Author Archives: drcharles

How To Read a Prescription for Glasses (It’s Easy!)

I get asked how to read prescriptions all the time, including those for glasses. Reading a prescription for eyeglasses from your optometrist is simple, here’s how: (short video)

How to Read a Prescription for Eyeglasses / Common Abbreviations

Ordering prescription glasses online from somewhere like EyeBuyDirect or glasses.com? Be sure you know how to read your prescription!

OD = Right Eye (R)
OS = Left Eye (L)
SPH = “Sphere” or strength of your lens. A “+” positive number means you’re far-sighted while a “–” negative number means you’re near-sighted
CYL & Axis will be filled in if you have astigmatism. That means your eye is not shaped spherical, but more like a football shape. The Axis is the angle of your astigmatism
ADD = Additional strength in your lenses like bifocal, progressive, etc.

Other EyeGlass Prescription Terms:

*PRISM = The prismatic power used to correct vision displacement. (When your eyes don’t align correctly)

*BASE = The way the base of the prism is facing: BU, BD, BI, BO

Pupillary Distance “PD” is the distance from one pupil to the other. PD is needed to order glasses online, but you can measure your own.

*Check out our coupons for EyeBuyDirect to save up to 50% on eyeglasses!

More coupons: Check out today’s coupons for Scrubs & Beyond, or this deal for 50% off a WSJ subscription!

Banning Trans-Fatty Acids in Restaurants Saves Lives, Improves Mouth-Feel

Good news for supporters of trans-fatty acid bans: in New York State counties that implemented restrictions on their use in restaurants and eateries, there were significantly fewer admissions to local hospitals for heart attacks and cardiovascular events.

Specifically, researchers found a 6.2% decline in admission for hearts attacks and strokes combined, and an even greater drop of 7.8% for heart attacks alone. Both reductions were statistically significant.

Evidence has accumulated over the years that consuming trans-fatty acids is associated with increased risk of heart disease, stroke, and diabetes. The FDA plans to restrict the use of trans fats in foods nationwide in 2018, but some localities in New York State went ahead and banned TFA’s in restaurants and eateries starting between 2007-2011.

Processed foods, manufactured for long shelf lives, profit, and the creepy notion of “good mouth-feel,” have long been the biggest culprits using TFA’s.

Look for and avoid ingredients like “partially hydrogenated oil” found in many baked goods, cakes, piecrusts, crackers, cookies, biscuits, breakfast sandwiches, margarine, microwave popcorn, cream-filled candies, doughnuts, fried fast foods, and frozen pizza.

Unfortunately manufacturers are currently allowed to list trans fat content as 0 grams if the actual content is below 0.5 grams – kind of like rounding down, except that those small amounts can add up.

A legacy of the Obama administration will go into effect in 2018, when the complete phase-out of trans fatty acids in American foods is scheduled to be completed. This happened despite intense lobbying by some companies and associations representing fast food and junk food interests.

The FDA estimated that up to 20,000 heart attacks and 7,000 premature deaths could be prevented each year with this phase-out, not to mention significant reductions in diabetes and cardiovascular disease prevalence. Perhaps $140,000,000,000 will be saved in healthcare costs over 20 years.

New York City in 2006 under Mayor Bloomberg, and then California in 2008, pioneered the way with this enlightened TFA-banning legislation, but the early 1990’s Congress and then President H.W. Bush deserve some credit, too.

The original Nutrition Labeling and Education Act of 1990, sponsored by Democratic Rep. Henry Waxman, passed both houses of Congress and was signed into law by the first President Bush (H.W).

Ahhh… those nostalgic days of working together for the common good. From Wikipedia:

The law gives the Food and Drug Administration (FDA) authority to require nutrition labeling of most foods regulated by the Agency; and to require that all nutrient content claims (for example, ‘high fiber’, ‘low fat’, etc.) and health claims meet FDA regulations.[2] The act did not require restaurants to comply with the same standards.

The regulations became effective for health claims, ingredient declarations, and percent juice labeling on May 8, 1993 (but percent juice labeling was exempted until May 8, 1994).[2]

Effective Jan. 1, 2006, the Nutrition Facts Labels on packaged food products are required by the FDA to list how many grams of trans fatty acid (trans fat) are contained within one serving of the product.[1]

So it is even more remarkable that a significant drop in heart attacks was seen with these more recent bans in New York, which really targeted the restaurant and eatery loopholes. Fast food and processed food companies had already decreased their use of TFA’s nationwide by some 85% over the past decades, as mounting evidence of harms and impending class action lawsuits loomed larger, and mandatory labeling of trans-fat content in foods increasingly drove educated consumers away from the products sitting on the shelves and lurking in the fryers. Nationwide there has been a trend towards lower cardiovascular disease prevalence, but this is multifactorial.

The deep fried Twinkie as we know it will recede into the annals of history, conjured only by roving bands of post-apocalyptic freedom fighters raiding pre-WW3 bomb shelter pantries to find the archaic ingredients.

Humans will no longer be seduced by the Frankenstein mouth-feel of partially hydrogenated oils, which honestly, always tasted malicious somehow anyway.

The Inherent Badness of Refinement

I had an interesting conversation with a psychologist friend of mine who specializes in treating sexual addictions. She did not tell me anything interesting in terms of specific cases, practices, or titillating bedroom details, but rather piqued my awareness of the brave new world of dating and casual sex as facilitated by apps like Tinder.

I felt old and naïve as I learned that with a few swipes of the hand on an iPhone, people seeking a casual sexual partner in real time are able to search through profiles of other people, learn perhaps that this person is currently 100 yards away, trade photos for evaluation, and then basically get in on. For someone with a sexual addiction, this immediate gratification is as volatile and irresistible as one might witness placing a kid in front of a basket of Halloween candy. Which brought us to the corrupting notion of refinement in all things.

Take for example the refinement of carbohydrates and sugar in food. There is perhaps no more logical explanation for obesity and its attendant health problems than the free reign of sugar and starch as commodities, separated and refined from their original source.

Every day I hear the self-defeating arguments from people unable to lose weight as they cannot break a seeming addiction to starchy snacks, chips, bread, juices, soda, ice cream, and the like. The middle aisles of the grocery store, full of processed and refined inputs that have been reassembled into something complex enough to be called food, are really just barren wastelands of destroyed nutritional principles, forgotten cuisines, and corporate brand addiction. Freedom may be found in the simple, unwrapped harvest of the Earth.

Alcohol has also been refined to the point of absurdity. For thousands of years humans found health and pleasure in complex beers, ciders, wines, and other products of fermentation – a process which in some ways unlocked additional nutritional values. But over the past several hundred years the process of distilling has refined alcoholic drinks from the complex brews of the past into the simple, potent, hyper-concentrated alcohols and liquors that are often the source of addiction, accidents, and medical problems.

I personally appreciate gin and a good mixed drink, and I have a hard time preaching about the evils of alcohol, because in moderation even distilled spirits can be enjoyable and “healthy.” But for those with a predisposition to alcoholism, the concept of refinement applied in this realm has been lethal.

Which brings everything back to the conversation I had with my psychologist friend about sex, and the refinement of this realm that seems to be going on now. I am actually quite ignorant about what is actually happening out there, but as I learned more about specific websites, it seems that all the complex gratification of a relationship, or the challenging pursuit of another attractive individual – physically, emotionally, spiritually – is being reduced to a smartphone app that sorts available penises and vaginas.

This is of course just the latest development in a continuum that stretches from Playboy, through explicit internet content, and on past all the various distillations of a basic instinct for pleasure that can be satisfied in increasingly refined, uncomplicated ways. Especially for those with an addiction, this impersonal and freely available world in all its iterations is actually imprisoning.

I think that one way to achieve physical health, emotional wellness, and sexual satisfaction would be to paradoxically and intentionally seek the laborious, unrefined world.

Spend more money and time buying real foods, and cooking them, socially, in our own home kitchens, according to the traditions of a cuisine.

If you drink, seek out thoughtful, complex brews, wines and a few spirits, and revel in the magic of the process that brought this relaxing complexity to your lips, instead of enduring vehicle after vehicle of simple ethyl alcohol poisoning.

And beware of the reductionism and refinement of sex that occurs all around us, from the catalogs that arrive at our doors, to the shows on television, to the apps that would transform and enable our most primal urges. Otherwise we will continue to spoil of one of life’s greatest and most exhilaratingly complex pleasures – the physical expression of earned love.

Refinement is dehumanization.

Fight the Powder.

We Should Construct Specialized Ebola Facilities in the US. Now.

The US should be ready to build facilities, akin to what the military has been setting up in West Africa – specialized Ebola hospitals with moon suits, free-flowing bleach solutions, and brave healthcare workers who have been properly trained, and will be properly compensated for their risk.

Conventional hospitals have failed to protect at least two healthcare workers from contracting Ebola, despite what sounds like fairly diligent safety precautions. The nurse in Spain, and the nurse in Dallas just diagnosed today, both practiced stringent precautions and wore protective gear. It has been postulated that a single Ebola virus is enough to transmit the infection between close contacts.

And, while the CDC director assumes there was “a breach in protocol” to explain the nurse’s infection, this is not reassuring to any healthcare worker who knows how impossible it is to achieve perfection in the care of sick patients. Doctors, nurses, medical workers – we are not trained, prepared, or equipped to deal with something like Ebola.

And even with buddy systems and moon suits, any human being lacks perfect motor execution when disrobing. And the disrobing protocol in this country does not even include being sprayed/bathed in a disinfection solution prior to disrobing – something done in Africa for years. This is outrageous.

Even with regional Ebola treatments centers, the diagnosis and triage of potential infections will likely continue to be through the conventional health system, as false scares will certainly outnumber true diagnoses. But once a diagnosis is made, that patient needs better care, and workers need better protection than all the reassurances thus provided by the CDC and WHO and hospital protocols.

The four hospitals in the country commonly cited by the news as having high containment units do not have sufficient beds to handle Ebola if it picks up speed and numbers. The death toll among healthcare providers in West Africa is much, much higher than the average population. It would be here, too.

The Ebola epidemic continues to grow exponentially in Africa. Today we have the luxury of hyper-focused contact tracking and supervised quarantines in the United States, but these efforts take considerable resources and attention, and will fall apart if the disease count grows. Such is the terrifying power of exponential math.

It is not a good idea to have Ebola patients in conventional hospitals like Texas Presbyterian. Conventional hospitals are already a nexus point of the worst antibiotic-resistant contagions in the world. We need to enlist the help of groups like Doctors Without Borders that really know how to protect their staff, and we need to start thinking about containing and treating this infection outside the normal hospital box.

Build it, and hope they never come.

Low Carb Versus Low Fat Diets, and How My HDL Went Up 20 Points

Which is a healthier way of eating – low fat or low carb? Several recent studies have been published addressing this question, and the answer seems to be that lower carbohydrate diets, with moderate amounts of fat (yes, even some saturated fat), produce healthier cholesterol levels, reduced markers of inflammation, improved cognitive function, and greater weight loss.

My own experience in this regard may be helpful to consider.

25 year-old Dr. Charles used to work out 4 days a week, run about 10-15 miles a week, and eat very little fat but very high carbohydrates. The orthodoxy at that time was that a low fat diet was the best. I rarely ate any fat, forgot about things like nuts and avocados. I drank 1% milk fat. In an effort to gain weight, I would eat cereal or spaghetti before bed most nights of the week.

Approximate Stats:

Weight = 170
Total cholesterol 165
Good HDL only 38 (normal >40, optimal >60)
Bad LDL 103
Triglycerides 100
Energy levels fairly tired after most meals
Moderate adult acne

But then into my 30’s I started to incorporate more aspects of the Mediterranean diet, cooking with generous olive oil, eating nuts most days of the week, more fatty fish and shellfish, grass fed beef or bison, drinking whole milk and more wine with dinner, and substituting Greek yogurt and eggs (time permitting) for morning cereal. I stopped carb loading at night and figured I would just accept my thin body instead of trying to bulk up. I do eat carbs, maybe the equivalent of 2 servings a day, preferably whole grains or more exotic stuff like quinoa, spelt, and plant sources of starch like corn, squash, bean, sweet potatoes. Fruit, vegetables, berries. Unfortunately I found less time to exercise or run, and my time spent exercising was cut in half or more, with little to no running.

New stats on lower carb, higher fat, less active lifestyle:

Weight = 160
Total cholesterol 199
Good HDL 60 (most positive change)
Bad LDL 128
Triglycerides 75
Energy levels improved after most meals
Minimal adult acne

Eating more fat and losing weight?

Eating more fat, albeit mostly unsaturated healthy fats, and eating much less carbs produced 10 pounds of weight loss, boosted my HDL cholesterol over 20 points, and provided me with a subjective sense of more energy, and possibly cleared up some acne. This is consistent with the recent studies you may be hearing or reading about.

Fat is not the enemy. Even saturated fat in moderation seems to be ok. The French have known this for centuries, as have Mediterranean cuisines.

I believe in eating low carb/low sugar and low total calories, with very little processed foods from the middle aisles of the grocery store. I believe in drinking grass fed whole milk, limiting cereals in the morning in favor of eggs, whole grain toast with almond butter slathered on top, or full fat yogurt with berries. I believe in a glass of wine or beer with most dinners, because it relaxes me and my vascular tone as well. I snack on nuts, and eat saturated fats like cheese and animal fat in moderation. I pretty much never drink soda or juice, but I do like ice cream maybe once a week.

A few years ago there was a potential block buster drug being developed to boost people’s HDL cholesterol levels. This was considered the holy grail of cardiovascular risk reduction, as most studies consistently show a reduced risk of heart attack and stroke with good, high HDL levels. Unfortunately the clinical trials were halted after it became apparent that this artificial HDL engineering with a pill actually increased mortality rates.

Fortunately it seems we can turn things around with diet, perhaps as I was able to do.

Now I have to return to my very stressful job, which is going to give me a heart attack anyway.

Obama’s Foreign Policy Is Linked to a Healthy, Restrained Immune System

With 58% of Americans disapproving of Obama’s foreign policy, mounting Ebola virus deaths, and flu season around the corner, I think it is important to synthesize an overlapping theme between how our country fights perceived threats, and how our bodies successfully or unsuccessfully fight disease. In short, I think Obama’s continued restraint and use of soft power is evidence of a good prognosis for the country.

In this analogy, our bombs and military are the most caustic weapons of the country’s immune system, akin to a fever of 105 degrees and impending sepsis. Does “nuke them all” work?

Diplomacy, espionage, surveillance, economic sanctions, and other soft tools of foreign policy can be likened to low grade temperatures, coughing, mucous, and all the other less dramatic symptoms of immune system activation.

Considering medications is a stretch, but stay with me. Cholesterol-lowering medications called statins actually do more than lower our lipid levels – they mildly hamper the immune system and reduce inflammation. Intuitively this would seem to be a bad thing when fighting a war inside the body against an invader. But statins are increasingly suspected to be a beneficial kind of weakening force that paradoxically might save us from an immune system run amok.

Is Obama like Lipitor?

Consider influenza. Often young, healthy people with robust immune systems are at increased risk of dying from pandemic influenza simply because their immune systems launch such powerful attacks that the body cannot withstand the friendly fire.

One study found that patients hospitalized with influenza were 54% less likely to die if they were taking a statin medication. It is postulated that statins modulate and dampen the inflammation unleashed by the immune system, thereby limiting collateral damage.

Another study published in the journal Critical Care recently found “that early treatment of sepsis patients with a statin reduced the occurrence of organ failure (a complication that often kills Ebola patients) by 83 percent.” An opinion written by two medical doctor/professors appeared in the New York Times this week calling for a trial of statins in those dying of Ebola for this very reason.

ISIS is a cancer, surrounded by other diseased states. Putin is MRSA. The Middle East is the Middle East. I’m glad we don’t have Bush and McCain running in with their hands unwashed to try and save the day. I’m glad Hillary isn’t trying to do her best Clint Eastwood.

So far Obama seems to be managing these illnesses like a well-restrained immune system. Even though we disapprove of his foreign policy, a majority of Americans want to stay out of these foreign conflicts – putting Obama in no-man’s land in terms of chasing approval ratings.

Personally I’m much more worried about the planet’s fever, the looming environmental catastrophes, and being on the front end of the greatest mass extinction the Earth has ever known.

Push fluids with ISIS. Only send in bombers and troops to Ukraine prn, and start World War 3 if America is terminal in the ICU. But for now I salute the commander for swallowing his bitter pills, sneezing and hacking up mucous, and enduring the taunts of weakness from viral media on behalf of the country’s health.

If You Don’t Look For It, You Will Miss It

Death leaves an invisible silence, a wrenching disappearance of love’s voice and presence.

Your father held you in your first moments, poured his love and life into your cup, and told stories that created a fabled purpose from the dull chaos. And then he was no more.

Are loved ones gone forever when they die?

They live a new, unselfish life within the murky, star-forming nebula of our memories. We conjure them in moments of anxiety, sing along with them in the music they loved, and see how they once adored us as we tuck our children into bed. And beyond our perceptions, they exist as nothing and everything.

And if we don’t keep a keen eye on the outside world, we may miss them there as well. On a birthday I looked down and saw this dirty little puddle. I paused, noting that it was heart-shaped. And as great art can move mountains within us, so too can dirty puddles speak for the dead:

I love you.

it said.

In the moment my father died there was a beautiful, September-like sky, crisp and blue like the month he entered the world. He shone in the sunlit footprints of his granddaughter as she ran down the sandy beach, brimming with her young life, a torch of his own.

My father jammed the electromagnetic waves of the police trying to call my cell phone to tell me of his demise. Four times I answered the phone to static, which has neither happened before nor since. Stay in this brilliant moment a little while longer, son. I’m with you and your family over this warm beach blanket as I join the sky, reveling in your daughter’s giggles. Remember nothing in the universe has produced a greater sound.

We are of the world when we are born into it, why should we not remain of it when we die?

Look for your loved ones, hear them, sense them, and hold on in inexplicable ways.

The Examining Room of Dr. Charles

A physician's commentary on current issues in medicine, clinical research, health and wellness.