Domino dazzles with another rundown of latest medical research

During his traditional main-stage presentation of top family medicine updates today at the Family Medicine Experience in Anaheim, California, he backed up advice for family physicians with references to more than three dozen different journal articles and studies.

But when AAFP News talked to Domino the morning of his FMX presentation, he said something that, at face value, seems somewhat contradictory: “You cannot change an emotional thought with logic.”

Like many family physicians, Domino continues to see patients bring theories of alternative medicine and misunderstandings about vaccines into the exam room. In patient interactions, the question is not just about explaining the difference between statistically significant and clinically significant. Rather, it’s about, as Domino told us, using your life experiences and stories to connect to strangers and friends alike.  

Domino did just that in his nearly hour-long presentation, pacing the Anaheim Convention Center Arena stage to deliver his trademark combination of education and entertainment. As he spoke, Domino channeled his New Jersey blood to make a few jabs and tell a few jokes along the way.

While Domino covered plenty of topics, he devoted a summary slide to some key takeaways that family physicians can take to their practices as soon as they get back home from FMX.

Paternity leave has an impact on breastfeeding

Many things are well known to correlate with improved breastfeeding rates: breastfeeding within the first hour of life, skin-to-skin contact, maternal breastfeeding education. But a new study showed that fathers taking at least two weeks off work also positively impacted breastfeeding.

“So when you see your patients in the prenatal talk up front, tell them that not only does Mom need to take time away from her work, but Dad does, too, and that's a great first move to help with your child.”

Half-strength apple juice works about well as electrolyte solutions

Electrolyte solutions are not exactly the tastiest thing to children. The good news is that half-strength apple juice is nearly as effective for acute gastroenteritis.

“Kids have kidneys, and they work. Half-strength apple juice rehydrates them and prevents things like need for hospitalization or need for IV fluid. So half-strength apple juice is just fine.”

Cancer and dementia are overtaking cardiovascular disease

Uncle George, Domino recalled, had never had any serious health problems until the age of 72, when he got prostate cancer. Over the next two decades, George had multiple heart surgeries and broke both of his hips. Domino said an exasperated George asked him, “I'm 96 years old. I never thought I'd live past 70. What am I doing here?”

The good news and bad news, Domino says, is that cardiovascular disease has dropped significantly over the last few decades. But instead of people dying in their 60s due to heart conditions, they’re living to their 70s and 80s, when they start to get cancer at higher rates—and, eventually, dementia.

Exercise should be part of cancer treatment

Cancer rates are rising, even though the rate of death from cancer is falling and getting pushed later in life. One of the most effective supplements to cancer treatment might be surprising: It’s exercise.

“You need to say, 'Listen, if you want to live, you got to go the gym. The day is over where you can just sit on the sofa. You can't feel badly. You need to work out every single day.'”

Reduce dementia with exercise, blood pressure medicines and vaccines

Similar to its effects on cancer, exercise is incredibly effective at warding off dementia.

“What can we do to lower the risk of dementia? Exercise works,” Domino said. “People really want to avoid dementia? Get them to exercise.”

Domino also pointed out that taking blood pressure medicines and avoiding viruses are good ways to avoid dementia. So, too, is keeping your brain active.

The good news for family physicians? Their rates of dementia are among the lowest compared to other specialists. “We kick ass,” he said to a big laugh.

Vaccines are safe and effective

Domino devoted a healthy chunk of time to vaccines. He relayed the time-tested facts about vaccines: that they’re safe, effective and good at preventing death. The presentation covered a variety of subtopics:

• On thimerosal: “The breadth of evidence and consistency in results shows this preservative is safe.”
• On MMR vaccines: “There's no correlation between the MMR vaccine and autism.”
• On measles vaccines: “I had to go to Houston in April, and I'm in that age group between 57 and 67 who got the semi-useful measles vaccine. So if you're in that group and you're a health care worker, you should probably get an updated measles vaccine because what you had was probably inadequate to protect you.”
• On RSV vaccines: “I love this vaccine.”
• On autism research: “The single greatest risk factor for having a child with autism is having a previous child with autism… If you don't control for that, you are missing the elephant in the room.”

Seed oils are good and butter is just fine

“There is no evidence that home use of seed oils has any potential to convert to trans fat and cause any cardiovascular risk,” Domino said. “The benefits of seed oils are amazing.”

What about butter? Domino noted that butter is less healthy than seed oils, but that in moderation it isn’t a problem. “So my advice: Cook with olive oil, love it, put it on your salad,” Domino said. “But if it is late summer and you've got that delicious corn on the cob, a little bit of butter is not going to hurt you.”

Fried foods and artificial sweeteners are out, water and coffee are in

A study published a few months ago caused a bit of a stir among the potato-loving community, of which Domino noted his wife was a proud member, when it showed some association between potato consumption and a higher risk of developing type 2 diabetes. Fortunately for the potato lovers, the data was more nuanced.

“Having three or more servings of potatoes per week increased that risk by a small amount, but when they broke it down, baked, boiled or mashed did not increase that risk,” Domino said. “It was only the fries! Three or more servings a week of fries increased the risk of type 2 diabetes by 20%.”

As for sugar-related food items, Domino outlined that sugar and high-fructose corn syrup were functionally the same. “Mexican Coke is a farce,” he quipped. And Domino says the literature is clear: Drink water—and some coffee—instead of beverages with artificial sweeteners.

Inhaling seems to be the main culprit in marijuana-cardiovascular disease link

“Marijuana data continues to be in flux,” Domino cautioned. But he thinks research shows that inhalation is the real risk with marijuana. “My sense is, from the data, that it's the inhalation of marijuana, whether you're vaping it or smoking it, that’s really the risk for cardiovascular disease.”

Statin use is associated with hearing loss

“As you can tell, I'm talking loud because I've kind of gone deaf in the last few years,” Domino joked. “It turns out that there's an association between statin use and loss of hearing and tinnitus."

Fortunately, not all statins pose an equal risk. Domino recommended moving patients to newer statins like Rosuvastatin as a result of the studies.

For sleep apnea, use inspiratory and expiratory muscle training

A few years ago, Domino said, he mentioned a new study where physicians were treating obstructive sleep apnea with inspiratory and expiratory breath training. He has since started that breath training for himself, and it’s worked well.

“You breathe into (the device) and you exhale through it and you build up these muscles,” he said. “I use one every day. The studies say twice a day is ideal. I'm lazy at night, so I use it once a day. It works great.

“My wife won't. And guess what? She snores.”

Add spirometry to identify COPD

An interesting study recently concluded that adding spirometry to CT screening could be used to identify undiagnosed COPD. “About one third of the people (in the study) had COPD,” Domino reported, “and more than 50% didn't know they had it.”

Being grateful leads to better health

“Sometimes it’s hard,” Domino says about being a family physician. “Sometimes it’s frustrating. Actually, many days it’s frustrating,” he chuckled.

But at the end of the day, Domino is grateful. “We have a really cool job.”

The final research Domino mentioned was a study of gratitude. The highest level of gratitude was associated with the lowest risk of all causes of death. If just a mindset shift has such a big impact, it’s worth thinking about. For Domino, family medicine is special and family physicians have plenty to be thankful for.

“We take for granted all the good around us.”