Today is going to be a little bit of a "grab-bag". First, I want to share with you questions from three of my patients concerning some interesting medical quandaries. And then there is some good news about a familiar and frequently used medication.

First, the questions.

Not too long ago, a middle-aged woman came to our clinic with a severe case of bronchitis. During the course of her visit, she opened her purse and asked me to review some lab work that had been performed several months earlier by a physician in a nearby city. It was the results of a thyroid study, and indicated that she was on the verge of having an under-active thyroid gland. Not quite full-blown yet, but headed that way. She related that she was starting to experience increased fatigue, weight gain, and hair loss. The correct diagnosis would be "subclinical hypothyroidism", and current thinking would recommend that she should be treated with thyroid replacement medication (The Journal of Clinical Endocrinology and Metabolism 2007;92). Her doctor informed her that she didn't need medicine at this point, and he wouldn't treat her until she had definitely abnormal labs.

She asked me my thoughts and I was very subtle and discrete. I told her to find a new doctor. She in fact should be treated. Not only would she feel better but she would also improve her cardiovascular risk factors such as her lipids. The next time you have thyroid blood studies done, make sure your doctor explains each value to you.

Not too long after that, I was talking with a sixty year old male patient of mine, and reviewing his medication list.

"John, are you still taking your aspirin each day?" I asked him. He had a history of elevated cholesterol and mild angina. Several years ago we had started him on a baby aspirin once a day.

"I sure am Doc, just like you told me," he answered. "In fact, about six months ago I started taking four regular aspirins a day, two in the morning and two at night. Figured if one baby aspirin was good for me, four adult-sized ones would be better."

That might explain the upper abdominal pain he proceeded to tell me about, and the blood he was noticing in his bowel movements.

It seems difficult for people to understand that if a small amount of something is good for you, that doesn't necessarily mean that a greater amount is even better. (There are some exceptions to this rule, such as hugs from your grandchildren or popcorn while watching a movie. Hmm, I'll have to think about the popcorn thing.)

In this case, a small amount of aspirin ( 81 mgs ) is all it takes to achieve the substantial benefits derived from this drug. More than that amount can cause GI bleeding and other complications. John and I would need to talk about this.

And then just last week, a young woman asked me about the benefits of eating chocolate. Just like many of us, she had heard and read about the benefits of adding chocolate to your diet.

As a matter of fact, I had just reviewed an article from the Journal of the American Medical Association (JAMA.2007;298) that dealt with this topic. The authors concluded that a small amount (6.3 grams) of dark chocolate each day lowered the blood pressure in adult volunteers. The key points here were (1) this was a small amount of chocolate (about a quarter of an ounce) and (2) it was dark chocolate only, not white or mild chocolate.

I shared this information with her, and she then told me she didn't like dark chocolate. She would just stick with her low-carb diet and exercise routine. That was working. But for those of you who like dark chocolate, this is the latest info.

And lastly, for those of us who are taking "statin" drugs (Lipitor, Crestor, etc), there is more good news. I have previously shared with you some recently discovered and unexpected benefits of this class of medication : reduction in the risk of colon cancer, improved bone density, reduction in the risk of Alzheimer's disease, and protection from some forms of kidney disease. Now we have evidence that taking "statin" drugs can reduce the risk of developing cataracts (clouding of the lens of the eye) by as much as 50%.

That's an amazing number and further studies will need to confirm this finding. But for now, dip your Lipitor in dark chocolate and hug your grand-daughter.

Or - We'll just have to see.