DRLUGO BLOG

Hello,
Well, I have been busy relocating my practice and will likely start writing more as time allows. Although I am a surgeon, I also have great interest in healthy lifestyles and I like to read about these topics. I recently read and article in Mens Health magazine and it was very interesting to see what they say about an active lifestyle.
Most people would classify an active person, one that exercises every day. Researches have found that although this is good, and definitely better than doing nothing, there is more to the equation.
If a person exercises once a day, but has a sedentary, or desk job, the fact that he/she spends most of the hours of the day sitting, erases some of the effects of the hour of exercise done once a day. Now, don’t get discouraged and feel as if you are wasting your time. It is definitely better than not doing it at all.
There are many ways to change this and to get the full benefit of the exercise and not let the sedentary job ruin it. Some of the recommendations made by the author are to stand and walk while you are on the phone. Take frequent brakes to stand up and move around, use the stairs every time, walk to lunch, eat smaller meals (common sense). In summary, try to compensate for the down time by staying active between periods of inactivity.
You can see the full article and details of the study in the latest Men’s Health magazine issue. All this seems common sense to me, but the truth is that it surprised me how there was an association of higher heart disease in people with the above lifestyle despite the fact that they still exercised. It even talks about back problems, shoulder issues, etc, associated to the long hours of sitting.
The bottom line is that our bodies are meant to be in motion and active. We need to get up and move. We spend way too much time on our butts. Fortunately my job is mostly standing, but I do spend too much time on my computer.
Well, I hope this sparked your interest to look into ways to increase your activity and stay healthy.

One more thing. Did you know that only one percent of Americans cultivate the land to feed the rest of us and in the past up to 40 percent of Americans were involved in agriculture. It amazes me that such a small percentage of people are responsible to feed our huge population. It is also scary, because you know that they are having to use artificial, unhealthy ways to keep up. Not to mention the carbon footprint created by the use of fertilizers and machines to accomplish this. Something to think about! Start your own garden, or better, community garden!
Thank you!
RLugoMD

We have a law now. It is a disappointment that our government has made this a political show of force. Despite millions of american opposing it, and a clear split, our president feels that this is the best thing for the country. Well, I found a nice summary of the law as it was passed done by a group of docs at The Methodist hospital. See below:Overview of the law

Cost = $940 billion over 10 years, major expenses are:

• Medicaid and CHIP expansion

• Subsidies for those who can’t afford insurance

• Small employer tax cuts

Funded from these sources:

• Penalties paid by individuals/employers that do not buy insurance

• Reduced Medicare scheduled payments and “bundled payments” for care

• Cuts to Medicare and Medicaid Disproportionate Share payments

• Premiums for long-term care insurance

• Cuts to Medicare Advantage plans

• Taxes on Cadillac health plans

• Medicare payroll tax increases

• Excise taxes on insurance companies

• Excise taxes on brand name pharmaceutical companies

In short what this means is higher taxes for companies, hence they will raise their prices or or contract,  leaving more people unemployed.  So more people will apply to free government insurance and the cost will continue to escalate.  More work for doctors at lower rates, so less doctors will be willing to take government insurance, creating a larger shortage of available docs.  Not to mention that some docs will be forced out of business due to increase in overhead.  More taxes for most americans to help subsidize those that do not contribute, those that choose to not make an effort.   More paperwork and complications for businesses.  Higher premiums in private insurance for those that do not qualify for the government insurance, which is most hard working americans.
I think that healthcare reform is needed, but I think that the current law and the way it was done, will only create problems and actually will not solve the problem.  It is a self serving, selfish agenda for Mr. Obama and Mrs. Pelosi.    The people making decisions have the wrong interest at heart and they do not get affected by these decisions or changes. I am concerned with the future ahead. I am not afraid, but I know that things will not be smooth. I know that money and deficit will increase to new highs and the system will self destruct. The frustrating part of all of this is that I know this could be done with less impact on the hard working americans and in a more meaningful way, if the right people are consulted and the real issues are targeted.  I hope americans really get interested in this issues and try to make a difference.  The american public needs to show what their real opinion is about this bill in the November elections.
RLUGO
www.drlugo.com

This is the month to raise awareness and have all your friends come and get their colon screened. The age is 50 or older. If there is family history of colon cancer I recommend starting in your 40’s. IT is an easy test to ahve done and it is very important. Come and make your appointment at www.drlugo.com

I am sure that many would wonder why a surgeon thinks about nutrition and exercise.  Why care, or how does that relate to the specialty.  Well, it is very important and sometimes overlooked by many patients and doctors.  It is one of the most important factors that will determine recovery and wound healing in general.  I have been a  witness of the benefits of exercising and good nutrition as positive factors in the recovery of patients after surgery and in effective wound healing.  I have not done a formal study with controls or unbiased from personal experience.  My observation has been  from personal experience as a patient and doctor.

So what is good nutrition and how much exercise.  these are good questions and my answer is not going to be a cook book, but a general one.  This will depend on each person and the genetic makeup that the individual has.  Yes the other factor here, as always, is genes.  As we know genes play a huge role in everything we do and that is something that we can not control totally yet!  So what do we mean when we talk about good nutrition.  A well balanced diet.  We should try to make every meal as colorful as possible.  Lets include all food groups, vegetables and legumes, fruits, protein in the form or meat, poultry or fish, fats and complex carbohydrates.  Yes, I said fat!  Fat is not a bad word and we actually need fat for our bodies to work well.  We actually need all types of fat and we should favor the unsaturated or vegetable fats, but saturated fat is not a poison as long as we eat it in moderation.  Another trick is to eat a high fiber meal with whole grains and little sugar when we eat these saturated fats and that way we help the body use the fat more efficiently and cause less problems.  Also remember water.  This is a very important nutrient for our bodies to work well and we forget about it.  do not wait until you are thirsty.  That usually is a warning that we are too low in reserves.  It is like the yellow light in our car when we are in reserves for gasoline.  This is not a good sign!

I am not writing this with the intention of teaching nutrition, since I do not claim to be an expert, but my goal is to motivate the reader to learn about nutrition more.  Investigate the vast world of knowledge and try to start eating a balance diet.  Look for books written by nutritionists and learn the facts and not the fallacies.  Be careful of people trying to sell a product or a pill or a magical diet.  The truth is that all diets work if we stick to it.  You can eat everything, in moderation.  The key to eating and weight loss is portion control.  Calories in and calories out.  This is the second part of the equation. This is very personal and should be calculated depending on our body frame, level of activity and medical history.  A balanced diet is important, but it does not mean that we should eat more than what the body can handle or is supposed to have.  More is not good!  Do you need vitamin supplements?  It is my opinion that you do not need this if you are making sure that the diet is a balanced diet.  IF you are not going to do this, then maybe a vitamin a day or every other day could help.  I do not think that is a substitute, but better than nothing.  Favor organic food and natural products.  Avoid canned, prepackaged and high sodium frozen meals loaded with preservatives.  Yes may be a little more cost, but the nutritional value is far worth it and your body will thank you

So in summary, what should you do to accomplish this.  Well, you may very well go and learn all yourself with a good nutrition book or invest in a good program at a reputable clinic or wellness center.  How do you know that you are in such place.  Ask your doctor and if he does not know look for people with professional credentials and not any Joe at a local gym.  This is an important step and decision and the learning process should be founded on facts and not anyone’s idea of what may work.  There is a huge world of knowledge about nutrition based on facts and not just beliefs.  Take the time to learn this, it is for your own good after all.

Exercise, is a very personal thing too.  IT depends on your goals and genetic make up too.  We all need different levels of exercise and activity.  This is probably an area that we can customize and personalize.  We all need some activity and this is a personal choice.  There is no doubt that exercise makes out the whole body function better and helps everything from the mood to the digestive tract.  I firmly believe that we are meant to be active and not sedentary.  I always have been a believer that exercise is the fountain of youth that we all look for.  Our cells like to be bathe in nutrients and blood flow accomplishes this.  We increase this through good exercise.  So which exercise s good, or better.  All exercise is beneficial.  My recommendation try something different every month and switch from time to time.  Make it fun and entertaining.    It does not have to be routine, boring or painful.  Yes you have to put an effort to see the progress and try to make is harder than a stroll in the park.   This should be a gradual increase in the  intensity. Don’t run from the couch to a marathon.  That will hurt you for sure.  Pick a program and complete it, then switch.  I think that with all the programs out there, you can get a new one every 6 months and work on all aspects of your fitness.  In this area, the choices are limitless.  I tell my patients, hire help if you are totally clueless.  Invest in it to get you started and then read and learn about it.  It is not that hard to learn with so much information available. there is no workout that works for everyone.  I personally like the P90 series(google p90).  This is a home workout and it is customizable.  Very good to start!

So, what do you do?  Get pumped up and start reading information.  Go to the grocery store and buy organic and natural products.  Plan your meals.  Start with breakfast.  Make one of the daily meals healthy, then work to two, etc.  Pick an exercise program that looks fun and then switch when you feel bored.  usually a switch every 4 weeks is good to shock your body and continue seeing progress.  These are general recommendations, but I assure you that with a little effort and time, you will reap tremendous benefits.  You will probably avoid surgery,  and if you have to have it, your recovery will be much faster.

www.drlugo.com

Thyroid disease can present in the form of a nodule or a lump.  This is most commonly seen in females, but can be seen also in males.  Most nodules are benign in nature and we observe them.  The first step in evaluating a thyroid problem is to determine the function of the thyroid gland by testing the leves of thyroid hormones.  Then we can evaluate the nodule using u/s.  Most cystic nodules (fluid filled) are benign and are observed.  solid nodules can be observed also, but these we like to test further and assure that there are no malignant cells or indication that they may be malignant.

The decision to operate may be made based on the appearance and behavior of the nodule, but also on the symptoms the pt has.  If there is discomfort, or a growing nodule than we can go to surgery and eliminate the problem area of the thyroid.  A needle biopsy can be done on a thyroid nodule and that can be helpful at times if enough tissue is obtained to r/o cancer.  Most of the time the findings are indeterminate and the decision to go to surgery is based on pt symptoms and u/s finings.  nother tool that is not used anymore as much is the thyroid scan.  this tells the physician if the thyroid nodule is cold or hot.  A hot nodule is a nodule that is actively producing thyroid hormone.  A cold nodule is inactive.  a hot nodule is less likely to be malignant than a cold nodule.  This is a good test if the decision to operate is not based on pt symptoms.  If the pt is having difficulty swallowing or other symptoms, the scan may not give information that would be helpful.

Every pt with thyroid problems is different and the decision to operate is made between the surgeon, endocrinologist and pt.  There are medical therapies that were not mentioned here, but that can be used to treat some thyroid nodules.  I do not go in detail this since this is a surgeons blog, but we consider all those when making an assessment and decision to operate.

For more details and information you can visit my website www.DR Lugo.com

Many patients are surprised to know they have diverticulosis and when they are diagnosed they worry about the condition.  I find that people use interchangeably the name diverticulosis and diverticulitis.  Diverticulosis is the presenceof small pockets in the intestine, diverticulitis is infection of these pockets.  Diverticulosis is most often diagnosed during a colonoscopy.  A barium enema can also be used to diagnose the condition.

drawing of cross section intestine with diverticuli   

actual pic during colonoscopy

Diverticulosis is a weakness of the colonic wall and it is felt that is the result of low fiber diets and the use or processed foods.  IT is mostly seen in people that are over 40 years of age and it is more common in the modern world where processed food is mostly consumed.  Diverticulosis is not a condition that should cause alarm or worry.  If you are told that the colon contains diverticula, is just for informational purposes.  You should include this in the medical history when asked.  If your doctor is aware of the presence of diverticula in your colon, then he/she can diagnose, faster, diverticulitis if it ever develops.

We recommend that people with diverticulosis adopt a high fiber diet and that way prevent or minimized the risks of diverticulitis.  This is know to correlate clinically.   There is also a general recommendation to avoid seeds or seed containing foods, but studies have failed to demonstrate a direct correlation of more attacks and the intake of seeds in the diet.  I recommend my patients to eat high fiber and not worry so much about avoiding things that they like to eat, even if these contain seeds (tomatoes, strawberries, pop-corn, etc)

Diverticulitis is a different story.  this is an infection of one of these pockets and this can be very serious.  It usually presents itself as L lower abdominal pain and sometimes with fever.  IT can also present with intermittent diarrhea and constipation associated or preceding the pain.   If you develop these symptoms, it is important that you seek medical assistant.  IT will most likely resolve with the appropriate diet and a short course of oral antibiotics if detected on time.  If left untreated, this can lead to a colonic perforation and eventual emergency surgery and a colostomy bag.  The current teaching is that two uncomplicated attacks of diverticulitis, should be followed with an elective L colon resection to avoid complications.  his has been questioned and is not necessarily and automatic sequence of events.  I believe that every patient is treated according to their general health, age and circumstances.  I do not think that it should be an automatic reaction for every patients that had two uncomplicated attacks.  You, the pt, should communicate with your doctor and discuss in detail the options.

If the pt has a catastrophic event, like a perforation of the intestine as a result of the diverticulitis, then surgery is indicated.  the best case scenario is when the infection i controlled with antibiotics.  sometimes even drainage of an abscess is done percutaneously, an then electively, possibly laparoscopically, the L colon is then removed at a later date.  This sometimes takes patience and good antibiotics to make it work, but the outcome is the best and avoidance of a colostomy is in itself a great benefit.

If you have any questions please visit my website www.drlugo.com, or ask me directly.   Than you!

RLUGO

1.pictures taken from Sabiston textbook 18th edition.

I am sure we all have heard how much money is spent in our country. we would think that we would be the healthiest country in the world. where is the money going? why are we not getting what we pay for? I am a doctor and I am also disappointed to see how the money is wasted. IT is not only one problem. IT is many problems together and not a simple solution.

I believe that a large part of the problem is that many companies and insurance companies, other third parties and many politicians make money at the expense of health care. the doctors make money, but the truth is hat every day we make less and we get more and more restricted on what we can do. the first mistake that we made was to loose control of patient care and the way we practice medicine. We have to follow insurance company guidelines and these companies only goal is to make money. It is outrageous how these companies want to run the medical decisions from an office in a distant city without even seeing the pt and in that way control the cost. I can not believe how many times pt care is denied and obstacles are set in place to save money and prevent pt care t take place. That is one problem. IT is more complex than what I stated here, but this is a large part of it. Another problem is the lawyers. there is so many lawyers out there that make their living looking for medical errors. The interesting part is that most of the lawsuits are not even malpractice. A lot of times they make their money because the doctor has no time and settles. why is this allowed. Well the clearest evidence of this abuse is that we have seen a reduction in frivolous suits in TX. The reason for that is the changes in legislation limiting the amounts awarded. All of the sudden, it is not profitable so they really pick and chose the cases. So was this in the best interest of the pt or in the interest of the lawyers pockets? Don’t get me wrong, malpractice should be monitored and quality medical care should be advocated, but this should not be a business where people get rich and in the process destroy other professionals lives. I am glad that there is a balance being reached finally. Even though the medicine we practice now a days is defensive in nature and that increases the cost. Doctors are expected to be perfect and never make a mistake. We are not allowed to use our medical instinct or knowledge. We have to prove over an over that we are right. So many unnecessary tests to just please the hungry lawyers.

Another part of this equation is the government intervention. I believe that it is important for doctors to be involved in the decisions made by our politicians. Many times I see that decisions on healthcare are made by politicians without real doctor input. This leads to mistakes and miscalculations. They think that by talking to doctor representatives they get the whole picture. Well, I find that many of the doctor group representatives are politicians first and then doctors. they do not always represent the best interest of the medical community, or truly understand what is like to practice i the community. to be a business owner and have to deal with the ever increasing bureaucracy. the amount of paperwork is incredible and continues to increase. Even with the electronic medical record implementation, we have to document so much, it is time consuming and increases the cost of medicine, since we have to increase the number of employees in order to comply and continue to take care of patients.

It is harder and harder to just practice medicine and focus on pt care alone. I am deeply concerned with the direction healthcare is taking. we see less and less people wanting to put the years it takes to get to be a doctor (in my case 13) and the debt that one has to also take. In many ways a single payor system seems like the best option to eliminate all the private insurance companies. IT is not a choice that doctors are making, it is a choice that is the best of two evils.

I wish doctors were ask for input on how to run the medical care of this country, after all we are the ones that provide it. We will see where this ends.

This is commonly known as reflux.  As the word suggests, there is reflux or regurgitation (comes up the throat) of stomach contents.  These stomach content is mostly acid, but at times, in severe cases can be food.  The symptoms can be as vague as bloating, but can involve burning in the upper abdominal area, pain, difficulty swallowing or a chronic cough.  Most people that have it treat it with over the counter remedies.  Although the symptoms usually respond to simple antiacid medication, we should not ignore these symptoms.  The mere fact that a person has reflux symptoms is an indication that something is not working well.  It may be caused by eating late late eating,  being overweight or a problem with the sphincter (circular muscle) that separates the eophagus from the stomach.  Reflux can also be the result of other diseases like scleroderma or even viral conditions.  Although common and easily treated many times, we should not ignore the symptoms and seek help.  A patient should not just treat the symptom and forget looking for the cause.  Just treating the symptoms can be dangerous and bad for the person.  Chronic reflux, if uncontrolled, could lead to cancer of the esophagus and or ulceration.  This is a big problem now a days since many of the reflux medications are available over the counter for the patient to treat themselves.  This allows for a person to treat a symptoms for a long time and not treat the cause.  IT is my opinion that this can lead to more serious problems.

 Although there are no real medical standards defined, on the frequency of endosopy to follow patients with reflux, I think it is appropriate to get this test done at some time to determine if there has been any damage made to the linning of the esophagus and then treat it accordingly.  

From the surgical stand point there is an operation called Nissen fundoplication.  This consists of wrapping the stomach around the lower part of the esophagus t try to restore the some of the physiology that is lost when the lower esophageal sphincter is not working.  Now a days it is done laparoscopically and has very good results when done well.  We reserve this for patients that get no relief with the medications known as PPI (proton pump inhibitors).  these are medications that we have been using for years now and usually are enough to stop the symptoms caused by GERD.  sometimes the pt has a large associated hiatal hernia. In these cases surgery is probably going to be necessary to improve the symptoms.  Not all hiatal hernias need to be operated on and this is a decision that the doctor can make with the patient.  Please visit my website for questions www. DRLUGO.com

Thi is a common ailment and many times misunderstood symptom.  People have the idea that when they have apin in the anus, it means hemorrhoids.  The truth  is that most of the time it is not.  I can not say the same about bleeding, bleeding alone can be a hemorrhoid, but if bleeding is present with pain, it is most likely an anal fissure.  an anal fissure is a small cut in the anal area.  Thi is usully the result of a hard bowel movement or straining.  the pt sometimes recalls the event that precipitated the symptoms, but most of the time they don’t.  The treatment for anal fissure initially is not surgical.  Most of these heal spntaneously or with minimal therapy that consists of warm bath and stool softeners.  The ones that do not resolve then should be operated on.  The operation for that is a sphincterotomy.  this means cutting of the sphincter(internal sphincter).  this will take the tension off the cut and allow it to heal.  

The most important part of fissure treatment is prevention.  If the pt goes back to bad habits of constipation, this can recur.  This is true for almost all anal problems (hemorrhoids and fissures).  

IT is important to note that blood in the anus and pain ca also be a serious problem, so by no means a person should read the above and then stay home.  It is important that someone identifies the so called fissure.  Like I have said i the past, any blood coming out of any orifice should be investigated, with or without pain associated.  Please call yur doctor or email me if you have any questions.  HAve a great day

RLUGO MD

Many people ask me what are the things that a person should do when they know that they are having surgery. How to prepare for such an event. My answer can be very technical or complex, but I try to simplify it. Just imagine that you are about to compete in the Olimpics. You have to prepare your body for a very demanding event. You should try to be in the best conditions possible from the nutrition stand point, rest and psychologically. The individual should start by placing positive thoughts in their mind. It is important that the person visualizes the surgey going well and a positive outcome. There should be minimal or no negative thoughts in the mind. Not to say that there will be no fear. It is expected certain degree of fear of the unknown, but we need to counteract this with positive thoughts and visualization. this is very powerful and very important. The pt should also try to rest the days before surgery and try to have good nights of sleep. this will normalize the cortisol levels. this is a very important hormone in the healing process and for the utilization of sugars and nutrients during moments of stress The pt should try to eat healthy and balanced food. This stimulates also the growth and replication of healthy cells. IT is never too late to start a healthy diet and then maintain it during the healing process. Excercise also helps tone the muscles and build some muscle mass to weather the tough times. Everytime we even think of exercise the body releases hormones that help us deal with pain and stress. these are called endorphins. IF the pt starts an exercise program and sticks to it, they can stimulate the release of endorphins and help with pain control and coping with the surgical stress. By this I do not mean a strenuous exercise for someone that has never done exercise. IT could be as simple as starting a walking program and build on it. Each person needs to start at a comfortable level and slowly build on it. Smoking and alcohol should be avoided as many days before surgery as possible. Both of these toxic substances can weaken the immune system and the power of the body to heal and recover. Finally make sure that there is a good support and planning for the recovery time. We should have a plan for the first few days after surgery and then the weeks following. Do not wait for after surgery to plan the recovery. It helps to have a realistic image and mental plan of the series of events and the duration. IT helps to communicate with your doctor who can give you realistic expectations on the timing and what to expect. He/She probably has done this many times and has a pretty good idea of the expected time for full recovery. These are simplified steps, but I think that are essential and very easy to follow. If you have any questions do not hesitate to ask me or visit my website drlugo.com.

HELLO