First off this is the first real piece of reader mail.  I was so shocked that after I woke up on the floor, I almost passed out again.

I am not one that expects any fan mail or hate mail (although I am not fishing for it either), but the feedback is excellent. So…

“I enjoy the blog when you write it.  I would love to see more articles regularly. You have a way of putting somethings in perspective that makes it easy to follow.  Curious as to what happened to Igor? Also, would you care to comment on metabolic syndrome? My physician says that I have it and that I should consider going on metformin which I read is a diabetes drug.  What do you think?”

OK, so first things first.  Thank you, kind person.  While I do not need praise, I certainly appreciate it.  I will let everyone know that I am trying to produce a piece each day (although I am failing at that at the moment), but I have been looking for good topics to work on.  I am working on upping my game at the keyboard as well as firing out a regular podcast.  The addition of my friend Chris, who has no medical background, has made the discussions much more informative and it has taken that feeling of me talking for 30 minutes like Ben Stein in Ferris Bueller’s Day Off. Chris and I have been friends for a long damn time, and he is the kind of friend that you pick up where you left off with as his wife, Shannon.  It was nice to pick someone thoughtful to sit down at the mic with, even if it is 800 miles away.  Feel free to submit questions or topics either via email or through the Facebook page.

Igor is a touchy subject that I will comment only briefly on.  When I started the page I did as you do here in Castlevania, I went to Home Depot and found a hunchback (actually we had been friends for a few years) who had an English degree that wanted to add some real blog experience to his portfolio and he thought it would be a fun project.  He did bring humor and correct grammar to the page as well as some very well written articles.  Anyhow, for one of the first times in my life we had a couple of very major differences that drove us not to be friends.  It wasn’t pretty, and there were things that we both should not have said, but the damage is done.  Igor has moved on, and hopefully, this will be the last I need to address that.  I apologize that his work is no longer available, it is quite good, but my request to keep that work available received a nasty reply as well.  Oh well, live and learn I guess.

Ok, lastly and more fun than the others is metabolic syndrome. So Mayo Clinic (ok do they really just have Mayo there or are they allowed mustard as well?) says. Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke, and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. So basically, you have a beer belly (even if you don’t drink) with abnormal labs (really simplified).  Or you just look preggers.

Well, as I have had to do, its time to swing by Primary Care.  It is also time to stop saying, “I think I can get this with diet and exercise.” Yeah dry that out, and you can fertilize the Sanai. Its time to admit that you do have issues that could, literally, be the death of you.  Most likely medication is going to be the answer for you but, it does not relieve you of the responsibility to lose weight and exercise.  The more that you can, the better your recovery from this will be.  You may never lose the syndrome, but it is completely and successfully treated.

If you decide to use magic thinking and use supplements to try and corral this condition, you may be less than satisfied with the results. When I talked about supplements, I mentioned that they are unregulated, not scientifically tested, and do not have to prove any of their claims.  Just because it says it lowers blood sugar, does not mean it consistently does.  Either way, please tell your provider if you are taking supplements as they can affect absorption.

So how do we deal with it as providers?  Ok look fat shaming does not work.  We need to find an approach that is more compassionate while still getting the message to our patients.  Some folks may never lose the “ole spare tire,” and that is ok.  The thing we need to do is encourage the regulation of blood pressure, cholesterol, and an effort at a healthy diet.  Many folks have difficulty just affording healthy options and are stuck with processed food, which sucks to maintain proper weight control.  If you aren’t versed in nutrition (some of aren’t) then maybe a dietician referral may be in their future.  Even one time with some useful information may be all they need.  Don’t be a dick. It is the quickest way to get most patients just to shut down.  If you are trying to help them, how is the patient not listening going to get the critical information? A better part of your mission as a PCP is to improve health, and a firm yet practical approach may be the best idea. A treatment plan does require buy-in from the patient.

We should strive to be in the best shape we can as providers. With the stress, we deal with as well as being an excellent example to our patients.

Okay, enough preaching. Be well and be kind to each other