Author Archives: olddochizon

Spinning your way to health

When you watch the Olympics, the indoor cycling events are raced on a curved, oval, wooden track called a velodrome (in fact our office sponsors cyclist Sarah Hammer in this years  Olympics in London, England.  Get to know her and cheer her on at USA,USA!)  The bikes they ride are fixed-wheeled without breaks. That is to say, the rider cannot coast and that the only way to stop is to eventually slow the pedaling of the bike.  It is amazing how fast the sprinters can pedal, getting their revolution of the pedal per minutes (termed: cadence) at close to 300 revolutions per minute. Note: most average riders pedal at a cadence of 60 per minute.

Taking a page from this book, they invented the spin bicycle, and with that a funny, sweat inducing activity called spinning. Spinning is the act of using a fixed wheeled, stationary bike typically in a classroom setting. These spinning classes are the aerobic classes of the new millennium.  There are spinning classes and even spinning studios almost everywhere once you start searching for them.  There are also home versions such as that has many excellent classes in DVD form that are great to follow at home.  Besides classroom-type, group spinning classes, they have several DVD’s that are actual tours of road bike rides from Southern California to Boulder Colorado and even Ireland (I don’t recommend the Ireland ride since, in Ireland, bikes ride on the left side of the street and every second it seems like you are going to “ fly on a windshield” with your bike).

Pedals on a spin bike have regular flat sides for regular court type shoes, but the other side is usually set up for actual bike shoes that clip into the pedal.  On some there is the old fashioned strap that will cinch over the forefoot.  While it is ok to ride on just the flat side, the rider will then only get about half the workout.  With the clip in pedals or the strap, the rider is able to also engage the backside muscles of his thigh called the hamstring.  Fixing the foot to the pedal allows the rider to pull up with one leg while pushing with the other side.  With time, practice and patience the rider improves the manner in which he turns the pedals.  The novice rider usually mashes in a vertically downward manner, using only the front muscles of the thigh (quadriceps).

The experienced rider has learned through hours of concentrated practice to truly pedal in circles with the hamstrings attempting to pull up at the same time the quadriceps are pushing not down, but in an efficient circle.  The foot remains flat to the ground throughout the whole pedaling, cycling in a path analogous to “scraping gum from front part of the shoe”.

What seems to make the spinning bike such a better experience than the traditional old fashioned stationary bike is the ability to pedal very quickly and to be able to easily stand on the pedals.  Standing on the pedals while spinning, rapidly uses a whole new set of muscles, especially the calf muscles (gastroneimus).  The first time a novice rider attempts to “dance on the pedals” (as experienced riders sometime call it) they quickly feel the burn in the quadriceps muscles.   A great resource for cycling is from a family doctor turned cycling coach in San Diego named Arnie Baker (  Last winter we got some middle aged, “usta could” together twice a week and did his indoor H.I.T. program (High Intensity Training) during the holiday season.

The spin classes are a variation of the rate of pedaling, the force of pedaling and changing from seated to standing positions. There are no numbers or levels with a spinning bike, there is only “the knob”.   A rider can adjust his “suffering in the saddle” based on small twist of the sometimes hated “knob”. The rider decides the amount of resistance with the knob, as no one in the class could possibly know except the rider.  Everyone wants to give an effort but it is easy to overdo it and suffer the ultimate humiliation of a spin class…putting too much resistance on the wheel then not being able to turn the pedal, resulting in the whole front wheel stopping as the other rider’s look in your direction and thinking, “rookie”. The knob can be a rider’s best friend or worse enemy. A heart rate monitor is advisable to help a rider decide how much to turn “the knob”.

Speaking of enemies, the instructors of spin classes are to be feared and rarely trusted. Novice spinning riders are encourage to arrive at class early so as to get a bike in the back where they are less conspicuous and are able to observe and learn from the more experience riders. Novice spinning riders should essentially never listen to the PYT, ie:“pretty, young thing”(God bless Michael Jackson)  in the front of the spinning class.  She, as most spin instructors seem to be, is in fantastic shape and most days runs several spin classes.  She, obviously, does not have a clue what it is like to be a middle age male who, “use’ta could” but now is significantly above their ideal weight.   She doesn’t know the pain of having knees that buckle but not our belts on our pants.  She has no clue that our backs go out more than we do.

So if a novice rider doesn’t listen to the instructor, then who do they follow?  The answer is we follow our own heart rate.  Experience riders know that whether riding a spin bike at the gym or a road bike in the Tour de France, all riders must “ride their own ride”.   With your trusty heart rate monitor (try, just get your heart rate to 120 beats per minute and just survive the first class no matter how much you think everyone is looking at you. Be safe and resist the temptation to try to impress anyone in the class.  It turns out that just getting your heart rate over 120 beats per minute will give you a training effect.   Don’t worry what others think of you.  I always remind myself that you wouldn’t worry what others think of you until you realize how little they think of you. (Yes, I tried to minor in philosophy in college (Go LMU Lions!)).


Now we get to the dreaded cycling clothes. Oh the tight fitting, spandex-laden cycling clothes. For convention, the cycling top and pants are called a “kit”.  The spandex stretching clothes are to minimize wind drag when riding outside. There are a serious of pockets in  back of the kit top to hold various items such as snack food/jells, cell phone, wallet , etc.  However, the most important item for comfort when riding is the goofy cycling shorts that look like the rider pooped their pants.   These can save the tenderest of bottoms on a spin bike or a road bike.  Biking shorts have a shami-like cushion sewn into the tush part to make the bike seats bearable.  They have styles where the spandex bike short is then covered by longer, baggier shorts, especially make for some mountain bikers.

As you improve from simply surviving a spin class to wanting to start to “hammer” a spin class, take a moment to figure your approximate training heart rate limit.  This is done by calculating the approximate maximum heart rate, then not riding over a certain percentage of that maximum heart rate (best training heart rate is usually 70% of the maximum heart rate).  A rough equation to calculate a maximum heart rate is subtracting the age of the rider from 220(expressed in beats per minute).  So if the rider is 50 years old this is calculated as: 220-50 = 170 beats per minute as a maximum heart rate. For exercise this is a rough estimate of maximum heart rate. We say rough estimate because the maximum heart rate does not just depend on a person’s age but also on their fitness level.  While it is true that a person’s maximum heart rate does decline with age, the rate of decline depends on the rider’s fitness level.  As we get in better shape our heart chambers get larger. This is a natural adaption from a regular exercise program.  Since the heart chambers, especially the left ventricle, does not need to beat as fast to get the blood to circulate in our bodies.  Somewhat counter intuitively, the fitter a rider is the lower maximum heart rate they can attain.  Usually, these fit rider have very low resting heart rates (instead of the usually 70 beats per minute, they are usually under 60 beats per minute).  The maximum heart rate, despite maximum effort (read that suffering), many times will be considerably less that that number predicted from the 220-age equation that is on a wall somewhere in just about every exercise gym.  On the other end of the fitness spectrum, the less fit rider’s maximum heart rate often can be significantly over the predicted maximum heart rate.   Jokingly, they can hit the predicted maximum heart rate simply “running to the refrigerator”.   Their heart chambers are usually smaller in volume than the average left ventricle and so they must increase the heart rate to get sufficient blood circulating in the body.


Suicide Prevention

Quote: “And whoever saves a life, it is considered as if he saved an entire world” –Mishnan Sanhedrin 4:5; Babylonian, Talmud Tractate Sanhedrin 37a



It is with a heavy heart that I write about suicide.  In a recent article from UCSD School of Medicine(Academic Med.2012;87:320-326) it reveals that suicide is the 10th leading overall cause of death in the United States. Women attempt suicide two to three times as often as men, but men successfully complete suicide at four times the rate of women and account for 79% of all U.S. suicides.  Of note, rates of suicide among physicians is, unfortunately, even higher.


Major depression seems to be the most significant antecedent risk factor for suicide.  Keith Hawthon, an editor of an important book on suicide, reminds us that suicide may not be easy to predict in men: Males are less likely than females to want to talk about their problems and relatively less verbal ability to describe what they are feeling.

In addition, there are a host of other factors that increase the risk of suicide including other mood disorders, substance abuse, anxiety, hopelessness and despair, adverse life events, personal history of physical or sexual abuse and family history of suicide.

Suicide and lethal risk taking are the leading causes of male mortality in the teens and twenties.   In the Vietnam War years four times as many Americans died of suicide as died in combat.

Ninety percent of suicides are associated with mental illness, most commonly depression.  There is a strong genetic component to risk for suicide; the risk is estimated to be 30-50 percent as a consequence of inheritance. Having a first degree relative who completed suicide increased the risk six fold (Why Men Die Young, Marianne J. Legato,2008).



Warning signs for suicide

The following signs may mean someone is at risk for suicide. Risk is greater if a behavior is new or has increased and if it seems related to a painful event, loss or change. A guy should seek help as soon as possible if they or someone they know exhibits any of the following signs:

Talking about wanting to die or kill oneself.

Looking for a way to kill oneself, such as searching online or buying a gun.

Talking about feeling hopelessness or having no reason to live.

Talking about feeling trapped or unbearable pain.

Talking about being a burden to others.

Increasing use of alcohol or drugs.

Acting anxious or agitated; behaving recklessly.

Sleeping too little or too much.

Withdrawing or feeling isolated.

Showing rage or talking about seeking revenge.

Displaying extreme mood swing.

National Suicide Prevention Lifeline: 1-800-273-Talk.

Dough is the Devil

We love things made of wheat…bread,rice,pasta, cakes, cookies and of course, PIZZA!!!  This is what our bodies love or at least like an awful lot.  However, what our body’s need is boring…protein and vegetables.  There in lies the battle.  What we want versus what we need.  The interesting thing about wheat, according to Dr. Davis in is current book, Wheat Belly, it that wheat has been genetically altered starting in the 1950’s.  Before this time, wheat came in only about 25 varieties and was not too unlike the wheat of Moses and the bible.  When Jesus said to ask our Father to “Give us this day our daily bread” he was talking about this ancient type wheat that even appears in our patriotic American songs with the phrase, “Amber waves of grain”. 

         The worry about food shortages and population explosion changed all that.  To improve the yield of an acre of wheat ten fold took enormous genetic changes to the wheat, creating something called “dwarf wheat”.  To get dwarf wheat took the varieties of wheat from the original 25 varieties to 25,000 varieties.  While we now get ten times the amount of wheat per acre, no body took the time to see what this new, franken-wheat did to humans. It turns out that this new wheat actually increases our appetites to the point that giving free bread in a restaurant before a meal raises our appetites so we order more wheat.  This is through a protein called glyiden that has a morphine like effect on our brains so we eat more food.  We are essentially addicted to wheat containing products.  This causes us to over eat and gain excess weight.  Hence the term, Wheat-Belly very analogous to the good old Beer Belly of old (since beer hops are made of wheat).

         So dough is a nutritional devil.  Now if a guy exercises a lot ( over two hours a day of cardio exercise like running, cycling, swimming) then nutritionally you can  earn dough.   In fact, to prevent bonking while distance road cycling you actually must eat dough type products to keep riding for hours.  But if  we guys don’t exercise that much, it is best to stick to mostly proteins and vegetables.  Fruit really spikes the blood sugar, similar to wheat so it should also be avoided on most days.  There is an inverse relationship between vegetables and weight. The more vegetable you eat the less you weight. Conversely, the more wheat you eat, the more you weight.  Simple in concept, hard to follow.  Tim Ferriss recommend in his great book, The Four Hour Body, to be good six days a week, then one day a week have a “DGW”…diet gone wild!  This will allow you to not feel deprived, stay true to the nutrition program the other six days, and tell your body you are not starving so keep loosing weight.  On this cheat day (the DGW) I truly believe that Hostess does not make a bad product ( especially their cupcakes).  If you only cheat on one day a week, it really doesn’t seem to wreck a weight loss program. Provided you are good the other six days a week. 

        So if you want to get to your ideal weight my mantra to my patients is to “Say NO to Dough”! but cheat once a week to stay sane.  This is a great way to get lean.   (And beware of waitress baring gifts…like bread!)

Colon Cancer Kills, here’s how to beat it

With guys especially, there are certain sensitive areas of the body.  Unfortunately, the large intestine known as the colon is an area that causes  many  cancers.  Cancer is a very scary word.  According to Dr. Agus in his new book, End of Illness, someone does not so much “have cancer” as the person’s body is “cancering”.   The normal tissues of the body go rogue and start growing in a dangerous way.  Since this takes some time, the sooner any cancer is picked up, the greater the chance to cure it.  One step better is to get rid of abnormal tissue before it changes into cancer.  Colon polyps almost always change to colon cancer. By taking out polyps in the colon you prevent (not just cure) cancer.  Colon cancer is especially common after the age of 50 years old.   Also, any bleeding from that area can also be a sign of early cancer.  To get your colon checked requires looking up the colon with a camera scope appley  called a colonoscopy.  They put you to sleep to check the colon and also will take out any polyps that they find. Early screening is best. Below are the top ten reasons to get screened:

10.   You enjoy getting your picture taken!-why not see if this Really Is Your Good End?

9. You heard about the prep-a perfect time to contemplate that bathroom renovation!

8.  Your over 50. or you have a family history. It’s Time!

7.  Colon  cancer  is  the second deadliest cancer, so you’re taking a stand to fight it.

6.  You got over juvenile phobias by the age of 12-Your’re ready to start acting like a grown up.

5.  Doctors recommend this method way more than “Just waiting to see what happens”.

4.  You’ve had symptoms and decided that embarrassment is not an excuse.

3.   You’d actually like to be around to see your grandkids.

2.   If something is found during your screening, it can be removed during the procedure.

and the number 1 reason to get screened is…’s your best chance to stop colon cancer before it stops you.

No butts about it.  Colonoscopy saves lives.

Motion is Medicine, especially for men

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease”.
~Thomas Edison

There is something magical about motion (walking,running, cycling, swimming,etc) .  We adults like to think we know more than kids.  We have our important things to do and even spend many hours essentially motionless in our work and daily activities.  Children, if left to themselves, move for the sake of moving. There is much to be learned from the young.

Currently the bane of modern health is a term called, “Cardiometabolic Syndrome”. In brief, it is the epidemic of obesity, diabetes, heart disease and strokes. Over half of all adults will die of heart disease. In spite of all our diet foods, artificial sweeteners and spending billions on healthcare, the increasing rate of cardiometabolic syndrome is dramatic.

Part of the cure for all this is motion.  We try to complicate it by calling it exercise, aerobics, plates, crossfit, etc.  But to our bodies, motion is truly medicine. The newest research brings us back to what every grade school child knows instinctively, recess is wonderful!

Let’s start with arthritis: As many of us over 50 years old know, “Arthur-itis” likes to visit first thing in the morning. The pain keeps us up at night and makes it hard to get going in the morning.  The problem is in the cushioning of our joints called cartilage. It is usually a white, firm, smooth substance that is also what makes up the structure of the tops of our ears.  Cartilage is white because it does not get it’s nutrition from blood but from something called, imbibement.  The best way to explain it is to think of a two inch sponge sitting in one inch of water.  If the sponge does not get squished or massaged, the top of the sponge will dry out and become brittle and flake off. This is what happens to our cartilage when we don”t use it. I have patients say, “I don’t understand why I have osteoarthritis, I just sit on the couch”. I have to tactfully inform them that the reason they have osteoarthritis is BECAUSE they sit on the couch.

You see, our joints are self-lubricating. That is to say, motion is lotion to our joints. Gentle, continuous motion will keep the cartilage (think sponge) moist, supple and smooth.  While hitting the sponge with a sledge hammer will get the fluid/water to move into the sponge, it beats up and destroys the sponge. This is what jogging to lose weight does. As we age and become above our ideal weight, it is not good for our cartilage to run/jog to get into shape. In fact, I turn it around for my patients and say,” you need to be in shape to run when you’re older”.  It is not fair to our cartilage to pound on it like the sledge hammer.  While it is America, and we can do anything we want… just because you can take the pain, does not mean it is good for you. While running/jogging can be good for your heart/engine, it beats up the wheels if we are over our ideal weight.

But I thought you said motion is good? It is, but “pain is a blessing” in terms of damage to our knees, hips and other joints. If you ignore pain, it is like ignoring the red light on our car’s dash board. Oh, you could but a piece of tape over the red light, but the car will suffer. Just like you could take a pill to mask the pain in your knees and run the marathon, ultimately your knees will suffer.  So, what kind of motion is good for my heart and my joints?  In my opinion, some form of cycling seems to be best. Having run six marathons (with 3 hours 5 min PR), I had to undergo arthroscopic surgery in both knees and cannot run even a mile now. But, I can ride over a hundred miles on my bike. For most of us, we can only run until we are into our forties, but frankly, we can ride until we are 100 years old.

Cycling, both indoor and/or outdoors is wonderful for cartilage. In my exam rooms, where I see many patients everyday complaining of severe, constant pain to their joints—especially their knees and hips—I have several river rocks on the counters. You know what “river rocks” are; they are the rocks people love to place in their gardens because they are smooth and round and pretty. But how did they get like that? Did someone take a grinder to each one (read, arthroscopic surgery)? No. They gently tumbled down the river, becoming amazingly smooth just by spinning in the water. In essence, a well fitted bike will do the same thing to your knees and hips. By spinning on a bike, gently smoothing and massaging your cartilage, it gives nutrition to the cartilage and mechanically smooths the surface eliminating most, if not all, the popping and snapping most people have in their knees. In short, cycling IS surgery.

So, for your cartilage sake, for your hearts sake and even for your mind’s sake, gentle motion is just want the doctor(this doctor) orders!


Why Men Die Younger than women

Except for birds, it has said that all male species die sooner than women.  It was noted as far back as 1750 that woman lived longer than men. Why is this? There are many theories. A trend in nature seems to be that larger animals, in general, do not live as long as smaller animals. In my medical practice we note that there are some old guys and some large guys but there seems to be few old-large guys.  If men want to live  long, fun lives the mantra to follow is “lean-fit-flexible”.  Put in a more practical term I tell them to be more like “Lance than Arnold”.ie  more endurance type activity versus only performing heavy resistance training. In a perfect world men do both cardio and resistence training. Cardio for the heart and head, the resistence exercise for bones and muscles.  There is something almost magical about an hour of cardio-type exercise everyday.  The NFL has a program for kids that is called “Play 60”, meaning every child should attempt to get 60 minutes of exercise a day.  I think this applies to adults as well, especially guys.

Besides body size, men die younger than women of just about all diseases. The latest data from the Center for Disease and Control (commonly known as the CDC) has women living at least five years longer than men in the United States.  Just about everyone has an opinion for this phenomenon .  Men seem to take more risks, especially when they are younger. When you search on youtube to see why men die before women there are some pretty funny video clips offered :

My contention for another reason why men die sooner than woman has to do with access to appropriate medical care.  Prevention is better than treatment.  I think a first step is for guys, especially after the age of forty years  to see a doctor or other health care professional yearly.  The “big three” that kills men is heart disease, cancers and stroke.  These are preventable.  Unfortunately most guys are reluctant to see a doc.  I think this contributes to their early death rate compared with women.  Using business terms, what get measured gets managed.  Guys love data so getting checked will let them know their own personal medical “scoreboard”.  Once they know the right numbers (blood pressure, weight, cholesterol, psa etc) to check they have a better chance to be successful.  In this case, knowledge can be power in the health battle.

Men are symptom minimizers

Men are tough.  They pride themselves in doing their job well and don’t complain. We doctors call them ” symptom minimizers”, meaning that they attempt to lessen any pain they have.  At an early age they are encouraged to be tough and then are usually given the best sports medicine advice in the history of sports medicine advice.  When they are injured playing sports, all of their buddies and coaches say, almost in unison these three exact words, ” Walk It Off”.  Yeah, get up, brush yourself off the limp/walk on the injury until it feels better. For minor ankle and knee sprains this sometimes works, but for heart,head and more serious illnesses this universal advice fails miserably.

When guys are young and feel bulletproof they can get away with minimal health care. In most high schools, if a guy plays sports they are required to have an annual preparticipation sports physical exam. This sports “physical” is really just a  “screening” examination for various diseases that could but them at risk if they play sports.   It really is not a preventive medical examination.  Decades ago the pre-sports test was very superficial.   Of note, the latest preparticipation physical exams are getting more in dept and this year we will perform 12 lead ECG’s on all high school athletes that agree to have this performed.  For many men, this is their last physical exam until they get a serious problem later in life.

Given all the different pains that a guy could suffer when should he actually see a doctor?  Especially as a guy nears the age of 40 years old, certain pains need to see doctor. Chest pain is a very important symptom to get checked out.   Especially if a guy has a family history of heart disease, any chest pain should be taken seriously.   Chest pains can be a sign that the heart is not getting enough blood flow due to a blockage to the blood vessels to the heart.  It should be noted that the pains in the chest associated with heart disease is difficult for the patient to describe. In fact,  a common first response to heart disease chest pain is denial of the pain by the patient. We quip that “de-nial” is not just a “river in Egypt”. (yes, doctors are horrible with puns).   Chest pain is not to be taken lightly and is not the time to try tough it out.  Unfortunately, it seems the the toughest of men are the ones who get early heart disease.

Men Die Young, Women Don’t Care: Introduction

Hello and welcome to  the Men Die Young Blog.  As a family and sports medicine doctor in southern california I take care of many types of patients.  While I like to treat illness I think it is far better to prevent disease and death if possible.  One segment of the population that I feel is woefully under treated and at risk for disease are men.   As almost everyone knows, men don’t live as long as women.   In my practice I see many middle-aged men (I use 40 years + as my start of middle age…harsh but true) that show up with advanced disease and when I ask when their last physical exam was, many times it was way back in high school over 20 years ago.

Women do a better job of going to the doctors and getting preventive care.  For various reasons, they usually get almost annual check ups.  I think this is a significant reason they live longer.  Guys are guys. We are told at an early age, especially if you played any sports to:  not complain, suck-it-up, do-your-job and don’t be a wimp.   Men don’t like going to the doctors, so they don’t.  I think this is significant reason they don’t live as long as women.

What strikes me funny is that while, essentially, everyone knows that men die young, there just doesn’t seem to be any alarm about this.  I kiddingly think that if women died younger than men that women would do something about it. There would most likely be an Avon-type fund raiser walk that would be promoted, a special colored ribbon to wear and maybe, if Oprah was still on TV, that she would do a special about how women need as good a medical care as men so they would live as long.  Guys die younger than women and frankly even the guys don’t seem alarmed.

While I am a big advocate to excellent healthcare for women, I do think that there should be some movement to get guys to start getting annual physical exams after the age of forty years old to minimize the risk of heart disease, cancers and stroke.  It breaks my heart when you hear of another middle aged man dying suddenly of a heart attack or getting an essentially preventable cancer.   While there has been some improvement in cardiovascular disease treatment, there is much work to be done.

While guys don’t want to go to the doctors, because I specialize in primary care sports medicine, they will see me without a stigma.  Since I am board certified in both sports medicine and family medicine, I wear two hats and “sneak in” preventive primary care medicine whenever I see a man for his latest injury as a weekend warrior.  There are gynecologist for women but there are no “guyologist” for men. I consider myself a “guyologist”.  My hope for this book is to break down the barriers to care for guys.  I am obviously kidding when I say that women don’t care. We have a rule in the locker room that we can tease about stuff that is not more than 10% true. So women really do care, but sometimes it doesn’t seem like they do.  Guys are even worse.

So the first step to solving a problem is always recognizing that there is a problem.  I think we as doctors need to do a better job at meeting the needs of men who are at significant risk for heart disease, cancer and stroke. The best way to treat disease is to prevent disease and do it in away that encouraged men to become lean,fit and flexible.

Gerardo “Jerry” Hizon,MD,