Prediabetes and cancer

Prediabetes is defined as a fasting blood sugar between 100-124 and a new study from China found that it might also be associated with a 15% increase in cancer (independent of obesity-itself a major risk factor for cancer). One diabetes medication that  we have used for years, METFORMIN (used both to treat both prediabetes and diabetes) has been shown to decrease cancer by 30% in diabetics but has never been proven to do so scientifically in prediabetes or in otherwise healthy patients.

The authors of this study suggest that metformin may be considered in any patient who has a high risk for getting cancer. Please note, that while metformin is cheap and safe, is not FDA approved for this indication.

Maybe it’s time for more studies.

A simple and free test to predict hip fractures in women

American Society for Bone and Mineral Research (ASBMR)-2014

The inability to either squat down to reach the floor, stand on one foot for 10 seconds or weak grip strength have all  been associated with an increase fracture risk in women.

While bone-mineral-density tests and other measures provide essential information on when a patient may need  osteoporosis prevention, research on signs of physical deterioration that can predict hip fracture has been lacking. The researchers looked at 2700 women and compared those who could perform these maneuvers with those that could not and found that there was a significant increase in fractures, especially those who could not stand on 1 foot for 10 seconds.

The good news is that this can been dramatically improved with physical therapy/balance therapy which we offer in our office through our KAIZEN TOTAL WELLNESS programs.

Try the test at home, and if you need help, please let us know.

Harvey S. Mishner MD


Osteoporosis Primer

As the old saying goes, an ounce of prevention is worth a pound of cure.  Bone mineral density screening is generally recommended for women 65 years and older and men aged 70 and older without risk factors. Screening should begin at age 50 for women and men with an increased risk.


The following increase the risk of osteoporosis:


Low body weight

Low body mass index (BMI)

Lack of exercise/sedentary lifestyle

Poor nutritional status

Alcohol abuse


Estrogen deficiency

Family history of osteoporosis



Getting adequate calcium and vitamin D is the cornerstone of osteoporosis prevention and treatment. Calcium and vitamin D are the only two supplements that have been consistently shown to decrease fracture rates. Dietary sources are preferable, but many people should get a calcium and vitamin D supplement, especially if they don’t get sufficient high-calcium foods and exposure to the sun. Recommend either calcium carbonate or calcium citrate for most patients.


Remember that even if you take medications for osteoporosis, such as a bisphosphonate, a calcium and vitamin D supplement is still important.


Soy isoflavones or ipriflavone seem to help prevent bone loss (But may also increase the risk of breast cancer). In combination with adequate calcium and vitamin D, ipriflavone can increase bone mineral density.  Women interested in soy should stick with soy protein.


Many herbs are promoted for osteoporosis, but there’s not enough good clinical evidence to support their use. Some trace minerals might help for osteoporosis prevention. But evidence is too preliminary to recommend separate mineral supplements. A multiple vitamin supplement generally supplies all of the trace minerals needed.


The importance of diet and lifestyle for preventing and treating osteoporosis can not be emphasized enough.  Smoking and excessive alcohol is bad for bones. Appropriate total body weight resistance  exercise is a great way to not only build bones but to stay in shape and improve health.


At Kaizen Total Wellness we are pleased to offer both Power Plate and bioDensity training to improve bone density.


Summer Food Safety

food-safety-2Studies show that older adults do a better job of handling food safety than any other group. Even so, when it comes to your health and safety, you can never be too careful. Warm summer days make it even more important to be careful about food safety.

Even though we have one of the safest food supplies in the world we still have many cases of food borne illness each year. The Center for Disease Control and Prevention estimates that 76 million Americans get sick, more than 300,000 are hospitalized and 5,000 die each year from illnesses caused by contaminated foods or beverages. Older adults are at greater risk of getting sick from harmful bacteria in food. Our immune systems weaken as we age, making it easier to get sick in our later years. Also, illnesses associated with advanced age, such as diabetes, cancer, and kidney disease, increase our risk for foodborne illness.

Food Safety Rules

Foodborne illnesses can be prevented by following some basic rules. The four basic rules of food safety are

Clean, Separate, Cook and Chill


Harmful bacteria can spread throughout the kitchen on cutting boards, countertops, utensils and sponges.

Wash Up:

  • Wash your hands, utensils and all surfaces with hot, soapy water before and after preparing food. Remember to wash your hands after using the bathroom or playing with your pets.
  • Cutting boards – wash cutting boards with hot, soapy water after each use.
  • Discard boards that have lots of cuts or scratches on the surface.
  • Keep towels clean. Use paper towels or cloth towels to clean kitchen surfaces. Be sure to wash cloth towels often in the hot cycle of your washing machine.

Handle Fruits and Vegetables Safely:

  • Wash all fruits and vegetables well, before peeling or slicing, under running water. Don’t use soap or other detergents.
  • Cut away any damaged or bruised areas; bacteria can grow in these places.
  • Store cut, peeled and broken apart fruits and vegetables, such as melon balls, cleaned cut carrots and broccoli at or below 40 F in the refrigerator.


  • Wash hands, cutting boards, dishes and utensils with hot soapy water after they touch any raw meat, poultry, or seafood.
  • If possible, use one cutting board for fresh produce and use a separate one for raw meat, poultry and seafood.
  • Never place cooked food back on the same plate that previously held raw food.
  • Separate and keep sealed all raw meats from other foods in your grocery cart and refrigerator.
  • To prevent juices from raw meat, poultry or seafood from dripping onto other foods in the refrigerator, place these raw foods in sealed containers or plastic bags.


Food safety experts agree that foods are properly cooked when they are heated for a long enough time – and at a high enough temperature – to kill harmful bacteria that can cause foodborne illness. These temperatures and times vary depending on the type of food. A food thermometer is the best way to know for sure that the food has cooked to the recommended temperature. The instant-read thermometer is an easy to use safe thermometer. It is not designed to stay in the food during cooking, but is used when you think the food is done. Just insert the thermometer into the thickest part of the food for 15 to 20 seconds and the dial will show the internal temperature. These thermometers are inexpensive and are available at stores that carry kitchen supplies.

Cooking Temperatures

We are most concerned that animal products are cooked to the correct temperature to prevent foodborne illness. Here are a few foods and the recommended temperature:

  • Cook roasts and steaks to at least 160 F
  • Cook chicken and turkey to 165 F
  • Cook ground beef to at least 160 F
  • Cook eggs until the yolk and white are firm. Don’t use recipes in which the eggs remain raw or only partially cooked.
  • Fish should be opaque and flake easily with a fork.
  • Once the foods are cooked, serve immediately to prevent bacteria from growing as the food cools. When cooking in a microwave oven, cover food, stir and rotate for even cooking. If you reheat food, leftovers should be heated to 165 F.
  • Bring all sauces, soups and gravies to a rolling boil to make sure all harmful bacteria are killed.


Chilling foods properly is just as important as cooking them safely. Germs grow fast between 40 F and 140 F – referred to as the Danger Zone

  • You can slow or prevent germs from growing on the food by refrigerating quickly.
  • Check the temperature of your refrigerator, it should be at 40 F or below.


  • Refrigerate or freeze perishables, prepared foods and leftovers within 2 hours. If the temperature is 90 F or above they should be refrigerated within one hour.
  • Never deforst food at room temperature. Thaw food in the refrigerator, in cold water or in the microwave if it will be cooked immediately.
  • Separate large amounts of leftovers into small, shallow containers for quicker cooling in the refrigerator.

Traveling with Food:

Remember when you bring food home from the grocery store or leftovers home from a restaurant it must be refrigerated within 2 hours of purchase or serving. Any perishable food left at room temperature for longer that 2 hours should be thrown away.

Be sure to follow these four rules – Clean, Separate, Cook and Chill to have a safe and healthy summer.


Courtesy of the University of Illinois College of Agricultural, Consumer and Environmental Sciences


Shingles and strokes


Clin Infect Dis 2014 Jun 1

A new study shows that patients who have the Shingles (Herpes Zoster) have an elevated risk to get a stroke that lasts for up to 1 year and then disappears.

Over 5 million patients were studied, and whereas the exact mechanism is unknown, the risk of getting a stroke was the greatest in the first month. Those patients who had ophthalmic zoster had an even greater risk of a stroke. (Whenever Shingles affects the face, this is to be considered a medical emergency and should be attended to immediately). Another interesting observation is that even patients who were treated with anti-shingles medication still had an increased risk of stroke.

This makes getting your SHINGLES VACCINE even more important.

However, please be aware that the Shingles vaccine is NOT 100% effective and that the younger you are (50), the more effective it appears to be. Patients who are on certain immunosuppressant drugs cannot get the vaccine.

Blue Cross is the only insurance company that I am aware of that may pay for the vaccine for patients younger than 60. The other commercial carriers usually kick in at 60. Medicare DOES NOT pay for Shingles vaccines, although supplementary insurance and MEDICARE PART D will pay a portion. If you have a Medicare replacement plan, please contact them about coverage as they usually WILL NOT inform my office concerning coverage.




1.       Any patient who has had a stroke or TIA (mini-stroke) should be screened for diabetes and obesity.

2.       All stroke patients should be screened for sleep apnea. (This is an easy test that can be done in your own bed. You DO NOT have to be obese to have sleep apnea)

3.       Patients should be seen by a registered dietitian and follow a Mediterranean diet. (Consults are available through our Kaizen Total Wellness program and may be covered by insurance)

4.       If the cause of the stroke is unknown, ATRIA FIBRILLATION (irregular, irregular heart beat) should be considered.

5.       If Atrial Fibrillation is found, the patient needs to be on a blood thinner. The newer medications for NON-VALVULAR A-FIB are safer and more effective than Coumadin

6.       Most stroke patients need to be on cholesterol lowering drugs, namely STATINS. Regular readers of my blogs are quite aware that NIACINS and FIBRATES may raise HDL Cholesterol, but DO NOT REDUCE STROKE RISK!


Sometimes the source of the stroke resides in the carotid arteries. Plaques can break away from the lining of the artery and travel to the brain. Unfortunately, no insurance company will pay for screening. In our practice, we recognize that some patients like to be more proactive with their health, so we offer both CAROTID and ABDOMINAL AORTA screening via sonography for only $99.

Flu vaccine update for 2014-2015

Morbidity and Mortality Weekly Report


When I review vaccinations with my patients, the one vaccine that most people do not want to get is their annual Flu shot. While it is true that some people may get mild cold-like symptoms for a few days following the vaccine, for the most part it is very safe and very rarely do I ever see a patient who has had the vaccine come down with the flu. Many patients still remember the Swine Flu fiasco from the 1970’s and refuse to get vaccinated.

Please be aware that people of all ages are susceptible to the flu and that it may occur anytime throughout the year, is more prevalent in the fall and winter. It may be hard to believe but people do DIE from the flu, especially those over 65 or who have diabetes, heart or lung disease.

The 2014/2015 composition will be unchanged from last year. We do offer Flu Vaccines in the office for our patients and no appointment is necessary. In spite of pharmacy advertisements, the best time to get your vaccine is in late September through November. Just about every insurance company pays for the vaccine, so there are usually no out of pocket costs for the patient.


Fruits and vegetables reduce the risk of strokes

Stroke 2014;May 8


There was a large study looking at patient databases dating back to 1947 (through 2014) looking at the connection between strokes and fruits/vegetables. There were 17,000 strokes among 760,000 participants. What they found was a 32% decrease in the incidence of strokes among people who ate the most fruits and vegetables, especially citrus fruits, apples, pears and leafy vegetables. This is probably also true for heat attacks too.

Remember, a healthy diet consists not only of fruits and veggies, but also lean protein, healthy fats and nuts. Processed sugar should always be limited!


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