Dr. Howard Smith Oncall

Vidcast:  https://youtu.be/TtWHs0_tqLI   Thyroid surgeons performing at least 40 yearly complete thyroid excisions have the fewest complications. Kaiser Permanente California now reports its review of 10,500 such operations over a 7 year period.   The chief complications of vocal cord paralysis and parathyroid hormone deficiency occur since the nerves to the larynx and the parathyroid glands must be carefully dissected out of the thyroid before its removal.  Although these complications begin to decrease when a surgeon performs 18 such procedures a year, they only hit bottom at more than twice that number.   When you have surgery, your surgeon’s experience with your prospective operator far outweigh his or her bedside manner.  If you can get both, all the better.   Meltzer C, Hull M, Sundang A, Adams JL. Association Between Annual Surgeon Total Thyroidectomy Volume and Transient and Permanent Complications. JAMA Otolaryngol Head Neck Surg. Published online July 25, 2019145(9):830–837. doi:10.1001/jamaoto.2019

Vidcast:  https://youtu.be/oaJHcZmrrN8   Most women are counseled to try a vaginal delivery following a previous Caesarian section (VBAC).  The latest evidence from the University of Oxford questions the wisdom of that recommendation.   More than 74,000 Scottish births over a 13 year period show that a VBAC is associated with a 7 fold higher risk of a uterine rupture, a 3 fold  higher risk of surgical injury, and a two-fold higher risk of sepsis and blood transfusion.  There is also a greater risk of stillbirth, a NICU admission, and a need for neonatal resuscitation.   If you’ve had a C-section and your OB is recommending a vaginal delivery, question carefully whether that choice is right for you.   Kathryn E. Fitzpatrick, Jennifer J. Kurinczuk, Sohinee Bhattacharya, Maria A. Quigley. Planned mode of delivery after previous cesarean section and short-term maternal and perinatal outcomes: A population-based record linkage cohort study in Scotland. PLOS Medicine, 2019; 16 (9): e1002913 DOI: 10.1371/journal.pme

Vidcast:  https://youtu.be/_MoJEEKE4ik   Our cells and bodies work on internal biological clocks which are lubricated for better efficiency by good old fashioned stress.  University of Minnesota biologists now report  this phenomenon in the journal Neuron.   Using a mouse model and tissue cultures of cells, the scientists unraveled the complex blend of signaling proteins that control the clock. They found that stress accelerates the speed of signal processing and improves the robust nature of cellular biologic clocks.   The bottom line is that some stress may well be good for you.  It literally keeps your system on its toes and speeds your reaction time.   Salil Saurav Pathak, Dong Liu, Tianbao Li, Nuria de Zavalia, Lei Zhu, Jin Li, Ramanujam Karthikeyan, Tommy Alain, Andrew C. Liu, Kai-Florian Storch, Randal J. Kaufman, Victor X. Jin, Shimon Amir, Nahum Sonenberg, Ruifeng Cao. The eIF2α Kinase GCN2 Modulates Period and Rhythmicity of the Circadian Clock by Translational Control of Atf4. Neuron, 2019; DOI: 10

Vidcast:  https://youtu.be/VHVmpX5vX2E   The Apple Watch, Samsung Galaxy and FitBit wearables are credible exercise measuring devices that take clinical testing into the real world.  Pulmonologists from Utah’s Intermountain Medical Center now report that these devices can match a standard 6 minute walk distance test for estimating lung reserve.   The study tested 52 respiratory disease patients over a 12 week period.  Their results proved that step counters could accurately predict the results from the 6 minute walk test.  Because the wearables turn in data from outside the clinic, their information is likely be even more relevant.   If you have a smartwatch or Fitbit, embrace use of their exercise apps as a metronome to help you give your body the workout it deserves....and needs.   Intermountain Medical Center. "Wrist-worn step trackers accurate in predicting patient health outcomes." ScienceDaily. ScienceDaily, 29 September 2019. www.sciencedaily.com/releases/2019/09/190929123811.htm   #Stepcounters #Apple

  https://youtu.be/0_CdQ5xGbdA   To guide your headstrong teen, present your opinions as rational suggestions rather than imperial directives.  Psychologists at Cardiff University studied the responses of 1000 adolescents to pointed suggestions delivered in various tones of voice.   Each teen heard 30 directives voiced by actors in 3 ways: a controlling authoritarian tone, a autonomy-supportive tone, or a neutral tone.  The results: heavy-handed demands trigger resistance and negative responses while suggestions delivered in a respectful, positive manner backed by credible rationales led to acceptance.   As always, interpersonal relationships benefit more from honey than vinegar.  As children grow and mature, they demand from us, their parents, respect for their independence and ability to make sensible decisions.   Cardiff University. "Teenagers less likely to respond to mothers with controlling tone of voice: New study showed adolescents were less likely to want to engage with schoolwork when mothers spoke

Vidcast:  https://youtu.be/JVUkY5c6kqw   Overdoing your training for an endurance sport can leave you mentally fatigued.  A French investigation, just published in the journal Current Biology, studied 37 thirty something male athletes during a 9 week training program.   Over-training led to feelings of mental exhaustion but also increased impulsivity with a preference for immediate rather than gratification.  Brain imaging tests confirmed that the altered decision-making was due to diminished prefrontal cortical activation.   This study once again emphasizes that our bodies work best when we moderate our activities.  If you are forced to overindulge, know that you shouldn’t be making any momentous decisions afterwards.   Blain et al. Neuro-computational impact of physical training overload on economic decision-making. Current Biology, 2019 DOI: 10.1016/j.cub.2019.08.054   #Endurancetraining #exercise #exhaustion, decisionmaking 

Vidcast:  https://youtu.be/XC4XX8lSwtw   Nearly 40% of Americans state that today’s divisive politics are stressing them out.  Even more distressing is that 4% are driven to suicidal thoughts.   Political scientists at The University of Nebraska-Lincoln surveyed some 800 subjects.  The data show that: 32% are unnerved by the relentless controversies on cable news. 29% lose their tempers more easily. 20% have lost friends over political fights. 11% report physical health deterioration.   To combat sickening politics, turn off cable news, exercise, get outdoors, and read.  Impose a “no politics” rule when you gather with friends if you want them to remain friends.   Medical University of Vienna. "People in unhappy relationships more likely to have suicidal thoughts." ScienceDaily. ScienceDaily, 7 September 2016. www.sciencedaily.com/releases/2016/09/160907081921.htm   #Politics #illness #suicide 

Vidcast:  https://youtu.be/SmZC939blGs   Choline supplementation may be one important key to preventing the dread dementia of aging.  A mouse model study by the Arizona State University finds that choline blocks formation of amyloid plaques and reduces numbers of microglial scavenger cells that damage normal brain cells.   The researchers fed their experimental animals, genetically prone to develop Alzheimer’s, an amount of choline 4.5 times that of the traditional recommended daily amount but half the allowable daily max.  Only the treated animals maintained normal cognitive abilities and performed well in a maze test.   Choline is found in eggs, beef, pork, chicken, turkey, fish, mushrooms, and readily available oral supplements.  The study suggests a daily consumption level of about 2500 mg. For men and 2000 mg for women.   Ramon Velazquez, Eric Ferreira, Sara Knowles, Chaya Fux, Alexis Rodin, Wendy Winslow, Salvatore Oddo. Lifelong choline supplementation ameliorates Alzheimer’s disease pathology and asso

Vidcast:  https://youtu.be/EgRJcmO3kns   Many studies convince us that healthy eating, consuming more fruits and vegetables while moderating intake of carbs, fat, and meats, reduces cardiovascular diseases and diabetes.  Now an Australian meta-analysis presents proof that such a moderating diet will also keep your kidneys in work order.   The researchers analyzed 18 separate studies following some 630,000 participants over about 10 years.  A consistently healthy diet was associated with a 30% lower incidence of kidney disease.   One study after another sings the praises of abundant fruits and vegetables in your diet.  If you want a long life, you must respect and maintain your body’s equipment and especially your brains, heart, lungs, kidneys, and liver.   Katrina E. Bach, Jaimon T. Kelly, Suetonia C. Palmer, Saman Khalesi, Giovanni F. M. Strippoli, Katrina L. Campbell. Healthy Dietary Patterns and Incidence of CKD. Clinical Journal of the American Society of Nephrology, 2019; CJN.00530119 DOI: 10.2215/CJN.00

Vidcast:  https://youtu.be/JpZFL6rGnfY   Slogans seem more believable if the words appear in alphabetic order or nearly so.  A University of  Texas study, just published in the Journal of Consumer Psychology, explores this phenomenon in detail.   Ten advertising claims, either written in an alphabetic sequence or not, were presented to a focus group and rated for truthfulness.  The truth ratings were significantly higher for those sound bites that flowed in alphabetic order..  For instance, “Bufferin Eases Pain” is more believable than “Pain Eased By Bufferin.”   The advertising agencies employ this brain preference to control your buying habits.  Knowledge is power.  Now you are aware of this advertising trick, so look for it in the advertising pitches you see and hear.    Dan King, Sumitra Auschaitrakul. Symbolic Sequence Effects on Consumers’ Judgments of Truth for Brand Claims. Journal of Consumer Psychology, 2019; DOI: 10.1002/jcpy.1132   #Alphabeticorder #advertising #truth  

Vidcast:  https://youtu.be/-gftb2MimL8   When you brew tea contained in a plastic teabag, it can release nearly 15 billion microscopic plastic particles into the liquid you’re consuming.  A new study from the American Chemical Society tested four different commercially-available teas that are packaged in completely or partially plasticized teabags.   A single teabag released 11.6 plastic microparticles and 3.1 billion even smaller nanoparticles.  We don’t yet know how dangerous such contaminants can be to humans, but experimental tests on small aquatic organisms, ok water fleas, show that plastic particles drive serious anatomic and behavioral changes.   Buyer beware so read labels and check online.   If you’re a tea lover, buy teas in bags without any plastic.  Those include Able & Cole, Clipper, Pukka Herbs, Teapigs, Twinings pyramid, and Waitrose Duchy.   https://www.sciencedaily.com/releases/2019/09/190925083805.htm   https://www.countryliving.com/uk/create/food-and-drink/news/a3291/plastic-tea-bags-

Vidcast:  https://youtu.be/ogsadES_aa4   Cancer survivors facing sleepless nights can be cured with basic sleep education.  Psychologists at Harvard’s Dana-Farber Cancer Institute, looking for a less resource-intense alternative to individual cognitive-behavioral-therapy, tested a simple 2 step program on some 51 participants.   It begins with a sleep-education class that makes that dry information about healthy sleep found in pamphlets come alive.  This session alone cured 41% of the group.   A second step for those with continuing problems is a short series of additional group meetings led by a psychologist or social worker.  This step brought the success rate up to 71%.   Healthy sleep is critical for all of us but particularly for cancer patients.  It stokes up the immune system and keeps the remainder of the body firing on all cylinders.   Dana-Farber Cancer Institute. "Chronic insomnia can be cured in cancer survivors with a basic sleep education class." ScienceDaily. ScienceDaily, 24 September 2019.  

Vidcast:  ttps://youtu.be/IC2HBiQBqf8   You’ll turboscharge your self-confidence by seeing yourself in the eyes of those outside your circle of peers.  A Brigham Young University study of 213 college students analyzed the phenomenon called the imposter syndrome in which even competent trainees feel they are faking it and will be embarrassingly exposed any minute.   The study shows that one in every 5 students suffers from imposter syndrome.  The most effective remedy for this self-defeating mindset is reaching out to parents and professors rather than peers for feedback on your work.   Even those suffering from imposter syndrome can perform well.  Eliminating the self-doubt just makes it easier and more pleasant for you to excel at school or work.   Richard G. Gardner, Jeffrey S. Bednar, Bryan W. Stewart, James B. Oldroyd, Joseph Moore. “I must have slipped through the cracks somehow”: An examination of coping with perceived impostorism and the role of social support. Journal of Vocational Behavior, 2019; 115

Vidcast:  https://youtu.be/Icbiaal4Abg   If you crack open that can of nuts and consume even half a serving each day, you’ll keep your weight in a healthy range and avoid obesity.  Harvard nutritional researchers conducted longitudinal studies on nearly 145,000 professional men and women for up to 24 years.   Subing in nuts for less healthy fare such as processed meats, refined grains, and sugary treats lowered the risk of gaining more than 10 pounds over a 4 year period by 23% and reduced the risk of obesity by 16%.  The investigators theorize that chewing nuts and digesting the fiber they contain tends to satisfy your appetite.   Eat those nuts, especially walnuts, instead of junk food each day.  You only need 7 walnut halves, 12 almonds, 8 cashews, 14 peanuts, or 23 pistachios.   Xiaoran Liu, Yanping Li, Marta Guasch-Ferré, Walter C Willett, Jean-Philippe Drouin-Chartier, Shilpa N Bhupathiraju, Deirdre K Tobias. Changes in nut consumption influence long-term weight change in US men and women. BMJ Nutrition

Vidcast:  https://youtu.be/SH6daqtuf0c   More than one in every 10 young persons with medical illness is currently using marijuana each day.  Public health researchers at the Universities of Nebraska and Kansas reviewed survey records from nearly 170,000 participants.   Frequency of use is highest in the youngest.  Twenty-five percent of young patients 18-24 use marijuana while only 2.4% of those over 65 do so.    The majority who use cannabis for medical purposes smoke it.   As more and more states pass medical marijuana laws, its use will continue to rise.  As that happens, standardization of available products and careful FDA oversight will help to assure safety and effectiveness.   If you are a user, be certain that your clinicians know it so that cannabis may be properly integrated into your care plan.   Dai H, Richter KP. A National Survey of Marijuana Use Among US Adults With Medical Conditions, 2016-2017. JAMA Netw Open. Published online September 20, 20192(9):e1911936. doi:10.1001/jamanetworkopen.201

Vidcast:  https://youtu.be/uwfSwkH0Hvk   At least once daily Sofrito, a sauce consisting of garlic and onions, reduces the risk of developing breast cancer by 50% or more.  Researchers at the Universities of Buffalo and Puerto Rico studied more than 300 breast cancer survivors and an equal number of healthy controls.   Those women consuming the most Sofrito showed the greatest benefit. The effect was dose-dependent, and those eating less had only a 40% cancer reduction.   Sofrito is a popular part of Latin, Spanish, Portuguese, and Italian cuisines.  This study confirms earlier ones that identified anti-cancer properties in so-called allium vegetables that include garlic and onions.  Ironically, their magic appears to be contained in the sulfur compounds that make them so smelly.   Gauri Desai, Michelle Schelske-Santos, Cruz M. Nazario, Rosa V. Rosario-Rosado, Imar Mansilla-Rivera, Farah Ramírez-Marrero, Jing Nie, Ajay A. Myneni, Zuo-Feng Zhang, Jo L. Freudenheim, Lina Mu. Onion and Garlic Intake and Breast C

Vidcast:  https://youtu.be/v4hLGckpOYI   Kids and teens who specialize in a single sport sustain more stress fractures, tendinitis, ligament tears, and musculoskeletal overuse damage.  Brown University epidemiologists and Boston Children Hospital orthopedists analyzed data from more than 10,000 youths over the past 22 years.   More serious injuries occur in those who exclusively play one sport, practice and play intensively, and in girls than in boys.  Girls bumped their injury risk by 30%.   For boys injury risk and severity rose when they played baseball or participated in gymnastics or cheerleading.   The investigators suggest that young athletes principally playing a single sport add a second one recreationally to spread physical stress over around their bodies.  They also recommend variations in practice workout exercises to achieve moderation in physical exertion.   Alison E. Field, Frances A. Tepolt, Daniel S. Yang, Mininder S. Kocher. Injury Risk Associated With Sports Specialization and Activity Volu

Vidcast:  https://youtu.be/2go_s2VQgnM   The pathologic love of yourself decreases almost 80% in most persons as they pass from their teen years into midlife.  Psychologists from the University of Illinois-Urbana-Champaign report this finding after studying some 237 participants over a 23 year period surveying them at 18 and 41 years of age.   Three key aspects of narcissism, vanity, entitlement, and leadership tendencies changed differently over time.   Vanity decreased the least and its persistence was associated with unsatisfactory relationships and broken marriages.  Entitlement decreased the most, and its demise was associated with greater life satisfaction. Leadership skills unexpectantly also decreased by 22%.   The decline of narcissism is a sign of overall psychologic maturity.  Those who gaze beyond themselves are happier and more beloved.   Eunike Wetzel Emily Grijalva Richard Robins Brent Roberts. You’re Still so Vain; Changes in Narcissism from Young Adulthood to Middle Age. Journal of Personalit

  Vidcast:  https://youtu.be/3grsczIEnEE   Regularly consuming green, oolong, or black tea at least 4 times weekly will improve your brain’s regional synchrony and your thinking skills.  A collaborative study recently published in the journal Aging looked at MRI brain imaging and neuropsychological test results as a function of tea drinking.   The imaging studies showed that regular tea drinkers had more efficient connections between various regions of their brains.  This speeds transfer of information and triggers enhanced performance on cognitive tests.   If you want to stay on the top of your intellectual game, tea makes an excellent beverage.  Previous studies have also shown that it improves your mood, reduces your risk of cardiovascular disease, and reduces your risk of age-related cognitive deterioration by some 50%.   Junhua Li, Rafael Romero-Garcia, John Suckling, Lei Feng. Habitual tea drinking modulates brain efficiency: evidence from brain connectivity evaluation. Aging, 2019; 11 (11): 3876 DOI: 1

Vidcast:  https://youtu.be/nzYmPzIEq-k   Sixty percent of adolescents ride with teen drivers who are distracted.  University of Michigan researchers report this information from their study of 877 surveyed families.   The most common distractions in the vehicle include deafeningly loud music in 46% of cases, cell phone use in 42%, and raucous teens in the back seat 39% of the time.  Even more concerning were data showing that the impaired teen driver was speeding in 45% of instances, sleepy 14% of the time, or intoxicated in 5% of cases.   Motor vehicle accidents kill more teens than any other cause.  Strongly encourage your kids to ride with peers who drive defensively and never allow them to drive with a teen who has had a license for less than 6 months.   Michigan Medicine - University of Michigan. "3 in 5 parents say their teen has been in a car with a distracted teen driver: Teens driving with teens: More than half of parents in a new national poll believe their teen has been in an unsafe situation ridin