Thursday, February 8, 2018

Flu Tests 101

Positive Rapid Flu Test for Type A Influenza    (C is Control)

Flu season is in full force. If you have high fevers, intense headaches, screaming muscles, razor blade throat pain and/or a wicked cough, should you go get a flu test? How reliable are these rapid tests anyway?

Let's cut to the chase: if you have flu symptoms and a POSITIVE rapid flu test (from a swab lovingly probed up inside your nose), YOU HAVE INFLUENZA. These positive tests are extremely accurate- typically 98-99%.  This means they are very SPECIFIC tests- if the test says you have flu, there is a 98% chance that you really do have the flu, so the likelihood of a false positive is very low.

HOWEVER, if you have flu symptoms and your rapid flu test result is NEGATIVE, you might still have the flu...and your doctor should rely on her clinical judgement. Why? Because these rapid flu tests are very SPECIFIC, but much less SENSITIVE. Sensitivity reflects the percentage of the time that the test is positive when the disease is actually there. Rapid Influenza Diagnostic Tests (RIDTs) average a sensitivity of about 62%, meaning the test turns positive 62% of the time in someone who is truly infected. Rephrased, up to one third of the time when a person has the flu, the test could miss it. Newer digital immunoassays (DIAs), and rapid nucleic acid amplification tests (NAATs) may have significantly higher sensitivities (as noted in this 2017 Systematic Review) but for now these tests have a lower share of the market, and many current studies are industry backed. Meanwhile, most of us in primary care have the less sensitive RIDTs in our practice, which are still quite clinically useful.

Why do doctors even use these tests if they are not super sensitive? Because it affects our treatment plan. If we have confirmation that someone has the flu (with a positive test), then we can feel more confident in NOT prescribing an antibiotic, and limit our conversation to pros/cons of taking an antiviral medication as well as medications for symptomatic relief. This step greatly reduces unnecessary antibiotics, which is critical in an era of increasing antibiotic resistance.
Additionally, knowing a patient definitely has the flu helps us advise them about returning to work/school/activities, since we know flu stays infectious for up to a WEEK. (So STAY HOME at least several days, AND if you have fever, wait until you are fever-free for at least 24 hours without taking tylenol or advil!)

If you had the flu vaccine, will that affect your rapid flu test?  No*. 


(*In prior years when the nasal spray flu vaccine was recommended, there was a chance that you could have a false positive test. Studies have shown that in the first several days after receiving the nose spray vaccine, people may test positive for the flu (even though they are not infected.)

Who should be treated with SUSPECTED illness?The CDC encourages doctors to treat all high risk individuals with suspected flu with antiviral medications. Who is "high risk": anyone hospitalized, patients in nursing homes, and people with immune problems, significant chronic problems (lung or heart disease, for example) or with severe illness such as pneumonia. However, HIGH RISK also includes all otherwise healthy children under the age of two years,  adults over the age of 65, and women who are pregnant or have just delivered their baby within the past two weeks. There are also other less common subgroups that are high risk such as people who are very obese (BMI >40), American Indians or Alaska natives, and youth under 19 who are on chronic aspirin therapy.

Who should be treated with CONFIRMED illness? 
Anyone in the high risk categories above should be treated with antiviral medications if they have a positive test, because treatment definitely decreases severe complications, hospitalization and even death.

Otherwise healthy, active adults who test positive for the flu should have a discussion with their physician about taking the antiviral medications. When taken within 48 hours of the onset of flu symptoms, these drugs have been shown to decrease the duration of the flu by one or two days...which may make a big difference to a student, parent or employee. However, these medications are not without side effects, and for some people, they may aggravate flu symptoms- particularly nausea. In controlled studies, the antiviral medications only cause about 10% more nausea/headaches/fatigue than placebo, but there is no doubt that in a minority of patients, the medicine causes more side effects than they are worth. However, since you have the FLU when you are taking the medications- you already likely HAVE nausea, headache, fatigue, etc- so it is often difficult to sort out. In my family, half of us can tolerate the antiviral medications with zero problems, and half...barely keep the pills down long enough to know.

BOTTOM LINE: If you have flu symptoms, get to the doctor as soon as possible (especially if you would consider taking antiviral medications), and understand that a positive test is REALLY positive, but a negative test does not definitely rule out the possibility of the flu. 



AND...that ounce of prevention...remember to GET YOUR FLU SHOT NOW to reduce your chance of getting the flu (or to at least minimize your symptoms if you do catch it.)

Thursday, January 18, 2018

Starting to Exercise? Time for SOLE Searching!


If your New Year's Resolutions include an exercise program, START by taking a close look at the BOTTOM of your shoes. If they look like mine in the picture above, get thee to a shoe store before you get moving with your walking/jogging/running plan. Note the smooth areas (not to mention the circular area trying to be an actual hole)- that means I have completely lost the tread and traction in that area. 

Are new, good quality running shoes necessary? YES. After two decades of private practice (and seeing hurt knees, hips and ankles that might have been prevented with proper fitting footwear), my mantra is "yes, new shoes may be expensive, but NEW SHOES are cheaper than NEW KNEES."

If you are walking or jogging regularly for exercise, odds are good that you should be replacing your shoes every six months...even though the "shoe still fits"- meaning you have no foot pain, and the tops may even look "practically brand new". 

BOTTOM LINE: Look deep into your "soles" to see if it is time for new shoes! 

PS. I strongly encourage you to head to a local running shoe store with experienced and knowledgable sales people to be properly fitted for shoes. They should not only measure your foot, but watch you walk/run/jog to help advise you on your shoes. Locally here in Austin, I recommend Ready to Run.

Tuesday, January 9, 2018

2018 SIMPLE Doctor Approved Master Cleanse


Happy New Year and Welcome to 2018! 

This year, my theme is SIMPLE. Attention spans are decreasing as fast as our waistlines are increasing (coincidence? Hmm). With tongue firmly planted in cheek, I'm putting everything in my life on a "diet"- or at least a simplification plan, from our overflowing garage and closets, to medicine cabinets, to e-mail in-boxes, to my blog word count, and yes, my own body. Like many, I happily over-indulged in treats, sweets and celebratory liquid calories during the holidays, but now it's time to face the scale, own the numbers and get to work.

How do I kick start my own weight loss program? 

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

SIMPLY PUT: 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 with 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 2018!

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

Thursday, June 22, 2017

2017 Resolutions - Take 2!


Here we are, staring back at nearly half of 2017 in the rear view mirror already...so how did you do on your 2017 New Year's Resolutions? For those of you playing along with me, you know I changed things up this year with my 20-1-7 Challenge, trying ONE new healthy habit each week. What stuck? What dropped off? What was the biggest surprise?

Looking back, I'm happy to share that the vast majority of challenges "stuck" and are part of my life routine. Which challenges became permanent changes for me?

  • HIDING MY PHONE in the car (putting in my purse or backpack) is likely the major new habit that is helping the community as much as myself. 
  • NUKING (microwaving) the dish sponge before and after use seems normal now.
  • USING a weekly medication dispenser dramatically improved my consistency.
  • FLOSSING (my biggest victory) is finally routine with my visual reminder from "future Jill"
  • WATER four times per day is back to being habit, rather than forced

What did not stick, but I will keep trying?
  • Playing the piano...I was out of town for several weeks, so no piano
  • YOGA- still WANT this, but haven't found the right method yet
  • Vegetable spiral tool- honestly, now my grocery store sells prepackaged bags of spiraled veggies, so I've been grabbing those rather than DIY
What worked, but not needed long-term?
  • ZZZ- I used a sleep monitoring app for four months, which really helped me prioritize both the quantity and quality of my sleep. 

The biggest SURPRISE?
  • Week #4 Brain Recharge with Kirtan Kriya meditation. This has become my go-to tool for insomnia or situational anxiety (like fear of flying). With or without the recording, I can use this "chant" to calm my mind, brain and body. 
BOTTOM LINE: July marks the start of the second half of 2017, so treat yourself to a do-over or create your next batch of resolutions to improve your health and happiness!







Monday, May 15, 2017

Positive Twist: 20-1-7 Challenge Week #20: The Final Challenge!



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.
Positive Twist: 20-1-7 Challenge Week #20

A couple years ago, I heard a motivational speaker issue a challenge- every time that you find yourself saying or thinking something NEGATIVE, add a comma and a "but..."and finish the sentence with a positive twist. (I wish I could remember her name, to give credit- my apologies.) For my last weekly challenge, rather than focusing on a physical change, I thought it would be great to focus on attitude.

Negative thoughts drag down our energy, feeding a cycle that can adversely affect not only our own mood, but those around us. Especially when life hands you a bunch of challenges at once- and really, that's how it seems to happen, right? Your family member is ill or has an accident, someone else loses a job or ends a relationship, AND your computer crashes...etc. Take a day and really "listen" to your self-talk. How often is your glass half-full, or the majority of your energy focused on what's WRONG, rather than what is working?

Recently, I've found myself spewing anger, frustration and disappointment over a situation that has consumed my thoughts the past few months. For my final 20-1-7 challenge, I'm ready to pro-actively change this negative whirlpool.  This week, I will focus on what is coming out of my brain and mouth, and will use this positive twist technique to reverse gears.

BOTTOM LINE: Every time you have a negative thought or comment, add "BUT..."with a concluding positive twist!

20-1-7 Challenge Week #1: COLOR

20-1-7 Challenge Week #2: Veggie Spiralizer


20-1-7 Challenge Week #3: Medication Dispenser


20-1-7 Challenge Week #4: Meditation


20-1-7 Challenge Week #5: WATER


20-1-7 Challenge Week #6: Exercise BOOST


20-1-7 Challenge Week #7: FLOSS

20-1-7 Challenge Week #8: ZZZ 


20-1-7 Challenge Week #9: RESIST


20-1-7 Challenge Week #10: No W(h)ining

20-1-7 Challenge Week #11: YOGA 

20-1-7 Challenge Week #12: CLUTTER CONTROL




20-1-7 Challenge Week #14: Hide It 

20-1-7 Challenge Week #15: Nuke It   


20-1-7 Challenge Week #16: Old School Keyboarding 


20-1-7 Challenge Week #17: Candy Day 


20-1-7 Challenge Week #18: Eye "Floss" 


20-1-7 Challenge Week#19: Travel Snacks: Not only did this improve our diet along the drive, but also shortened our travel time (since we eliminated several fast food stops!) Definitely a Win-Win!

Monday, May 8, 2017

Travel Snacks: 20-1-7 Challenge Week #19


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.
Travel Snacks: 20-1-7 Challenge Week #19

At home and work, I have a well-established routine for bringing healthy snacks. I always take a thinly sliced apple and a single serving-size of peanut butter or a handful of nuts. However, when I travel...the lure of french fries and Coke will create a force field that sucks my car right in to that drive through (with a long list of rationalizations why I "deserve" this treat.) And honestly, I have no problem with the occasional fast food, but our family tends to have LONG driving trips, and relying on fast food for multiple feedings over several days does our bodies/brains/stomachs no favors.

So- this week, I fly across the country to help our college daughter drive the 1200+ miles back home. My challenge is to make our FIRST food stop be a grocery store- where I stock our car with some nutritious body fuel and bottled water. Yes, we will still enjoy some Culver's delicacies on the drive, but my challenge is to make that the exception, not the default.  

Side note- this summer, especially if you are headed out on a family driving vacation, start your trip with handy healthy snacks in single serving sizes. Our favorites include baby carrots (& single serving hummus),  apples, raisins, nuts*, Luna bars and pretzels. Nothing that melts, nothing that can be "squished"...and we try to limit choking hazards.

BOTTOM LINE: Traveling or not, try taking healthy snacks WITH you to reduce the siren call of fast food!

20-1-7 Challenge Week #1: COLOR

20-1-7 Challenge Week #2: Veggie Spiralizer

20-1-7 Challenge Week #3: Medication Dispenser

20-1-7 Challenge Week #4: Meditation

20-1-7 Challenge Week #5: WATER

20-1-7 Challenge Week #6: Exercise BOOST

20-1-7 Challenge Week #7: FLOSS

20-1-7 Challenge Week #8: ZZZ 

20-1-7 Challenge Week #9: RESIST

20-1-7 Challenge Week #10: No W(h)ining

20-1-7 Challenge Week #11: YOGA 

20-1-7 Challenge Week #12: CLUTTER CONTROL



20-1-7 Challenge Week #14: Hide It 

20-1-7 Challenge Week #15: Nuke It   

20-1-7 Challenge Week #16: Old School Keyboarding 

20-1-7 Challenge Week #17: Candy Day 

20-1-7 Challenge Week #18: Eye "Floss" Feedback: Lid scrubs are so simple to add to your shower routine! Not sure if I can credit the lid scrubs or a change in pollen, but my eyes have been less irritated every day. 

Monday, May 1, 2017

Eye "FLOSS": 20-1-7 Challenge Week #18


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.
Eye "Floss": 20-1-7 Challenge Week #18

We all know flossing our teeth is a good idea, right? Certainly our future 70 year old selves would engrave that in our bathroom mirrors if they could. Every dentist that I know is quite faithful about flossing daily. Interestingly, most eye doctors that I know have a similar but lesser known ritual for their eyes. Not actually eye "floss" as my title teased, but eye LID SCRUBS.

The base of our eyelashes are well suited to collect debris, especially if you fall in the mascara, eyeliner or eyeshadow-wearing cohort. While we dutifully wash our faces and possibly use a makeup removal cloth, most can attest from the smears under their eyelashes in the morning that this is not the most thorough of processes. 

"BLEPHARITIS" is the medical name for inflammation of the eyelids. Symptoms include red, itchy eyes, often with some crusting or flaking alongside the inflamed edge. Contact lens wearers often blame their lens for this irritation, only to discover that it is the lash area causing the problem. If you suffer from this issue, then a simple routine of "lid scrubs" may significantly improve your ocular health. 

Lid scrub products are sold commercially as wipes, or you can DIY with non-irritating baby shampoo. Simply keep a small bottle in your shower, and when you've finished your normal shower/shampoo routine, squeeze out a drop of baby shampoo on to the tips of your fingers, rub them together, and then gently massage the base of your eyelashes (with eyes closed, obviously) for about ten seconds, then put your face back into the spray of the shower and rinse thoroughly. That's it! 

My own eyes have been itchy and mildly irritated for the past few weeks, which I have attributed to the oak pollen that blankets central Texas in the spring, but this is a great time for me to return to the hygiene habit of lid scrubs. 

BOTTOM LINE: This week, add lid scrubs to your daily shower routine- all it takes is a small bottle of no-tears baby shampoo and less than a minute of your time

20-1-7 Challenge Week #1: COLOR

20-1-7 Challenge Week #2: Veggie Spiralizer

20-1-7 Challenge Week #3: Medication Dispenser

20-1-7 Challenge Week #4: Meditation

20-1-7 Challenge Week #5: WATER

20-1-7 Challenge Week #6: Exercise BOOST

20-1-7 Challenge Week #7: FLOSS

20-1-7 Challenge Week #8: ZZZ 

20-1-7 Challenge Week #9: RESIST

20-1-7 Challenge Week #10: No W(h)ining

20-1-7 Challenge Week #11: YOGA 

20-1-7 Challenge Week #12: CLUTTER CONTROL



20-1-7 Challenge Week #14: Hide It 

20-1-7 Challenge Week #15: Nuke It   

20-1-7 Challenge Week #16: Old School Keyboarding 

20-1-7 Challenge Week #17: Candy Day Feedback: The candy habit was more ingrained in my routine than I would have thought, so rather than simply giving up my candy "rewards" during a work day, I substituted a new sweet treat- dried fruit (strawberries or bananas).