While both traditional, or allopathic, medical schools and osteopathic medical schools provide the same rigorous health education, osteopathic training adds a more holistic, hands-on component involving manipulation of the musculoskeletal system – for instance, the use of stretching and massage to reduce pain or improve mobility.

“These findings offer reassurance to patients by demonstrating that they can expect high-quality care regardless of whether their physicians received their training from allopathic or osteopathic medical schools,” said senior author Dr. Yusuke Tsugawa, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and associate professor of health policy and management at the UCLA Fielding School of Public Health.

The study will be published May 30 in the peer-reviewed Annals of Internal Medicine.

Both types of physicians are licensed to practice medicine in every state. Currently about 90% of practicing physicians hold MD degrees and 10% have DO degrees. But the latter group is rapidly growing due to an increasing number of osteopathic medical schools, with their numbers having swelled by 72% between 2010 and 2020 compared with a 16% increase in MDs during the same period, and their ranks are expected to continue expanding.

In addition, osteopathic physicians are more likely than their MD counterparts to serve patients in rural and underserved areas.

The researchers relied on four data sources: a 20% sample of Medicare fee-for-service beneficiaries, amounting to about 329,500 people aged 65 years and older who were hospitalized between Jan. 1, 2016 and Dec. 31 2019; Medicare Data on Provider Practice and Specialty; a comprehensive physician database assembled by Doximity, and the American Hospital Association’s annual survey on hospital characteristics. Of the patients, 77% were treated by MDs and 23% were treated by DOs.

The researchers found that patient mortality rates were 9.4% among MDs vs. 9.5% among DOs, patient readmission rates were 15.7% vs. 15.6% respectively, healthcare spending was $1004 vs. $1003, and lengths of stay were 4.5 days for both.

The results are similar because both types of medical schools deliver rigorous, standardized medical education and comply with comparable accreditation standards, including four-year curriculums mixing science and clinical rotations, Tsugawa said.

The study does have some limitations, the researchers write, primarily the fact that they focused on elderly Medicare beneficiaries who were hospitalized with medical conditions, so the results may not apply to other population groups. In addition, they limited outcomes to specific measures of care quality and resource use, so these findings may not generalize to other outcomes.

But the findings “should be reassuring for policymakers, medical educators, and patients because they suggest that any differences between allopathic and osteopathic medical schools, either in terms of educational approach or students who enroll, are not associated with differences in quality or costs of care, at least in the inpatient setting,” the researchers write.

Additional study authors are Dr. Atsushi Miyawaki of UCLA and the University of Tokyo; Dr. Anupam Jena of Harvard University, Massachusetts General Hospital and the National Bureau of Economic Research; and Dr. Nate Gross of Doximity.

The study was funded by the National Institutes of Health’s National Institute on Aging (R01AG068633) and the Social Science Research Council.

Make decisions with your doctor that meet your needs.
Discuss risks, benefits, and costs of tests and treatments. Ask about other options and preventive things you can do.
Be sure you are getting the message.
If you have trouble hearing, ask your doctor to face you when talking and to speak louder and more clearly.
Tell the doctor if you feel rushed, worried, or uncomfortable.
You can offer to return for a second visit or follow up by phone or email.
Learn more about communicating with your doctor:
https:/www.nia.nih.gov/health/ doctor-patient-communication.
National Institute on Aging

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States—more than even all types of cancer combined. One of the simplest indicators of a person’s heart health is their cholesterol levels. But what exactly is cholesterol, and what kind of tests are available? Dr. Robert Segal, a board-certified cardiologist and founder of Manhattan Cardiology, has answers to those questions and more.

First and most importantly, what exactly is cholesterol?

“Cholesterol is a natural, waxy substance made by the liver that’s found in most tissues of the body. It has a lot of important uses from digestion to hormone production,” says Segal.

The liver produces enough cholesterol for all of the body’s functional needs, but cholesterol can also be found in many foods. In effect, this dietary cholesterol can lead to having too much cholesterol overall in the body—and in particular in the bloodstream—where it starts to stick together and build up.

“Because of cholesterol’s waxiness, it can stick to the inner walls of arteries. Once that starts, more and more cholesterol tends to build up, narrowing and hardening the arteries. This increases blood pressure, decreases the supply of oxygen to the heart, and can directly cause a heart attack,” says Segal.

There are a few different types of cholesterol that are important to know about.

Low-density lipoprotein (LDL). This is often referred to as “bad” cholesterol or “L” for “lousy”, although the body does need a small amount of LDL cholesterol for normal functioning. Lower LDL levels are associated with lower risk of heart disease and stroke.

High-density lipoprotein (HDL). This is often referred to as “good” cholesterol. HDL cholesterol can collect extra LDL cholesterol and return it to the liver to be broken down and removed from the body. Higher HDL levels are associated with lower risk of heart disease and stroke.

Triglycerides. This is a type of fatty compound the body uses to store extra energy. Triglycerides can be broken down later to release energy, but if the need never arises, the fat continues to build up. Lower levels of triglycerides are generally healthier.

“Often times when someone’s cholesterol levels are too high, there aren’t any noticeable symptoms until they have a heart attack or a stroke. But if someone knows they have high cholesterol, there’s a lot that can be done to lower their risk of those dramatic outcomes. That’s why it’s so important for people to regularly have their cholesterol levels tested. This is generally a simple procedure that can be performed during an annual physical,” says Segal.

There are several types of cholesterol tests available. Some are more generalized, while others have more specific uses.

• Lipid Panel. This very common test can be performed in a doctor’s office and yields results in a couple of days. Blood is drawn and sent to a laboratory for analysis. This type of test typically directly measures total cholesterol, HDL, and triglycerides, and then uses this information to calculate LDL levels.

• HDL-C test. This test is usually ordered as needed as a follow up test to a standard lipid panel. It can show whether HDL levels have gone either up or down since a previous screening.

• LDL-C test. Where a standard lipid panel uses a formula to calculate LDL levels, this test directly measures LDL cholesterol. For people with very high triglyceride levels, this may provide a more accurate assessment of LDL levels.

• Lipoprotein (a) = LpA  The amount of lipoprotein in your blood is determined by a lipoprotein test. You may be at an increased risk for heart disease and stroke if you have a high level of lipoprotein (a). 

• CAC test. A coronary artery calcium score uses a CT scan instead of a blood draw. The scan measures the amount of calcium in the arteries around the heart to determine how much plaque is built up. This type of test can help doctors decide if someone would benefit from taking statins (a type of medication) to lower their cholesterol. The higher the calcium score, the higher risk of heart disease.

“Cholesterol tests are an efficient and effective way to find out if someone’s cholesterol levels are too high. But that information is only useful if some sort of action is taken,” says Segal.

While statins and other medications are one available option, most of the time the most significant long-term benefits can be gained from making lifestyle changes.

A diet low in trans fat and saturated fats, refined sugars, and red meats can help lower cholesterol. These foods can be replaced with fish, fresh vegetables, nuts, legumes, seeds, and whole grains. Regular moderate exercise, healthy sleep habits, managing stress, maintaining a healthy weight, and quitting tobacco products are also all associated with improved heart health.

“The best part is that these options don’t require special equipment or a prescription. They’re simple concepts that most people understand intuitively. Sometimes it’s just about getting back to basics,” said Segal.

Manhattan Cardiology is the premier facility for preventive cardiology treatment in New York. Our cardiologists practice under the guiding principle that early detection is the best form of prevention.  www.manhattancardiology.com

Water plants thoroughly to promote deep drought-tolerant roots that help boost the plants’ pest resistance.  Wait until the top few inches of soil are crumbly and moist before watering most plants. Newly planted perennials, trees, and shrubs need more attention and water than drought-tolerant plants or established ones with more robust root systems that are better able to absorb more moisture. During extended dry periods, even drought-tolerant and established plants may need supplemental water.

Water early in the day to reduce water lost to evaporation. Avoid late evening watering that leaves foliage wet at night, increasing the risk of disease.

Apply water directly to the soil above the plant roots using soaker hoses or drip irrigation whenever possible. Water is applied where needed and the slow, steady flow of water is better able to infiltrate the soil and moisten the roots with less runoff.

Check soil moisture daily in container gardens and several times a week for raised beds. Both dry out more quickly than in-ground gardens and need to be watered more often. Save time and water by incorporating Wild Valley Farms’ wool pellets into the growing mixes. This sustainable product is made from wool waste. University research found it reduced watering by up to 25% and increased air space in the soil, promoting healthy plant growth.

Further conserve water by spreading a two- to three-inch layer of shredded leaves, evergreen needles, or shredded bark mulch over the soil in garden beds and around trees and shrubs. Mulching conserves moisture, keeps roots cooler and moist, and suppresses weeds. As the organic mulch decomposes, it adds nutrients and organic matter to the soil.  Just pull the mulch away from tree trunks, shrub stems, and the crowns of other plants to avoid rot.

Include plants that are more tolerant of the weather conditions in your area. Those that tolerate both heat and cold extremes will thrive with less care once established.

Incorporate organic matter like compost into the soil. It helps the soil accept and retain water so you will need to water less often. It also adds nutrients to the soil so over time you will need to fertilize less often.

Use a low-nitrogen, slow-release fertilizer if your garden plants need a nutrient boost. These types of fertilizers release small amounts of nutrients over an extended period. The low level of nitrogen reduces the risk of damaging heat-stressed plants.

Remove weeds from garden beds and borders as soon as they appear.  These “plants out of place” steal water and nutrients from your desirable garden plants. Plus, many harbor insects and diseases that are harmful to your garden plants.

Provide stressed plants with a bit of shade from the hot afternoon sun. Container gardens can be moved to a more suitable spot during heat waves. Add a bit of temporary shade to garden plants that are struggling to survive in the blazing hot sun. A strategically placed chair, lattice, or umbrella may be all that is needed. As temperatures drop, you can move plants back in place and remove the temporary shade.

Your garden will greatly benefit from these changes to your summer garden care.

Melinda Myers has written more than 20 gardening books, including the recently released Midwest Gardener’s Handbook, 2^nd Edition and Small Space Gardening. She hosts The Great Courses “How to Grow Anything” instant video and DVD series and the nationally syndicated Melinda’s Garden Moment radio program. Myers is a columnist and contributing editor for Birds & Blooms magazine and was commissioned by Wild Valley Farms for her expertise to write this article. Myers’ website is www.MelindaMyers.com.

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Of course, they cannot guarantee you will see Humpback whales, even in season, so think of it as a 3-hour tour with possible benefits (but not as much adventure as Gilligan’s Island–ha ha). I was there in mid-January and the whale pods were everywhere. FYI. You can see the whales spouting from shore and then breaching (rolling) and often with their signature flip of the tail.

The fun of going on a whale watch tour is that you get much closer than on dry land and with a good camera you can catch the tail display. And while the whales might be elusive you are almost guarantee to see Spinner dolphins who glide along the boat’s hull and often back up on their tails like “Flipper” from the mid-1960s TV show. And often you will see bottle nose dolphins as well. You can also catch flying fish schools and the occasional ray sighting.

Our expedition was lucky enough to see several Humpback pods. It was encouraging to see so many returning to Hawaii to spawn. After fertilization from the bull male, the female cow carries the singleton whale for about a full year. And then gives a live birth and also nurses the calf for up to a year. The calf is born swimming. And though they are weak they swim behind their mother’s “slipstream” to keep up. These gentle giants swim in pods. So if you see one spout, there will likely be 5 or 6 more in succession.

I got there early enough to snag the upper-level front row seats on the 65-foot catamaran. The bench seats face backwards toward the stern…but I swung around facing the bow. From that vantage point I was able to see almost all of the sightings.

From the pier and once we cleared the low speed area for the small boats the engines fired up and we went toward the spouting (as in “Thar she blows”). Very happy to find out we were powered by twin Suzuki 350-HP engines and not just sails and oars. Always want a retreat planned in case the Gentle Giants defy their name.

The price was approximately $112 and no there is no senior discount. Why? Because the majority of people with money and time on their hands in the middle of the week are Baby Boomers. I’d guess it was 90% old fogies with sunblock, big hats and of course loud gawdy Hawaiian print shirts. I say the louder the better, in case you go overboard.

Sally Franz and her third husband live on the Olympic Peninsula. She has two daughters, a stepson, and three grandchildren. Sally is the author of several humor books including Scrambled Leggs: A Snarky Tale of Hospital Hooey, The Baby Boomer’s Guide to Menopauseo, and Wired Sal’s Parody Songs and Skits. To see Sally Franz perform these songs, go to her YouTube Channel. And check out her newest book, Wired Sal’s Parody Songs & Skits. YouTube address @SallyFranz: https://www.youtube.com/@SallyFranz

“The body converts food into a kind of sugar called glucose, which then gets released into your bloodstream. The pancreas makes a hormone called insulin that allows your cells to consume the glucose. This is how the body’s cells get energy. But with diabetes, either the insulin isn’t being produced, or the cells aren’t responding to it, so glucose builds up in the bloodstream, and that can lead to major issues,” said Pate.

There are many types of diabetes. Type 1 and type 2 are the most common, with type 2 accounting for about 90% of all diabetes cases and type 1 making up most of the rest. Type 1 is something people are born with and is usually diagnosed by early adulthood. With type 1 diabetes, the body simply stops producing insulin. Type 2 diabetes develops over time. The pancreas still makes insulin, but the cells in the body stop responding to it.

Gestational diabetes is also common. This form of diabetes occurs during pregnancy, and it’s something doctors will be alert for during this time. It usually resolves on its own after childbirth, but not always. Other less common forms of diabetes can include:

• Latent autoimmune diabetes in adults (LUDA, sometimes called type 1.5)
• Maturity-onset diabetes of the young (MODY)
• Diabetes caused by certain medications
• Diabetes caused by other diseases like pancreatitis

“Prediabetes is also a significant form to be aware of. About a third of US adults fall into the prediabetes category, and most don’t know they have it. Having prediabetes means that your blood sugar levels are too high, but are still shy of the requirements for a type 2 diabetes diagnosis. It’s so important to know about this, because this is when it’s still possible to avoid diabetes,” Pate said.

Symptoms of both diabetes and prediabetes can include:

• Being very thirsty or very hungry
• Having to urinate often
• Fatigue
• Blurry vision
• Unexplained weight loss
• Tingling or numbness in the hand or feet
• Frequent infections, including yeast infections
• Having sores that don’t heal or heal very slowly
• Dry skin

However, many people might have diabetes or prediabetes without having any symptoms yet, though complications will eventually become noticeable. For people with an increased risk of diabetes, regular testing of blood sugar levels could help catch this disease early and avoid serious problems.

Type 1 diabetes is more common in people with immediate family members who also have type 1 diabetes. It can occur at any age, but it’s usually diagnosed by early adulthood.

“People are at higher risk of developing type 2 diabetes if they’re overweight, over the age of 45, or have a family history of diabetes. Exercising fewer than 3 times per week also increases risk. Anyone who has ever had gestational diabetes also has a higher risk of eventually having type 2 diabetes,” said Pate.

While type 1 diabetes cannot be prevented, type 2 can be prevented by making healthy lifestyle choices related to diet, exercise, and tobacco use. Some of the ways to reduce the likelihood of developing type 2 diabetes include:

• Quit smoking, or avoid starting
• Follow a daily exercise routine that includes at least 30 minutes of moderate activity
• Eat more fruits and vegetables, as well as whole grains
• Avoid refined carbohydrates, saturated fats, and trans fats
• Reduce portion size
• For people who are overweight or have obesity, aim to lose 5% body weight, and then maintain that weight

Once diabetes sets in, a doctor will be able to diagnose it using blood testing. They will also gather information about any family history of diabetes or autoimmune disorders.

“Even after someone has been diagnosed with type 2 diabetes, the prevention methods are still effective for minimizing the impact of diabetes, though at that point they might also be prescribed medications which may or may not include insulin,” said Pate.

“For people with type 1 diabetes, insulin injections will definitely be needed. There are a lot of different ways to monitor and deliver insulin, and different types will either start working more or less rapidly and will last for different amounts of time. A doctor can help navigate the varying options to find a good fit,” Pate added.

Over time, diabetes is associated with a number of serious complications. Some of these include:

• Stroke
• Heart disease
• Heart attacks
• Kidney disease
• Nerve damage
• Infections
• Loss of vision or hearing

“For those at risk of diabetes, it’s so important for overall health to reduce your risk while you can. Making a few healthy choices now will pay dividends later. And for those who aren’t sure where to start, ask your doctor,” said Pate.

Medical Offices of Manhattan offers comprehensive health care at four locations in New York City. www.medicalofficesofmanhattan.com.

Denise Pate, MD, is a board-certified internal medicine specialist and Medical Director at

Medical Offices of Manhattan.