The Holistic Genome

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International classification of health codes – ICH 1

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iStock_000007804869XSmall.jpg Have you ever wondered why we have the International Classification of Disease codes, or ICD for short, but we don’t have an International Classification of Health? This is a major short-coming! Really! How are we to understand the significance genomic contributions towards our health, unless we have a standardized why to describe it? This goes back to my prior discussion, what is Health? It can’t just be the absence of disease!

The ICD codes have been around for a while and we are on the 9th iteration. Mostly they are used for billing purposes for insurance companies to approve or deny coverage. However, during my experiences with billing, I found it frustrating to try to classify a patient as ‘Healthy’. The only way I was able to get reimbursed from the insurance company was if I found something wrong with them. This is a fundamentally conflicting philosophy if my mission was to keep them well!

Ergo, I propose that we concentrate our efforts for a structured vocabulary to take Health into consideration and I therefore declare the start of the ICH codes, International Classification of Health, version 1 – ICH-1. Anyone want to help me?

Written by Jonathan Holt, DO

August 4, 2009 at 9:50 am

Posted in health, holism

Nature verses nurture

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Life is about balancePut simply….  life is about balance!

We see it in our everyday life.  Work and play, day and night, life and death, mind and body…. etc.

We are born from an already vast collection of information that has taken billions of years to evolve. 

Our genes are a blue print that start us off and our environment nurtures us and allows us to thrive to reach our fullest potential.  Thus life could be considered the complex interactions between genes and the environment. 

I see it everyday in the delicate art of practicing medicine.  I advise all of my patient to find balance in their lives.  My mantra has always been …  Work less, eat healthy, relax more, exercise more, find balance. 

I also see it when I prescribe medications, too much medication they have an adverse reaction, not enough and they are under-treated.  Find balance. 

Thus I have come to the conclusion that life is about balance.  It was once said that, “Life is the blended harmony of the yin and yang”

The yin-yang is an appropriate symbol for the struggle to find this balance.  It represents the two sides of the equation, yet both in balance.  And at the center of the other you find its opposite.  Yin and yang are complementary opposites within a greater whole.

Written by Jonathan Holt, DO

December 23, 2008 at 8:19 am

Posted in health, holism, spirit

Family History

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Family 

 

Family Medical History

As you gather with your family to give thanks, perhaps it is a good time to talk about the family tree and discuss your family’s medical history.

Some direct-to-consumer genetic testing companies try to argue that their services are a replacement for a family history.   I strongly disagree. 

However, I am always amazed at the lack of knowledge my patients have regarding their family’s medical history. I have rarely seen a compete and thorough family history documented in a primary care chart. 

Why is this?

Partly, busy primary care physician do not have the time it take to take a thorough family history. It takes on average 9 minutes, but average new appointment time is only 15-20 minutes.  

There is also the concern regarding the security of family member records being stored in a patient’s medical record. 

I have also noticed that this is because it just not discussed or family members are ashamed to discuss it, or the details get lost in translation.  A family history of ‘stomach cancer’ which was only revealed to be ‘ovarian cancer’ suddenly changes my approach in the setting of associated cancers such as Breast Cancer. The specifics on the type of cancer can very helpful.  I have at time resorted to getting death certificate documentation for the actual cause of death, when this is necessary.  A great service is call Vitalchek where your can order these documents electronically. 

There is also a great tool offered by the United State’s Surgeon General’s website that helps families input their family’s medical history and makes it downloadable and accessible.  

So, at this time of reflection, take a moment to share this with your family and have a discussion around the dinner table.  

Happy Thanksgiving!

Written by Jonathan Holt, DO

November 27, 2008 at 12:54 pm

Don’t worry, your genes are happy!

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Don't worry, your genes are happy!It has long been postulated that the overall happier you are the healthier you are.  It could also be argued the opposite.  Now, researchers in Australia have found genes that predict your personality traits that affect ‘happiness’ in the March issue of Psychological Science.  “Subjective well-being” was studied among 973 twin pairs to test the hypothesis that your genes account, to some degree, your happiness.

Subjects, in the United States, were called via telephone and asked a series of questions.  Identical verses paternal (non-identical) twins were questioned regarding their overall ‘subjective well-being’.

Subjects, who didn’t hang up on them, were asked three questions regarding their ‘happiness’ and then mailed the Midlife Development Inventory (MIDI), a self-administered 25-item personality questionnaire.

The researchers then analyzed the differences between the identical and non-identical twins and categorized their personality scores results into the areas of: NeuroticismExtraversionOpennessAgreeableness and Conscientiousness.

The idea being is that identical twin share all (well, almost all) of their genetic information and non-identical, only share 50%.  The researchers showed that the correlations of genes affected an individual’s personality traits which subsequently affected “subjective well-being” in identical twins was substantially greater than those of non-identical twins.  There were, however, no genetic effects that were unique to “subjective well-being” alone.

Thus, while your genes contributed to your personality in areas of Neuroticism, Extraversion, and, to a lesser extent Conscientiousness, it was your personality that mattered more!  Specifically, one’s ability to endure and ‘bounce back’ from an emotional stress.

Remember, there is no gene for the human spirit! So, don’t worry, just be happy!

Written by Jonathan Holt, DO

November 25, 2008 at 12:09 pm

Posted in health, spirit

Health – not just the absence of disease.

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Toothbrush and dental flossI recently returned from my dentist with a surprising finding!  I don’t take good care of my teeth!  ME!??  I mean I’m a health and wellness nut! 

Like many other people, I don’t floss often enough.  I try to do it everyday, but it never seems to be a priority. As a busy physician, there just always seems to be something more important to do…Like saving lives, refilling prescriptions, sleep and blogging!:)

This is symbolic of our dilemma to our health. It never seems to be a priority until it is too late and you need that root canal.  We know what we should be doing to stay healthy, but we don’t! Do we really need to sequence the genomes of the bacteria in our mouths, before we are willing to take the time to brush and floss? 

Similarly, diet and exercise never seem to be a high priority for most of us.  What good is it to find out if you have fast muscle fiber or slow muscle fiber type if you don’t ever exercise?  To often we procrastinate and find excuses. 

Irrespective of one’s genetic testing results showing an increased risk for coronary artery disease, we all should be getting more cardiovascular exercise!

Irrespective of one’s risk of deep venous thrombosis, we all show get up and stretch our legs on long airplane rides!

Enough said, I’m off to brush and floss my teeth.  You should too!

Written by Jonathan Holt, DO

November 15, 2008 at 12:02 am

Posted in health