Monday, January 16, 2017

Dr. Grimes' 20-1-7 Challenge: Week 3

Dr. Grimes' 20-1-7 CHALLENGE: 
  • For the first TWENTY weeks of this year,
  • Pick ONE healthy change every Sunday, and
  • Commit to that change for SEVEN days.
20-1-7 Challenge Week #3:
Time to practice what I preach, and get back to using my own weekly medication box!  This week's 20-1-7 challenge is to fill and use my dispenser. 

As a doctor, you would think I could manage to take my ONE prescription medication plus or minus a couple vitamins ...yet I find on many days that I literally cannot remember whether or not I took them. Like everyone else, I'm in a hurry in the morning, barely paying attention as I brush my teeth (which is when I grab my medication). I tell patients all the time that this is exactly why birth control pills come in a day-labeled package! Truly, if you take ANY medication on a daily basis (even OTC antihistamines or vitamins), please try using a weekly pill dispenser. Special note to parents of teens- have THEM start using one, including the weekly pill dispensing, so when they head to college, they are very comfortable with this system- especially if they take ADD medications. 

20-1-7 Challenge Week #1:
At EVERY meal, I added one more COLOR (translation, one more serving of fruit or vegetable that is a different color than whatever I started with on my plate.)   

20-1-7 Challenge Week #2: 
This week, I put a new "twist" on my vegetables by using a new veggie spiralizer ($6 at the grocery store) and replaced pasta and rice all week with spiraled zucchini or yellow squash.
Result: Honestly, we ate out more than in this week, so I give myself at best a B- on this one; I used the spiralizer enough to do it quickly, but had very few meals with this new tool. On the plus side, I am going strong continuing my push for extra veggies/fruit at every meal!

Sunday, January 8, 2017

Dr. Grimes' 20-1-7 Challenge: Week 2

Dr. Grimes' 20-1-7 CHALLENGE: 

  • For the first TWENTY weeks of this year,
  • Pick ONE healthy change every Sunday, and
  • Commit to that change for SEVEN days.

20-1-7 Challenge Week #1:
At EVERY meal, I added one more COLOR (translation, one more serving of fruit or vegetable that is a different color than whatever I started with on my plate.)   

Result: I realized I had been eating well, but filling up more on the "extras" (like my gluten-free pasta or bread) than on more nutrient-dense vegetables. I like that this forced me to expand my fruit/veg choices beyond my usual comfort zone, and had me looking for new things to try in the produce aisle. 

20-1-7 Challenge Week #2: 

This week, I will put a new "twist" on my vegetables by using a new veggie spiralizer ($6 at the grocery store) and I will replace pasta and rice all week with spiraled zucchini or yellow squash. 

I love my GF pasta and rice so much that I have one or the other at a minimum of one meal per day. Replacing them with a vegetable should be another big leg-up for my overall nutrition. This week will be a challenge, but who doesn't love a new inexpensive kitchen gadget? I used an apple spiralizer (that cored, peeled and spiraled, see image below) for many years- always a favorite with my girl scout troops for snacks. It's amazing how simply changing the SHAPE of foods can make them more appealing. Try the apple one for your kid's lunch! Then pack one for you, too.

BOTTOM LINE: For week #2 of the 20-1-7 challenge, try a new cooking gadget that will help you find fruits/veggies more appealing! Consider trying a veggie spiralizer...

Friday, January 6, 2017

Master Supreme Cleansing 3 Day Detox Diet 2017!!

Are the toxins piling up in your body, clogging up your gut and choking your life force, leaving you with crippling fatigue? If you are ever sucked in to late night tv infomercials, you will likely see pictures of "colons" with fatty-looking deposits stuck to all the walls, narrowing the lumen so only a tiny amount of stool could pass through. This image is so set in our collective consciousness that I would estimate at least a third to half of my patients believe if they complete a "cleanse" they will not only permanently drop ten pounds, but they will cure their constipation, bloating and gas, as well as significantly improve their energy level. As such, I am routinely asked not whether or not TO cleanse, but WHICH cleanse I recommend.

To be honest, for the first decade of my private practice, I would launch into my standard speech about how ridiculous the whole concept of "cleansing" was. Let's look at the facts. We know that when you truly "cleanse" a colon with a bowel prep (the solutions you drink before a colonoscopy that cause diarrhea to the point of clear liquid stool) the colon will be sparkling clean for the GI doctor. While the owner of that clean colon will have temporary weight loss from that loss of stool and fluid, within two to three days, their weight is right back to where it began. Established bowel patterns (chronic constipation, bloating, pain, etc) are not eliminated and frequently not improved (or transiently worsened) from this medical cleanse. So why bother with an "optional" cleanse if we know it won't change the outcome?

Good question, Dr. Grimes. (thanks, lol). My second decade of practice, I figured out the answer and created my own special cleanse recipe for those who inquired. I still make sure that my patients understand the purpose of a "cleanse" is not to do a roto-rooter job on your colon, arteries or liver, and that, by itself, the cleanse is not magical. However, taking a dietary step backwards (and yes, giving our bodies a break from the zillion preservatives, colorings, and extra products within our standard daily fare) can be a positive health choice. Additionally, my three day "cleanse" can be a wonderful jump start to healthy eating and, if needed, weight loss. So, without further ado:

Dr. Grimes' Master Supreme Cleansing 3-Day Detox Diet:

In one sentence: Drink water, and eat fruits, vegetables, and a protein source at every meal.

Yep, that's it. Processed foods are eliminated. This cleanse is automatically gluten-free and dairy-free (which helps those with undiagnosed celiac disease or lactose intolerance).  Skip everything with high fructose corn syrup and additives or chemicals you can't pronounce. Skip carbonation, caffeine and alcohol. Yes. Those are extras our body does not need. If you are going to get a caffeine-withdrawal headache, keep one cup of coffee but drink it plain- no sugar, cream, etc. Feel free to add a lemon, lime or orange wedge to your water if you want flavor. Please skip sugar substitutes (aspartame, etc.) We are going for a "cleanse" here!

What counts as a protein source?

  •  Eggs, fish, nuts, beans or lean meat
Can you cook them?
  • Absolutely! This is not a "raw food" diet, but a simplified diet. Feel free to use olive oil (one to two tablespoons should be enough per meal), salt, pepper, or herbs to season and cook the protein or veggies. 

How much should you eat?

  • Limit your protein to a serving roughly the size of your expanded, cupped hand (at each meal)
  • Fruits and vegetables? No maximum, but a minimum of two servings per meal (a handful is one serving.)

How often?

  •  Eat four meals: (essentially breakfast, lunch, afternoon snack and dinner.)
  •  Make sure your first meal is within an hour of waking up.

How much water?

  • One large glass at each meal, and any time you are thirsty (no maximum)
Despite the tongue-in-cheek Master cleanse name, there is nothing special or magical about this recipe. Does it work? Well, yes- it does. It "works" to help you realize what your body needs, versus what your mouth, eyes or mind want. For those with lactose intolerance or celiac disease, this often "works" to improve bowel/abdominal bloating and discomfort. For those trying to focus on better nutrition and weight loss, this frequently "works" as a great jump start. Can you modify this and use yogurt as a protein source? Certainly! The point here is to spend a few days with simple eating and no extra..."extras". Wishing you good luck and great health in 2017!

Bottom Line: If you're looking to "cleanse" your body, make it simple and stick to water, fruits, veggies, and simple proteins (eggs, beans or meat) for a healthy jump start!

Sunday, January 1, 2017

Ready for the 20-1-7 Challenge?

Happy 2017!
Are you New Year's RESOLVING to improve your health? As a family physician, I hope the answer is YES! All of us have room for improvement, even if we are going from good to GREAT. Regardless of your starting point, I'd like to offer a new health strategy.

Here is my 20-1-7 CHALLENGE: 

      For the first TWENTY weeks of this year,

      Pick ONE healthy change every Sunday, and

      Commit to that change for SEVEN days.

Simple enough, right? Obviously, feel free to KEEP that new healthy habit if it is working for you. Even if only half of your twenty new health changes end up sticking, think how far ahead you will be! Trying something new each week will help you stay motivated, and knowing you only "have" to keep up the new change for seven days gives you bite-sized improvements that should encourage success.

I will post my personal health improvement goal each week, which will keep me accountable. Feel free to share my suggestions or create your own. I'm going to start with dietary changes, but my 20-1-7 challenge will not be limited to the traditional "diet and exercise"- let's shake it up!

20-1-7 Challenge Week #1:

At EVERY meal, I will add one more COLOR (translation, one more serving of fruit or vegetable that is a different color than whatever I started with on my plate.)   

(Example: My breakfast is typically a yogurt and a banana, so I will keep that, but add in a serving of berries. If dinner is spaghetti and a green salad with tomatoes, I will add in carrots or yellow squash.)

BOTTOM LINE: Join me in the 20-1-7 CHALLENGE and let's improve our health!

Wednesday, December 14, 2016

Shades of Black and White: Skier's Toe (Nail)

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was the entire nail black or only the base?  "Skier's toe" is a common and often very frustrating injury from skiing.

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot.

If this happens to you- do NOT wait to go in to a clinic, because the success rate in fixing this problem is much higher the earlier it is treated. The treatment procedure involves burning a tiny hole through the nail, which allows the trapped blood to drain. There is typically only a few drops, but the pain that small amount of blood causes underneath the nail (if not removed) is fairly intense.

As with so many medical problems, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. Using the newer thin ski socks, rather than old school super thick ones, also helps. (Don't worry, the new fabrics keep your toes warmer, despite what it might appear.) This painful injury should NOT occur if your shoes/boots fit correctly.

BOTTOM LINE: Make sure your ski boots and socks fit properly, and avoid getting skier's toe!

PS. In prior blog posts regarding this injury, people have commented about home remedies. While in experienced hands, the red-hot tip of a flame-sterilized paperclip may be used to swiftly burn a tiny hole through the nail, I would definitely NOT recommend trying this on your own. Among other challenges, people have been known to pass out from simply watching this procedure done on another person's toe...

Thursday, December 1, 2016

Check Your ALTITUDE!

Going skiing for winter break? Whether you prefer downhill or cross country skiing, please remember that the high altitude might add in a few medical challenges. Be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness) and if you are susceptible to this issue, look closely at ski resort ALTITUDES. Full disclosure, my destination of choice is Crested Butte, CO, which is one of the higher pun intended.

HOW HIGH do you have to be for altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby. This is very common- an estimated 75% of people visiting mountains with altitudes higher than 10,000 feet will get some degree of altitude sickness. Note that many people have a significant difference in degree of symptoms between altitudes of 9000-13,000 feet- which may explain why they "felt fine" skiing last year at a different resort.

For Colorado skiers: 
The highest ski mountains are in Arapahoe Basin and Loveland (13K), with Breckenridge barely under at 12,993'. Snowmass/Aspen, Keystone and Copper Mtns peak at roughly 12,300-12,500', with Crested Butte and Winter Park closer to 12K. Vail is 11,500 while Durango and Steamboat are around 10, 500. To get below 10K, consider Buttermilk at Aspen (max 9900) or Steamboat Springs Howelsen Ski Area at only 7,136. Obviously the ski towns themselves are not at these peak mountain summit heights, and many resorts offer lodging at a variety of elevations- consider this factor when deciding about the convenience of ski in, ski out, as sometimes you are better off further down the mountain.

When does altitude sickness begin?
Symptoms usually start within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?
  • Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
  • Severe:  All of the above plus vomiting and shortness of breath
  • Note that in severe forms, there can be brain swelling (High Altitude Cerebral Edema) and/or fluid collecting in the lungs (High Altitude Pulmonary Edema)- these are medical emergencies.

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications. For mild insomnia, try over the counter melatonin.

  • Increased hydration with water or sports drinks, and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
  • SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
  • If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

Friday, November 11, 2016

Wait, Is It Broken?

Image B. Rushing

"I can move it, so it's clearly not broken..." Maybe, maybe not! In primary care settings, the majority of fractures that we treat are diagnosed days after they occur (sometimes weeks), ignored because of this inaccurate belief. Wrist fractures are notorious for this presentation, because often there is not dramatic bruising or deformity, and swelling may not be impressive. Finger, foot, and ankle fractures tend to have much more impressive dark bruising and swelling, but even with these injuries, the affected area can most frequently still be moved voluntarily (albeit with significant discomfort).

Fractures come in many shapes and sizes. Fortunately, most fractures are not "open", meaning most have no break in the skin (no bones sticking out anywhere). Some fractures are simple a hairline crack or a small buckle in the bone, while others break all the way through the bone and may shift out of place under the skin. The only way to be certain whether or not there is a fracture is with imaging- most commonly an ordinary X-ray.

What should you do if you think you may have broken a bone? Is it an emergency? If it is "open" (bone sticking out), of course this is an emergency, and this most likely would have occurred in a very traumatic situation such as a car wreck or other high speed injury. Call 911. If the limb is obviously distorted, or there is new and persistent numbness, tingling or decreased circulation (area turning cold, pale and/or blue), you need immediate medical help.  In less traumatic situations- you smash your toe against a door walking to the bathroom at night, you step off a curb funny, you fall on an outstretched hand- your injury may be urgent, but not emergent. Follow the RICE pneumonic- Rest, Ice, Compression (ace wrap) and Elevation while you are waiting for medical care.

BOTTOM LINE: Voluntary movement of a finger, toe, hand, foot or leg does NOT mean a bone is definitely not broken- head to your doctor if you are having persistent pain, swelling or bruising, and find out for sure.