of Gastroenterology. 17.27 (2011): 3178-3183.

Inflammatory Bowel Disease and Depression

http://health.msn.com/health-topics/digestive-health/ibd-and-crohns/kids-with-crohns-disease-colitis-often-struggle-at-school-study

For the March 5th, 2012 discussion about the Inflammatory Bowel Disease (IBD), there is one interesting lay article Dr. Cohen posted for our interesting discussion which was that the students who have had the symptoms of IBD were struggling academically by missing classes. The study from the Nationwide Children's Hospital in Columbus, Ohio noted that the students who have IBD are at a higher risk of getting the "internalizing" problems such as depression. This depression can lead kids not doing well in school. As I read this lay article, I wanted to know more about the possible relationship or association between the IBD and depression.

I came across with this Neuroscience paper to answer my curiosity:
From inflammation to sickness and depression: when the immune system subjugates the brain.
Dantzer, R. et al. Nature Reviews Neuroscience 9, 46-56 (January 2008).

It turns out that the inflammatory cytokines such as Interleukin-1a, Interleukin-1b, Interleukin-6, and TNF-a from IBD can play a role in the brain to induce the "sickness behavior" which is very similar to and hard to differentiate from the depression according to the paper. Out of these cytokines, Interleukin-6 released from the stimulated cells can cause the down-regulation of Treg and up-regulation of Th1 and Th17 which are very strong pro-inflammtory. These can activated M1, classically-activated macrophages and lead to chronic inflammation, in this case on the mucous membrane of the gut for IBD.

Overall, the inflammation can negatively affect the health of the brain in this case causing the depression via cumulative actions from cytokines.

Cool it!

I was sitting here like the nerd I am, not thinking of the UofA basketball team or attractive ladies walking by, but of how to slow ischemic stroke and decrease the stroke infarct volume. A very simple idea popped into my head: hypothermia!  What do you do when you break your leg and it swells? You put ice on it! Why not do that to the brain?

It is also already known that many who suffer heart attacks or drowning in cold water have a much higher chance of survival than at non-hypothermic conditions. So I started my research and was actually very surprised to actually see people are studying/testing this. I had no idea this was an actual concept! **Victory dance that I actually had a good idea! <('-'<) <( '-' )> (>'-')> ***

One group studied two ways of cooling; surface cooling and endovascular cooling. Intravascular cooling is being studied now and is not included in this article. Both trials (surface and endovascular) results show the feasibility of the concept but cannot comment on the safety of the procedure. 

Models of temporary ischemia with administration of hypothermia show a reduction in infarct size and improvement in behavioral outcomes.They show that hypothermia initiated after 5 minutes of ischemic stroke onset protected the cortical ad hippocamplan neurons. However, hypothermia was not effective when initiated 30 minutes after. This is much different in animal studies. Both 2 and 6 hour delays show protective effects. A 22 hour delay showed to be even more neuroprotective.

They hypothesize that the mode of protection comes from the fact that it causes metabolic rate of the brain to slow as well as reduces release of inflammation markers and free radicals. I would imagine it would also help with reperfusion injury as well once the embolism is removed.

Surface cooling can use air blankets, water mattresses, alcohol bathing, cooling jackets, and ice packing. Advantages are its simplicity and ability to even be performed at home, in a crude way, while waiting for the ambulance. However, this takes several hours to reach the desired temperature.

Endovascular cooling uses catheters that can be inserted directly into the central venous system transferring heat via transduction through an internal circulation in the catheter. This is much quicker, tighter temperature control and reduces shivering quite a bit.

With either case passive re-warming is used afterwards. These therapies could be combined with neuroprotective agents to augment each other. 

http://stroke.ahajournals.org/content/38/2/794.long

Woman suffers stroke after hickey

Just in case anyone was interested, here was the lay article that Dr. Cohen showed the class when I was taking Cardio. I guess the moral of the story is don't get hickeys after the age of 40 =]

http://www.dailymail.co.uk/health/article-1349201/Woman-suffers-stroke-amorous-partner-gives-love-bite.html

"They try to make me go to rehab.."

Since I have an interest in rehabilitation, I wanted to look at what kinds of treatment are used for people post-stroke and what kinds of things therapists do to try and prevent recurrent ones. As a quick review, a stroke is when blood supply to the brain is disturbed, due to an event such as lack of blood flow to the brain caused by a blockage or a hemorrhage. Loss in brain function from a stroke may result in inability to move limbs on a particular side of the body, inability to talk or understand speech correctly, or visual impairment.  According to the American Heart Association, when considered independent to other cardiovascular diseases, strokes are the 3^rd leading cause of death in the US, and it is proposed that incidence may continue with the growing population of elderly Americans, increasing rates of diabetes and obesity, and great prevalence of cardiac problems and inactivity among communities. Think of it this way… 1 person nearly every 45 seconds suffers a stroke, 1/3 of which are recurrent. It is crazy to think about! Post stroke, only about 14% of survivors are able to fully recover; about 25-50% still require some assistance throughout their lives, and others, in severe cases, receive partial paralysis. By implementing exercise training and physical activity, stroke survivors strive to regain ability to do daily functions, such as dressing, bathing, or walking, learn how to manage muscle or joint pain, and improve cardiovascular fitness.

Rehabilitation programs asses each patient and design a program around their current condition, medical history, any neurological complications or other medical conditions, and lifestyle. Programs typically address 3 main goals. The first goal for the patient is to start a physical conditioning regimen to recover the prestroke level of activity. The second goal is to prevent recurrent stroke and cardiovascular complications; by starting aerobic conditioning programs, stroke survivors can enhance glucose regulation, decrease in body weight and fat stores, lower blood pressure, lower serum triglycerides and LDL cholesterol, and increase HDL cholesterol and improve cardiovascular functions such as blood flow or coronary artery endothelial function. The third rehabilitation goal is for patients to improve aerobic fitness despite limitations. As for recommended exercise programming, the American Heart Association recommended that patients should utilize aerobic training modes (leg, arm or combo) ergometry at 40-70% peak oxygen consumption, and train 4-7 days a week with duration of 20-60 minutes a day of exercise. Treadmill training in particular can be very beneficial, as patients can decrease their body weight by holding on to the handrails while regaining their ability to walk, as well as increasing the grade of incline or speed as they gain mobility. It is remarkable that in incorporating exercises such as upper-body and resistance training or stretching, patients can improve sensorimotor impairments and performance time, as well as range of motion, respectively.  The AHA provides a nice table that shows programming recommendations for stroke survivors that is quick and easy to read and understand!  (http://circ.ahajournals.org/content/109/16/2031/T1.expansion.html). Although this information focuses on the physical rehabilitation, it is very important to recognize that other members of the rehab team are just as essential in the process; occupational therapists aid in finer tasks such as eating, or writing, a speech-language therapist can help with speech impairments or difficulty swallowing, and psychologists/psychiatrists are important in assessing the emotions a patient goes through. 

It is very interesting to see how different people recover from something as serious as a stroke. My friend’s father, for example, completely hid that he had a stroke from his daughters for a while and they never knew the difference, whereas my mother’s best friend from nursing school had one post car accident and now has a speech impediment. I am very interested to see what is in store for cardiac disease/stroke prevention and rehabilitation as I continue my own career in healthcare.

If you would like to read more, here is the full AHA article!

http://circ.ahajournals.org/content/109/16/2031.full

Stroke of Insight

As most of you may already know, a stroke is somewhat of a "brain attack", or what happens when blood flow to a part of the brain stops. There are two main types of ischemic stroke: one in which a clot may form in an artery that is already very narrow creating a thrombotic stroke. In addition, a cerebral embolism, or an embolic stroke can occur in which a clot breaks off from some part of the body, or from a place in the blood vessels of the brain and travels up to the brain. Plaque built up on an artery wall or blood vessel from cholesterol, fat, and other substances can lead to a blood clot, which may block blood from reaching the brain and cause an ischemic stroke. On the other hand, a hemorrhagic stroke (less common) occurs when a blood vessel in part of the brain becomes weak enough to burst open, causing blood to leak into the brain.

The symptoms of stroke depend on what part of the brain is affected and usually develop suddenly and without warning. Symptoms of stroke are usually most severe at onset and may possibly slowly get worse, or they may occur on and off for the first day or two. The brain is an incredibly complex organ, with each area having a responsibility for a particular function or ability. The brain is divided into four primary parts: the right hemisphere, the left hemisphere, the cerebellum and the brain stem. The right hemisphere of the brain controls the movement of the left side of the body as well as analytical and perceptual tasks, such as judging distance, size, speed, or position and seeing how parts are connected to wholes. A stroke in the right hemisphere usually causes paralysis in the left side of the body known as left hemiplegia. Patients of right-hemisphere strokes may also have problems with their spatial and perceptual abilities in addition to changed behavior, judgment abilities, and short term memory difficulty. Similarly, survivors of left-hemisphere stroke may also develop memory problems, which can include shortened retention spans, difficulty learning new information and problems in generalizing and conceptualizing. The left hemisphere of the brain controls the movement of the right side of the body as well as speech and language abilities. A left-hemisphere stroke often causes paralysis of the right side of the body, known as right hemiplegia.

A stroke in the cerebellum can cause coordination and balance problems, dizziness, nausea, vomiting,  and abnormal reflexes of the head and torso. The brain stem, however, is the area of the brain that controls all of our involuntary, "life-support" functions, such as heartbeat, blood pressure, and breathing rate. It also controls eye movements, hearing, speech and swallowing abilities. Survivors of a brain stem stroke may also develop paralysis in one or both sides of the body because of the impulses generated in the brain's hemispheres that must travel through the brain stem on their way to the appendiges.

Jill Bolte Taylor, a brain research scientist, experienced and studied her very own stroke in the left hemisphere, but after spending eight years recovering, she feels more enlightened and stronger than before. She gives a very emotional, captivating and detailed description of her experience during and after her stroke on T.E.D talks, for which I have provided the link below!

http://www.ted.com/talks/jill_bolte_taylor_s_powerful_stroke_of_insight.html

References:

http://www.stroke.org/site/PageServer?pagename=EFFECT

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001740/

Stem Cell Transplant program (Reply to diabetic group)

Here is the stem cell treatment for diabetes I was speaking of.  The link below is actually the patient handbook giving information as to how it works and the process behind it.  It also includes support services as well. There is an initial visit to talk to you about the process which then moves to pre-transplant testing to see if you are an candidate. They must then place the central line (plastic tube placed in a large vein used to collect the stem cells). The stem cells are then "mobilized" from the bone marrow into the blood where they can be collected. You are then given immune suppressors and then infused with the stem cells into the islets.

In juvenile diabetes the beta cells in your pancreas do not work properly and are attacked by your immune system.  Wiping out the immune system ( and the beta cells I think. Dont quote me on it) and infusing stem cells allows WORKING beta cells to grow back.  They have most patients go years and years without any sort of insulin therapy, and others (after years as well) start to need light insulin therapy, yet nothing close to what they used to have to use.

Definitely a very amazing procedure. Frightful still, yes, for wiping out the immune system is no small thing. That thing is there for a reason.  One thing I did not catch is whether or not they wipe out only certain cells of the immune system or the entire thing.

https://www.nmff.org/documents/Patient_Education_Booklet2.pdf

GET A GRIP!

Wanting to be a surgeon I naturally looked for surgical procedures that may help stroke.  Now, this does NOT mean I want to wave around my scalpel stabbing everyone and their mothers.  Being so invasive, surgery should, for the most part, be thought of as a last resort.  However, as techniques and new devices advance it could start to be viewed as less invasive than powerful chemicals.

             One such device is called SHELTER (Stroke Help using an Endo-Luminal Transcatheter Embolus Retrieval).  It does exactly what it implies: it physically grabs the embolus.  However, this is much different than the catheters we are used to.  It has an outer sheath and for capturing the clot and an inner rod housing a collapsible metal umbrella. This umbrella has holes to let non clotting RBCs through while capturing the actual clot. It also has a soft springy polymer coating to prevent vessel puncture. 

            SHELTER is the first device to both filter and remove clots, the first to entrap the clot from both its near and far ends, and the first capable of accessing small vessels in the brain.

             What may be even more impressive is their silicone model used to test the device.  They say in many ways it is a more accurate test than using mice.  This could be possible, after all mice or not people.  But then again, silicone is not flesh.  Nonetheless the testing model is a silicone copy of human cadaver blood vessels and can even have aneurisms, atherosclerosis and "plaque.”

             I would imagine this testing would not only cut back on animal models but also serve as a more accurate way for physicians to train their SHELTER abilities.

             The “window” for saving vital brain matter closes around 2 hours for clot busters.  After those 2 hours the clot buster has a hard time fixing anything.  With this device that window is wide open for a longer period of time.

             But we must still keep in mind that this is a surgery and can cause complications of its own.

The link shows some very interesting videos from the brothers than made this device. I HIGHLY recommend watching the videos if you are as big of a nerd as I am and love this stuff.

http://medgadget.com/2010/06/shelter_for_emergency_stroke_therapy.html

Air Pollution Linked to Higher Risk of Heart disease and stroke

http://healthland.time.com/2012/02/15/air-pollution-linked-to-higher-risk-of-heart-attack-and-stroke/

Hi, after first week of stroke, I was wondering how stroke can be important to our life nowadays. Stroke is one of third leading cause of death and a major cause of disability in our world, especially industrialized countries. Since world is getting developed with new and fascinating technology, there is always something that causes other trouble. Research says that air pollution can be linked to higher risk of heart disease and stroke. According to the research, the risk for healthy people may be relatively low, however, almost everyone breathes polluted air, and there was 34% higher chance to get stroke from patients who were admitted with stroke after a 24-hour period of moderate air quality. This percentage is not very high, but still it is kind of dangerous to the patients who already admitted to stroke once. I really hope this only applies to the huge cities such as L.A., New York City, Chicago, etc where most of pollutants are coming from car exhaustion. Sadly, researchers also found  that the danger was greatest for those exposed to black carbon and nitrogen dioxide, both emitted from fuel-burning car engines. 
I guess going with green is the best way to survive nowadays! :)

http://www.emaxhealth.com/1275/intranasal-stem-cells-improve-motor-function-parkinsons

http://online.liebertpub.com/doi/abs/10.1089/rej.2010.1130?journalCode=rej

As promised, in the articles listed above, is more information regarding the promising stem cell treatment of Parkinson's disease. The first one being a summary of the research, or a lay article and the second being the actual published research article. I didn't notice before bringing up the article in class, but one of the author's,  Lusine Danielyan, MD, of University Hospital of Tubingen in Germany included in the article we focused on in class titled "Snorting Stem Cells" also reported on  the results of their latest work using stem cells to treat Parkinson’s disease published on Feb. 3rd in Rejuvenation Research (in the journal link above).

The numbers I reported in class were a bit skewed because as stated in the lay article, the mesenchymal stem cells sprayed into the rat noses migrated to the brain and survived for at least 6 months. Dopamine levels increased in previously damaged areas and motor functions improved up to 68% of normal in the stem cell treated rats. I got the number '36' from the part of the lay article that reports, "In 2009, scientists from the University of California, Los Angeles, reported on the world’s first clinical trial using autologous (derived from the patient) neural stem cells for treatment of Parkinson’s." Although only one patient was treated, the authors reported that the individual’s motor scales improved by more than 80 percent for at least 36 months. Unfortunately, this is only data on one patient, but 36 months of improved motor skills at 80% is impressive! This is definitely information that leaves me wanting to know more and wondering if other diseases such as stroke can also be turned around. I tried searching for information on any possible negative side-effects of intranasal stem cell therapy, but it appears that the authors did not report on any. If anyone else can find any, please share, otherwise we can just hope that future research will soon determine what they are, if any!

Lap band side effects

People often want to believe that there is a quick fix for obesity and Diabetes type II. The lap band has become a popular method of weight loss and in some studies has been shown to reverse or decrease type two diabetes. The following article describes some of the side effects that are important to be aware of before a patient decides to proceed with the surgery. The major side effects include post-surgery infection, band slippage, acid reflux and band erosion. The next link is about the diet restrictions following the lap band surgery. The major diet restrictions include sugar, high-fat, high-calorie drinks, starchy foods and pure fats. The most important thing for those reading publications on the lap band need to consider is that it is a lifetime change that is not simply a quick fix but a long dedicated process.
 http://www.livestrong.com/article/188592-lap-band-side-effects/

http://www.lapband.us/diet-restrictions.html

"Metabolically Benign" Obesity

Hey Guys!
I know last week a lot of people were perplexed and intrigued by the idea of "Metabolically Benign" Obesity from the article about obese young adults with and without insulin resistance. The following is a link to an article that attempts to explain the idea. I think does a good job of addressing the different concepts involved. I remembering discussing in class that the type of obesity that is most likely to contribute to disorders like MS is visceral. The article states that the affects of increased visceral fat (especially fat in the liver) have been correlated with increased insulin resistance in patients. Another interesting aspect of the article is that they discuss the influence of different body type phenotypes on the likelihood to develop diseases that are associated with obesity. Feel free to comment on the article or the idea of Metabolically Benign Obesity!

http://www.medscape.org/viewarticle/579018

An article titled "Tucson doc leads bid to help diabetics" in our very own local news source caught my eye because it really relates to some of the information we learned in class last week and hits close to home with a beloved family member.  It's exciting to know that University of Arizona Medical Center's very own Dr. David Armstrong and his clinic are leading the way in saving limbs of diabetics. I thought it was really interesting when he said, "A population that was once called pre-diabetic is now included in the (diabetes) population." because there are now more people with slightly lower blood sugar included in the definition. Some of the data presented about diabetes is scary and alarming, but a relief to learn that improvements in blood-sugar control, foot care and diabetes management, along with declines in cardiovascular disease have led to a decrease in the rate of leg and foot amputations among U.S. adults age 40 and older with diagnosed diabetes by 65 percent between 1996 and 2008. Unfortunately, I did not see a reference or link for this study done by the U.S. Centers for Disease Control and Prevention, but it is published Jan. 24 in the journal Diabetes Care as stated. If anyone has any thoughts on this article or can add any knowledge, please do!

Read more: http://azstarnet.com/news/science/health-med-fit/tucson-doc-leads-bid-to-help-diabetics/article_50cc780b-4613-5e79-8699-5025851c0f60.html

http://www.webmd.com/baby/news/20090210/obesity-carries-pregnancy-risks

This past monday in class, we had quite an extensive discussion regarding the affects of obesity on pregnancy, for both the mother and the baby. This article talks about a bunch of different birth defects that are linked to obesity, and what the general cause may be. Reading the article, I was most interested in seeing how defects like cleft palette or limb reduction abnormalities were proven to be linked to obesity and the low grade inflammation. Feel free to comment on anything from the lack of detail regarding the actual study(ies), to how this article may actually encompass the big picture: where inflammation isn't an isolated issues and can potentially cause deformity in a wide variety of systems, that are related to obesity in an indirect manner. 

America, stop making excuses!

http://www.time.com/time/magazine/article/0,9171,1914974-1,00.html

I was looking through the archives of Time Magazine the other night for an assignment in another class and came across this article. The title of the article was what first caught my attention, as it probably would almost anyone, "Why Exercise Won't Make You Thin".  After reading and discussing all the lay articles we've looked at in class, I had my skeptical, scientist hat on and I figured that this article was bound to have some ridiculous-ness to it--and it did.  I was actually quite entertained by some of the statements that the author makes.  Like, "exercise turn[ing] fat into muscle" (like magic!) or categorizing walking while carrying groceries as moderately strenuous activity (what is this man buying at the grocery store?!).  Like the other lay articles we looked at, this one seems to divert the fault of obesity to something other than ourselves.  Hey, America! Stop with the excuses!!

As we saw in many of our other articles in class, Cloud does a good job of inserting names of various scientists from Universities around the world to make his article "credible". As a plus, he adds in a few quotes from some of them and talks about various experiments that have taken place.  As far as the quotations go, he uses pretty general quotes and the reader doesn't know the context they were spoken in, but they are in fact true--like, "If you're more physically active, you're going to get hungry and eat more". To the lay reader, this article must seem very throughly researched and cited.  No wonder the general public has all these crazy ideas about diet and exercise! These are the types of sources that they are getting their information from, and it makes me a little frustrated that facts can be construed in such a way that Cloud seems to make his point.

When I was an undergrad (and actually had some free time), I was a triathlon maniac and would come home from a 3 or 4 hour ride on the weekends and eat everything edible in the kitchen--no joke.  Cloud argues that "being in shape" means that I have more muscle than fat (probably true) and that the fat that I've magically turned into muscle by working out will burn only 40 more calories than the fat will.  I can't claim to know if these numbers are correct or not but Cloud, what about all the calories I burned during the 3 hours I spent on my bike compared to those who slept in? I'd be willing to bet that the difference in caloric expenditure between my 3 hour ride and your 3 hour sleep is over ten times the 40 calorie difference you claim exists between the lean and the sedentary.  Additionally, after my workout I'll continue to burn extra calories during my EPOC (excess pose-exercise oxygen consumption) period, while the sedentary person will continue to burn calories at their normal rate.  So, Triathlete Jessi could eat waaaay more calories (much more than 40!) than Grad Student Jessi while not becoming obese because of all calories that I was burning while I was working out AND recovering from those workouts. Cloud never addresses this extremely relavent and important fact!

The tired, lethargic post workout feeling that Cloud describes is most likely due to lack of nutrition before or during the workout! If you workout, your body needs nutrients! I can't believe that this man is not only telling the public not to exercise, but also that eating after exercise is what is bad about it!

I could probably rant a little more about this article, but let's here what you guys have to say about it!

Avoiding difficult discussions?... 

I thought I would share the link to the NPR story about doctors who are hesitant to discuss weight issues with their patients. I found this story interesting and pertinent to yesterday's discussion. 

http://www.npr.org/blogs/health/2012/01/27/145990665/heavy-doctors-avoid-heavy-discussions-about-weight