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Arthritis Podcast

  • DONEE PATTERSON, MD: Good afternoon. I am Dr. Donee Patterson from Einstein Healthcare Network and I am filling in for the lovely and intelligent Sara Lomax-Reese in her absence. I feel blessed and honored to be doing what I love most, which is health education and talking about making our communities healthier. I hope you will stay tuned as we convene for our bimonthly Einstein Healthcare medical segment. Today we will be talking about joint health because joint health is a widespread public concern. Some estimates say that over 40 million people are affected by arthritis in the U.S. today. This is something that typically affects people as they get older, but even can affect children. The CDC, the Center for Disease Control, estimates that about 300,000 U.S. children under the age of 18 are being diagnosed with some type of arthritis as well. Chances are, with 40 million people having arthritis in the U.S., that you or someone you know has arthritis. We will be exploring what arthritis is and the different types and how to recognize it. Of course, I would be untrue to myself if we didn't talk about some preventative measures. We will also have an Einstein orthopedic expert, Dr. Richard Grant, who will join us today, and then for the second half of the show we will be discussing cigarette usage. If we know that four of the five leading causes of death are related to cigarette smoking, then why would anyone continue to smoke? We want to explore this. We want to hear what you have to say. Make sure you tune in to us. You can stream online to www.900amwurd.com or you can download the WURD app. We want to hear what you have to say. Do we have our caller on the line? We have our guest, Dr. Richard Grant. Hello!

    RICHARD GRANT, MD: Hi! How are you? 

    PATTERSON: Hello, hello. So where are you joining us from? Tell us.

    GRANT: I am joining you from Cleveland, Ohio. I just finished a clinic there and you know as clinics go, sometimes the clinics run a little bit longer then you would like, but I am here and ready and prepared and looking forward to our discussion.

    PATTERSON: Awesome. Dr. Richard Grant is a prominent orthopedic physician and he is relatively new to Einstein. We are looking forward to spending more time with him and we are here talking about joint health. We know that millions of people are affected by arthritis, but I just want to explain to people what arthritis is in general, but I am going to back up and I am just going to give a little disclosure. I want to let people know that I have no ties to any pharmaceutical company. I am not being paid by anyone to discuss or advertise or solicit any medication at all. In fact, we just want to talk about arthritis and what it is and how to recognize it and some preventative measures and then if we get to it we will talk about some of the general treatments, but I just wanted people to know that. So let's go back. The word arthritis in general means joint inflammation and it is just a general term of a multitude of different disorders that mean joint inflammation and usually there is some type of pain or stiffness associated with it. Dr. Richard Grant, can you explain to our listeners the difference between the most common causes of arthritis, which are osteoarthritis and rheumatoid arthritis?

    GRANT: Yes. Osteoarthritis has everything to do with the loss of cartilage at the end of the bones. I have been seeing patients with arthritis since about 1980 or so. I have been operating on patients with arthritis and taking care of patients who do not need surgery, but need recommendations. I tell them that if you look at the end of a bone, almost any bone, even a chicken bone, and you see that protective cartilage or gristle as we used to call it as kids, that's what protects our joints. It is a shock absorber. It's live tissue and it remodels to some extent, but it can also break down. When it breaks down, and we end up with walking bone on bone, the bone underneath the cartilage at the joint is no longer protected and we find that for some reason plain run of the mill osteoarthritis runs in family. So that if one family member has it to the extent that they have arthritis requiring joint replacement, there is about a 37 percent chance that other members of the family will need that, but let's contrast that to rheumatoid arthritis. Rheumatoid arthritis is really a disease of the immune system, what we call autoimmune diseases where the immune system for some reason recognizes parts of the joint, the covering of the joint, the end of a joint as being formed material and for some reason it develops antibodies against that cartilage and it starts to attack it and to break it down and that's what gives people with rheumatoid arthritis the disease that they have. It can be very crippling. Unfortunately, as opposed to osteoarthritis, rather then it affecting just one joint, like left knee or right knee, it usually affects all the joints of the body where that same type of cartilage is present and we have a lot of joints that have articular cartilage. 

    PATTERSON: I want people to understand that there are multiple different types of arthritis. There's osteoarthritis where that break pad, as you were describing, the break pad between the joints wears down and rheumatoid arthritis, that is more so an immune response that's attacking our body, but there is also gouty arthritis and there is psoriatic, so people who have psoriasis, they are more likely to get arthritis and there is a fancy one called ankylosing spondylitis that affects younger males more often, but you can also get an infectious type of arthritis, like Lyme disease. So if people have multiple exposures to Lyme they can actually get a Lyme arthritis. I just want to make sure that people understand that you can get multiple ones, multiple types of these arthritis at one time. Do you see that in your experience?

    GRANT: Well, we do. Every once in a while if we are in an area where there's ticks and deer ticks, we will see the Lyme disease process where patients will get that sort of bulls eye lesion. Often they will go undiagnosed because a lot of times they say that the diagnosis you never make is the one that you don’t think of and if you don’t see Lyme disease that often you will miss it. For ankylosing spondylitis, we have patients who develop ankylosing spondylitis, but usually those patients will be referred into us by rheumatologists because they'll develop stiffness in every joint and then for the gouty arthritis I see a lot of patients with gouty arthritis that come into the office. Usually with gouty arthritis it is a problem of they're not taking their medication, their gout not being under control. Once they are on a medicine to control the production of uric acid, usually they will get better, will not require much in the way of orthopedic treatment, but more in the way of internal medicine treatment and care as far as regulating their medications and monitoring their uric acid levels. The other one that we often see, the other type of arthritis, is post-traumatic arthritis, where young people will have injuries to their joints when they're playing sports as young people, motorcycle accidents, car accidents, where there is actually damage to the articular cartilage and that comes back to haunt them maybe five, ten years later down the line. 

    PATTERSON: Right. My claim to fame as a family doctor is prevention. In conditions like heart disease and stroke and diabetes we strongly emphasize that people do things to prevent these conditions from even happening or getting worse. Do you think that early prevention is important in a diagnosis of osteoarthritis and rheumatoid arthritis?

    GRANT: Well I think it is becoming even more important now then it has ever been because one of the things that we are seeing in orthopedics, I think we are seeing it throughout the country, is that there is direct correlation between obesity, lack of exercise and the development of arthritis. We have noted that if your body mass index is very, very high, well into the 40s, we are even seeing some patients now with a BMI of 50, just a measurement between the height and the mass. Patients who are overweight have about a 61 percent increased risk for development of arthritis. 

    PATTERSON: Wow.

    GRANT: Versus patients who are 30 percent at risk, but they have a normal weight. Individuals who do not exercise have weaker muscles on either sides of the joints and I tell my patients, you have to kind of think of your muscles as being springs on either side of your joints because when we are walking, since we are bipedal, we see about three to five times body weight going through our joints as we walk. If you gain ten pounds you see 30 pounds more going to that knee or that hip when you are walking. I think that we can't ignore the fact that obesity contributes to arthritis. In addition to trauma, in addition to the kind of things that we talked about, immune system issues, ankylosing spondylitis, or gouty arthritis, these are all things that contribute to arthritis.

    PATTERSON: Right. So I don’t know what the weather is where you are, but where we are it is pretty wet and damp and rainy and so many people swear that weather affects their arthritis. What do you think about that theory?

    GRANT: I think there is a lot to that and it is funny that you would mention that because you know when, you know, your grandmother when you were a kid growing up would say, you know it is going to rain? Well, how do you know that grandmother? Oh, I can feel it at my joints. There is scientific evidence that we have these pressure receptors in our bones and our bones are very, very sensitive to pressure. Bones that are inflamed tend to be a little more sensitive with respect to pressure changes. People who have severe arthritis can determine whether or not a weather front comes in. If the weatherman has it wrong on television you can always check with your grandmother because there is truth to that.

    PATTERSON: I love it. I love it. So it is known that cartilage doesn’t show up on plain x-rays. 

    GRANT: Yes.

    PATTERSON: How do you use x-rays in help treating arthritis?

    GRANT: I think you always want to start with an x-ray, but I think more importantly you really want to sit down and talk to your patients about what kind of symptoms they've been having, what they've been experiencing, and what hurts them and where.

    PATTERSON: Sure.

    GRANT: What the x-ray does and how the x-ray helps us, it helps us to determine whether or not a patient actually has an angular deformity of their joints because a lot of the patients that I see will either be bowlegged or knock-kneed. If the patient is bowlegged or knock-knee what happens there unfortunately is that the pressure that is normally distributed throughout the joint over a wider surface is now…

    PATTERSON: Did we lose you? We lost him. He will call us back. So we were just talking to Dr. Richard Grant who is a new, one of Einstein's new orthopedic specialists. I am Dr. Donee Patterson from Einstein Healthcare Network and today we are talking about joint health. You can listen, you can stream live on www.900amwurd.com or you can download the WURD app. Do we have Dr. Richard Grant back 

    GRANT: I am back on. Can you hear me?

    PATTERSON: We sure can. We were talking about x-rays.

    GRANT: Yeah, we were talking about x-rays and all I was trying to say was that the history is important, talking to the patient, but with x-ray we can determine whether or not someone is predisposed to have osteoarthritis or degenerative arthritis and a lot of the has to do with the fact that there can be angular deformities. The person can have what we call Genu Varum or Genu Valgum and really for the knees we call that being knock-knee. So it is important to get the x-rays to look at the hip, the knee, or whatever the joint is that you are looking at because you may not be able to see cartilage because the x-rays travel right through the cartilage itself, but bounces off of the bone, but you can see where there is a closer distance between the two ends of the bone and there are things called bone spurs, which patients are always worried about. The bone spurs don’t really cause you any problem. They are just an indication that your joint is overloaded and the bone is reacting to it, but if we really want to then go further, after we've gotten that basic test of the plain x-ray, then the next thing we will do is we will get what's called a magnetic resonance imaging study.

    PATTERSON: Which is also known as an MRI. I think people might know that name.

    GRANT: MRI, so a lot of patients will say, well, the doctor ordered an MRI, I wonder why he did that. Well, he did that because he is looking for one or two things. Sometimes you can have areas of the cartilage that are gauged out and I tell patients, I said, your cartilage is sort of like a nice street that's been blacktopped and then you have a tough winter and then you wear potholes in it and the potholes go down into the ground.

    PATTERSON: Right, right.

    GRANT: Well, that's the same kind of thing that happens to our gristle or articular cartilage, but in addition to that, what we also look for is sometimes you will have an associated torn meniscus, which is an additional shock absorber in the knee. The knee is so complex that sometimes you need to have an MRI to determine what the pain generator is.

    PATTERSON: You had mentioned about being bowlegged or knock-kneed and many children that we see have that. Do you recommend aggressive treatment of that or reversal or just to let the child grow as they normally would grow?

    GRANT: I would first recommend careful observation, careful observation because what you don’t want to do is miss the time when you might need to have a critical surgical intervention or a progressive bracing program. Now it is true that when kids are born and they first start walking, they are a little bit swayed back, potbellied, and pigeon toed and that gives them better balance because if you stick your belly out and you walk pigeon toed and you increase the curvature of your back it gives you a better center of gravity so kids tend to do this a little bit. By the time they hit age 2, 3, and 4, their legs should be straightening out, and you don’t wan to miss something like Blount's disease where you have a kid that may have severe bowing, and there's things that can be done with bracing, weight loss, sometimes just surgical intervention. I don’t want to work through it. I think they should be followed by pediatric orthopedists. That orthopedist can get periodic x-rays and determine whether or not some sort of critical intervention needs to be done and you don’t want to miss that period of time. 

    PATTERSON: Got it. Got it. So we have a couple of minutes, maybe two, three more minutes before our first break and I am sure a lot of the listeners are wondering about supplements like glucosamine and vitamin D supplements. Do you have an opinion about that?

    GRANT: I think since I have been in Cleveland, where you can have long winters, grey periods, and same thing in Chicago and a lot of the midwest, what happens is that we are deprived of vitamin D and vitamin D really comes from exposure to the sunshine. That sunlight helps us to make vitamin D. We can create our own vitamin D, but then there is such a thing as vitamin D supplements. In the area where I am now in Cleveland there is about a 30 percent chance that your vitamin D levels could be low. Why is that important? To a lot of people it doesn’t make any difference, but to the general population, especially as you get older, you need vitamin D to be able to get calcium to go from the intestines into the bone. I think of it as a transport or a bus or a train. 

    PATTERSON: Right.

    GRANT: If you don’t have normal vitamin D levels you are not an efficient carrier or transporter of your calcium. At one time we used to recommend that once women hit menopause they should be taking a huge amount of calcium. I think the Institute of Medicine has come back and said no, those studies weren’t that good, why don’t you put more of an emphasis on vitamin D because we need an efficient transport of calcium. I think vitamin D and calcium is important. Those who are worried about that, they can go to their doctor and get them to draw a serum vitamin D level because vitamin D of course is stored in your fat stores, but more importantly, there should be a good combination lifetime for calcium and vitamin D intake. Exercise is also very, very important. Supplements like chondroitin sulfate and glucosamine, they have been around for a long time. The patients probably know more about it then the doctors because we are not really sure how it works or what it does. We know that glucosamine and chondroitin sulfate is essential to the nutritional support of cartilage. You get some of that in your diet, but if you feel like you need more you can take it, but make sure you get a high quality. 

    PATTERSON: Exactly.

    GRANT: A high quality drug. Don’t go getting the cheapest thing. Don't go get the most expensive thing. Get something that's tried and proven, not taken off the shelves. Get it from a good chain, a dependable chain that you know is accountable and then use it. Think of it not as a strict medicine like Motrin or Nuprin or something like that. Think of it more of a nutritional supplement. You are supporting your cartilage by taking this additional huge molecule that supports the collagen.

    PATTERSON: Exactly. We are about to take a break. If you could hold for us, Dr. Richard Grant, we will come back on the other side. This is WURD AM talk radio here in Philadelphia. You can access us on the air, online and in the community. And we are back. I am Dr. Donee Patterson from Einstein Healthcare Network filling in for the lovely and beautiful Sara Lomax-Reese in her absence. So we are talking today with another Einstein expert, Dr. Richard Grant, who is an orthopedic surgeon and we are talking about joint health today. I do want you to know that you can call in. The local number is 215-634-8065. Our toll free number is 1-886-361-0900 and you can listen or stream online at www.900amwurd.com. We have a caller. How are you doing, KG, from West Oak Lane?

    KG: Hi. 

    PATTERSON: You had a question?

    KG: Yeah, I have a question regarding the calcium. I know I have some spots on my body and we do the biopsy and they say it's a deposit of calcium. I want to know how that happened and with that situation now I am scared to take calcium. What is recommended for me?

    PATTERSON: So that is a good question. A lot of times when women get mammograms what we will see on the mammograms are clusters of calcification and we get concerned about that because it could be an indication that there is cancer and those actual clusters of calcification have to be removed and biopsied and evaluated further. It is an awesome question because women often wonder is it the calcium that I am taking. Is it the supplements that I am taking that are making these changes? You need to directly talk to your physician about how much calcium is on your blood. They will do a blood test and see how much calcium is in their blood and each person needs to be taken as an individual and your calcium needs to be adjusted. Please see your doctor about how much calcium you need to be taking. Also while we are on the subject, there are people who have kidney stones, who they just make kidney stones and a large percentage, about 50 percent of people who get kidney stones, their stones will be calcium stones. Those people need to adjust how much calcium they get in their diet as well, but each person needs to be taken as an individual. I think we have another caller. We have Gina from North Philly.

    GINA:  Hi, good afternoon to you.

    PATTERSON: Good afternoon.

    GINA:  I will make this real quick. I am 61. I am postmenopausal. I do have a hip issue, but the orthopedist has told me it is largely due to my overweight. I gained a lot of weight over the winter. However, I have lost a couple of inches in height that I am concerned about and it turns out that one of my hypertension medications may be or is the culprit and I just wanted to alert people. I want to ask the doctor how is that possible. I think they said it depletes the body of calcium. Now I don’t just take calcium, but I get a lot of sunlight, vitamin D, to put the calcium into my body so what happened, how many people know that hypertension medication can deplete the body of calcium and causes a lack of absorption, which caused my decrease in height? I am just really upset. How did I go from 5'4" to 5'2" in like two years? I am so upset.

    PATTERSON: That's another great question. Everything in medicine is risk versus benefit and so as physicians we never want to, you know, our motto is first do no harm. We never want to give anything that's harmful, but if you will remember the number one killer of all Americans, no matter what age, it does depend on age, but no matter what race or what sex, is heart disease and so high blood pressure is a risk factor for that so it is very important for us to make sure that your blood pressures are well-controlled. With that said, it is not necessarily, and I don’t know your exact medicines, you might want to tell us, with that said it is not the exact, any medication at all or any supplements or even vitamins over the counter, or even herbal things over the counter can decrease your absorption to calcium, not everything but several things do. It decreases your amount of calcium so if you are not getting a good amount of calcium then your body does not hold onto it as well so this is a lesson for us all. We need to tell our teen girls and our nieces and our daughters that are in their 20s and 30s, make sure you are getting adequate amount of calcium now so that when our bodies start to change and go onto menopause that we have strong foundations. The average amount of calcium that we should be getting on a daily basis and it is different for different people, but on an average it is about 1200 milligrams of calcium a day and pregnant women need much more calcium in their bodies. If all of us have been taking our calciums regularly, then the medication doesn’t have the effect to lose weight. Make sure that you are on bone preserving medication so that you preserve the height that you have now. Talk to your doctor about getting a bone density test. It is an x-ray that tells you if you have lost some mass in your bones and there are things that you can do to help prevent more bone loss. Thank you, Gina. Thank you for your call.

    GRANT: I especially would endorse that bone densitometry study, too. I think that should be done periodically, especially if you are worried about losing weight, I mean losing height. Losing height may be indicative of osteoporosis that's progressive that needs to be addressed. 

    PATTERSON: All menopausal women, all women who are no longer menstruating and girls who aren't menstruating because perhaps they have an eating disorder or they're an athlete and their periods have stopped, they do need to have bone density tests and it's an x-ray and you should talk to your doctor about and while we are on the same lines, if your doctor has not checked your vitamin D level, those are for women who are premenopausal, so their menses are slowing down or they are full blown menopause, they should ask their doctor to have their vitamin D level checked as well. I think we have another caller. We have Roger from Cheltenham.

    ROGER: I have a question about the rotator cuff. That's a joint, too. 

    PATTERSON: Yep, it sure is.

    ROGER:  In the rotator cuff, I had surgery on the rotator cuff that I tore and it was repaired quite successfully. Then I ended up having a minor tear on the opposite side and I guess to my knowledge they had to change it. I know one time a doc was telling me in order to repair a rotator cuff, even if it's a minor tear, they have to retear it and then reset it again. Is that still pretty much the case or has there been new technology involved in rotator cuff repair when there is a minor - and also a lot of times rehabilitation is also sought for minor tear, too. I just wanted to get your opinion on that.

    PATTERSON: Dr. Grant?

    GRANT: Yeah, sure, the rotator cuff tear is taking up a lot more of our thought processes as we are developing more specialists in the area of sports medicine because we have people who actually do their residency training and then go out and take special training and we actually have some people who do shoulder all year round and that's all that they concentrate on. We are seeing there are a lot more papers published on this. Usually what happens with rotator cuff is the tissue, as it gets older, has more of a tendency to tear. For a small tear most of the sports medicine guys usually recommend rehabilitation because the mechanics of the shoulder are still pretty efficient even if you have a small tear. I think what the philosophy is is that you try to rehab the muscles around the shoulder first, make them stronger, and that may help you to avoid an operation. If the tear gets to be too big, then the shoulder gets to be less efficient in terms of doing overhead work or playing overhead sports like we see with pitchers or someone who is a football enthusiast and may be a quarterback, but as far as the business about retearing it, I think what they may be speaking about is rather then retearing it, what they may do is they may remove parts of the tissue that are old and damaged and you can't get a stitch in those tissues and so you are trying to get to new stronger tissue where you can do a better repair. I think that's probably the concept as opposed to just retearing it. Does that make sense?

    PATTERSON: I think we lost Roger.

    GRANT: We lost Roger? After all that?

    PATTERSON: After all that, but I think that was a good answer, thank you. I think we also have Mike from Norristown.

    MIKE: Yes, Dr. Donee, how are you?

    PATTERSON: Hello, Mike.

    MIKE: I just wanted to call in and just send our support and just tell you you are doing such a great, phenomenal job today hosting this show. I just wanted to send support from your Tabernacle family. That's all. 

    PATTERSON: Thanks so much, Mike. Thank you.

    MIKE: You are so welcome. Have a good day.

    PATTERSON: You too. You too. I think we have another caller. We have Derek from Chestnut Hill. 

    DEREK: How you doing this afternoon?

    PATTERSON: Great. How are you?

    DEREK: I am maintaining, maintaining, good health. That's my goal. 

    PATTERSON: Awesome. You had a question for us?

    DEREK: I have two questions. How important is vitamin D for males and also how would a doctor feel about One A Day over 50? I am over 50 and I want to get into a good vitamin, but like you said, not too expensive, not too cheap, or something that's stood the test of time, I guess. What do you think about One A Day?

    PATTERSON: Dr. Grant?

    GRANT: Yeah, I don’t have any problem with One A Day. I really don’t. I think that some of us take things on a daily basis. I have a tendency to take the medicine that the doctor ordered for me. High cholesterol runs in our family so I take my Lipitor. I am convinced that baby aspirin is protective for adults so I take that and I usually take at least one multivitamin per week. Now I may not take it per day, I may take it per week. Couple things there. Vitamin D is important for males because even though males will lose less bone mass as they become adults compared to women because women have to deal with menopause, males can still have fragile bones. I have seen some males come into the emergency room with broken hips in their 80s or 90s and sometimes in their 70s, especially if they're smokers. So males need vitamin D as much as women need vitamin D.

    PATTERSON: Absolutely.

    GRANT: Vitamin D is different though. When you take vitamin B, vitamin B will come out through the kidneys. Vitamin D is stored in your fat stores. To check vitamin D to see if you have adequate vitamin D to make the absorption of calcium efficient, usually the doctor has to draw blood on you and check your serum levels. Our physiology, male physiology and female physiology, when it comes to vitamin D, is the same. I have never heard of anybody say vitamin D is handled differently in males then it is in females. So it is essential for both. If you do take a multivitamin each day and you do well with it. I don’t think that there is any reason to change that. I don’t see that there is any negative impact of that. I agree with your philosophy. Don't go to the most expensive place to get it. Go to some place like a chain of drug stores or grocery stores that have been around for a while and use something that you know that you are going to take on a daily basis and make sure that you check with your doctor to make sure that all of your vitamin levels are where they should be, especially your vitamin D.

    PATTERSON: I just want to add to that that of course diet is the best way to get your nutrients, so from fresh fruits and vegetables, things that are high in calcium and milk products, if some people can drink milk, but also that there are vitamins that you can get an overdose of, that's D, A, K and E. So you don't want to just take all kinds of supplements. I have patients that come in with bags and bags of things and they don’t recognize that there's vitamin D in this and vitamin D in that and vitamin D in this and so you can get an overdose of certain vitamins so be careful. Make sure that your doctor knows everything that you're taking. Bring all of the supplements and everything and then I do want to say about vitamin D, there is some association with vitamin D deficiency and depression. There are some recent studies that show that vitamin D deficiency, these people are getting depressed, so that's one thing that we want to keep in mind for males and females that it actually may give you some energy and it may help a little bit in the treatment of depression or prevention of depression. Do we have time for one more quick caller? We have Beverly from Nicetown. Thank you, Derek, by the way for your call. Beverly?

    BEV: Good afternoon, doctors. Donee, you answered the question I was really so curious why some people are extremely pigeon toed, my daughter in law and my grandson. I thought it was inherited, but you said it was the balance problem. We, as black people, try to make our children walk too early. I thought that might've been the cause of it, but what you said if the parent could recognize the problem the parent could prevent or do some steps to prevent the pigeon toed? I don’t think…

    GRANT: My point was that sometimes when kids are starting to walk they do everything they can to maintain their balance and not fall. They'll assume the best position to help them to move about efficiently without falling and that is the position that they start out with and then eventually their legs straighten out and they should come back to a normal straight leg with just a little bit of knock knee. Most of the normal population is about maybe three degrees knock kneed. 

    PATTERSON: Awesome. Did that answer your question, Beverly? Thank you so much for your call.

    BEV: Thank you.

    PATTERSON: I think that we are at a break and I just want to end this conversation by thanking Dr. Richard Grant who is calling us from Ohio, just to thank you so much for your time. We know that your time is valuable.

    GRANT: Thank you.

    PATTERSON: I really hope that the WURD listeners got some great information and stay tuned because on the end of this break we are going to talk about the hot topic of tobacco here in the U.S. and what we can do to be healthier. Thank you, Dr. Grant.

    GRANT: Thank you so much and I will see you at Elkins Park soon.

    PATTERSON: Okay. Listen, you can follow me on Twitter @DrDonee and you can also stream live, www.900amwurd.com. Hello again. This is Dr. Donee Patterson from Einstein Healthcare Network here in Philadelphia and I am filling in for the wonderful Sara Lomax-Reese. We are going to switch gears right now and talk about tobacco use and how it affects our health and our community. I just want to thank the people that are sending me messages on Twitter and sending me texts. They are telling me they are getting great feedback about vitamins and bone health. Hopefully you will tune in and get more information about smoking. We would love to hear your comments on Einstein's Facebook page. That is www.facebook.com/einsteinhealth or you can follow me at Twitter @DrDonee. I send out free health tips every day on Twitter so join me on Twitter. Let's talk about tobacco. One study examined all the counties in PA and it ranked Philadelphia the least healthiest county. I believe it was something like 37 counties and Philadelphia was 37. It also commented that Philadelphia has higher then average rates of physical inactivity, higher then average rates of obesity, high school dropouts, childhood poverty, and tobacco use. We know that cigarette smoking is the number one cause of preventable, premature disability and death in the U.S. If we know that and we know that four of the five leading causes of death are related to cigarette smoking, why does anyone still smoke? I want to hear from you. I have theories about it, but perhaps someone has ideas about why people, who know the risk factors of smoking, still smoke. We are going to open the lines. The local line is 215-634-8065 and our toll free number is 1-886-361-0900. We are here talking on WURD AM talk radio and I am Dr. Donee from Einstein Healthcare Network. Let's go back. In the U.S. an estimated, almost 50 million people are smokers. That was astounding to me, 50 million people. That number breaks down to be about 25 million men and 23 million women. Over 400,000 smoke related deaths occur every year. That's 150 billion healthcare dollars are spent. That's dollars that we could be using to help save children or to treat breast cancer or do breast cancer research. That's 150 million healthcare dollars. Also, I am interested in knowing if we tell people that smoking can cause cancer and smoking can cause emphysema and chronic bronchitis, why are 50 million people still smoking? We have in a cigarette, there are 4,000 different chemicals and they are chemicals that we know. Not all 4,000, but at least 50 of those chemicals, we know directly can cause cancer. There is carbon monoxide, which if you have high levels of carbon monoxide you can literally kill a person. It is an odorless, colorless gas that has known to kill people in their houses. There's arsenic. There's formaldehyde. Formaldehyde is what we use to embalm dead bodies. There is cyanide that is used. That's the powerful killer that rich men in the past used to put in people's drinks or put in people's foods to take them out. Would you ever lick a bar of cyanide? Would you ever take a little teeny sip of formaldehyde or some arsenic? I say not. So why do people still smoke? I want to hear from you. I want to hear from the smokers. I want to hear from the people who have quit smoking and what they did to stop smoking, I want to hear from the people who are being affected from second hand smoke, all those people, I implore you to call. Locally, we have the number as 215-634-8065 and our toll free number is 1-886-361-0900. Three things I want you to remember today are that there are many reasons for us to quit at any age. You have to decide that it's important for your health and that you don’t want to play with your health and that you want to quit. You have to do it for yourself. That's what I am finding in my patients. They really have to make it up in their mind that this is something that they want to do for themselves. I just need you to think about this. Imagine cancer. Imagine cancer treatment and the copays to go see that doctor and the pain associated with it. Think about your family and what your family would do without you. I want you to imagine these things. The second thing I want you to know is that it really is hard to quit smoking, the average person tries to quit about five to six times before they are successful. You have to know this and you have to plan. Can you think about if you were going to build a house or even change a tire on your car, you have a plan, you have an idea about what you are going to do. You need a plan about when it gets hard or when you are stressed out. You need to know what you would do in that situation. You also need to know that there are common nicotine withdrawal peaks. In the first week that's when the first nicotine withdrawal peak is the highest. You need a plan for that. You need to have a support group. The third thing I want you to know is talk to children and teens about not smoking. Adult intervention has been proven to decrease the risk or decrease the usage of teens and children smoking. So about 90 percent of adult smokers begin smoking as teens or preteens. I want to implore you to talk to your teens or preteens about the hazards of smoking and doing drugs. I want to know. Does it make a difference to you if I told you that within 20 minutes of stop smoking your blood pressure lowers? Does it make a difference if I said within 24 hours your chance of heart attack decreases if you stop smoking and within two to ten weeks your circulation improves and after one year your risk of heart disease drops to that of half of a smoker? I hope that people who are smoking or allowing themselves to be exposed to secondhand smoke, I hope that they really think about this. Maybe cost is the thing that is driving people to not smoke. Somebody call and tell me how much a pack of cigarettes costs today. I think it is about $6. In one week, if you smoke a pack a day, and cigarettes are $6, in one week you save $42. I don’t know about you, but I can figure out something to do with $42. In a month you save $180. In a year you save $2200. In ten years you save $29,000. In 20 years you save $80,000. So if you have smoked a pack of cigarettes for ten years, you have given the tobacco companies $29,000. I just want you to think about that. We have some callers on the line. We have Barbara from Mount Airy.

    BARB: How are you today?

    PATTERSON: Hi, Barbara, I am great. How are you?

    BARB: Talking about money, it's the almighty dollar. Let's start from the top. The medical society know it. The tobacco company know it because they put ingredients in the cigarettes to make people smoke.

    PATTERSON: Absolutely.

    BARB: So what are we talking about? Where is your government? We are the United States. They don’t give a hoot. All they want is that almighty dollar. I stopped smoking when cigarettes, I think, was about a quarter and that's been a long time ago.

    PATTERSON: That might have been a little bit ago because you're right, I think we are past $6 now. Barbara, thank you so much. I think that you're absolutely right and I appreciate your call because that brings up an awesome point. Nicotine is very addictive and I want to just emphasize that people tell me all the time, Dr. Patterson, why would I ever use the nicotine patch if that's what's already in the cigarette? But the nicotine is not the cancer-causing chemical. The nicotine is what addicts you. There are 400, 500 other cancer-causing chemicals in that cigarette every time you take a puff. So you are absolutely right. Even though our government may be regulating tobacco, smoking, buying a pack of cigarettes, is a choice. That's what you are choosing to spend your money on. I am asking people, begging people, if that's what it takes, to consider stop smoking. Do it for you. Do it for your family. Save that money. Go on a major trip and then send me and Tiff a postcard from somewhere and tell us what you used that money for. We have another caller. We have Donnie from North Philly. How are you doing, Donnie? Did we lose Donnie? 

    DIONE: It's Dione.

    PATTERSON: Dione from North Philly. That's my fault. How are you?

    DIONE: That's okay. Good, good. I smoked, originally I started when I was a teenager in high school some years ago. I quit for a long period of time, then I went through a situation where I was really highly stressed, and started back. This was like two years and as of New Years, I decided that I was going to quit and I did go through the program that you offered, I think it was the city, but anyway where they gave you the patch and counseling. So far I have been smoke-free for six months now. 

    PATTERSON: Awesome. Awesome. Do you miss it?

    DIONE: Yes, sometimes I do. 

    PATTERSON: Okay. What's your plan for if you get stressed out? Do you have a plan?

    DIONE: I still have the patch. In the last six months I only had to put it on once, but what I have been doing is breathing exercises, like simulating, not actually smoking a cigarette, but taking deep breaths. That really helps. The thought only lasts for like a minute. I think about it, okay, I thought about it, now let it go and move on to the next thing.

    PATTERSON: I am so proud of you. I am so proud of you and if it is okay with you I will continue to pray for you and I ask the whole Philadelphia, anyone that's listening, to pray for Dione and we just encourage you. Thank you so much for your call and I encourage you, Dione, to go out and encourage other people that you see that are struggling with stop smoking. I encourage you to go and tell them that it is possible and they're going to be healthier and I am very proud of you. Thanks for calling.

    DIONE: Thank you.

    PATTERSON: I think we have another caller. We have Moe from the Northeast.

    MOE: Hello?

    PATTERSON: Hello, Moe, are you there?

    MOE: I am here. Hi, Dr. Donee. How are you?

    PATTERSON: Hi, Moe. How are you?

    MOE: Good. I am calling in, congratulations, Dione, on your six months of being smoke free.

    PATTERSON: Awesome, yay.

    MOE: I am jealous. It's an addiction. It really is a bad habit and it's like being addicted to caffeine or something like that. 

    PATTERSON: You are absolutely right.

    MOE: I've tried multiple times to quit smoking and levels of stress just send you right back to it. I have tried the patch. I've tried other things. They just don’t work. I am at a loss for what to do. 

    PATTERSON: Listen, I want to encourage you. I think that you're brave and smart for even trying. I encourage you to talk to your doctor. I want you to get a support group, a support network of friends and I really believe that it's possible for you and anyone else who is listening. Most people try about five to six times before they quit and it is very hard. Even heroin users say it is harder to stop smoking, but you can do it. On a final note, I just want to encourage anybody who smokes or anyone who is exposed to secondhand smoke, to stay away from it and I just want everyone to be healthier no matter where you are, you can be happier and healthier. Follow me on Twitter @DrDonee and I just want to thank the listeners of WURD and Sara Lomax-Reese for giving me this opportunity today to speak to you and share some health information. Coming up we have Keeping it Real with Al Sharpton next.