Gifts that keep giving!

Happy Holidays! In this season of gift giving, we need to remember that there are gifts for the here and now, and other gifts that "keep giving" long after the holiday decorations come down. Despite being the author of Seductive Delusions- How Everyday People Catch STDs- in this case, I am not referring to the undesirable "gift" of an STD...

What am I talking about is a gift of HEALTH. How many of us have friends and family members who struggle with their weight, and we give them a gift of chocolate or other calorie laden treats? Or the friend who perhaps drinks too much, and we give them a bottle of wine or scotch? We justify these gifts because, well, it's what they really like! And hey, it's an easy choice.

Let me challenge you, however, to think a bit harder and if you really care about that person, give them a gift that will promote their health. Yes, it can still be something fun. (Forget the bag of celery with a bow on top.) No, it does not need to be a $3000 elliptical machine or treadmill (although if you happen to be wealthy, knock yourself out!) 

How about a pedometer? A new workout top or shorts? Fun workout socks? A person training session? A healthy cookbook? (My all time favorite is Cooking Light's 5-Star Recipes- available on amazon) A gift certificate for a massage or manicure? How about a lesson- ballroom dance, kayak, or martial arts?

No money? Make a gift certificate to be a walking buddy every Tuesday morning (or whatever).

Bottom Line: This season, show you really care by encouraging your loved ones in the universal quest for health, and not undermine their efforts with "easy" gifts that aggravate existing health problems. 

'Tis the season...

'Tis the season for many things-goodwill, peace, holiday parties, and...coughs and colds. What can you to prevent getting sick during this hectic time of year? As should come as no surprise, the best defense you can have against germs is a combination of staying healthy (see how it always comes back to good nutrition, exercise, and sleep!) and washing your hands. Use those wipes that many grocery stores  now provide and wipe down the handle before you place your hands on that shopping cart. Cough and cold viruses are easily passed from one person covering their mouth to cough or rubbing their eyes and then putting their hands on a door knob, stair rail, or yes, shopping cart-allowing the next person to touch that same object and then touch their own face/mouth and pass the virus. Washing your hands frequently and being aware of NOT touching your eyes, nose or mouth will help reduce your chance of catching these common germs.

 What about extra vitamin C and zinc? Well, best evidence medicine has indeed shown that extra vitamin C will reduce symptoms and possibly shorten the course of the common cold. Zinc lozenges have been proven to decrease susceptibility to these germs, but do not shorten the course of illness once you are infected.

If you do get sick, remember the things your mom taught you. Stay well-hydrated (which keeps the mucus flowing, rather than being dried up and sticky), take tylenol or ibuprofen for fever and aches and pains, and remember feel-good home remedies like old fashioned vaporub (menthol topical decongestant) or the newer versions where you place a menthol-releasing tablet in your shower. 

If your nasal mucus turns green, does that mean you need antibiotics? No, typically not! Viruses can turn snot green as easily as a bacterial sinus infection. See your doctor if your symptoms are worsening or persisting beyond several days, or you have localizing symptoms (such as one sided ear pain or teeth pain) which may indicate an ear or sinus infection that could possibly require antibiotics. 

What about OTC antihistamines and decongestants? Adults may find the benefits outweigh the side effects, so SHORT term use of a topical nasal spray or oral decongestant may relieve stuffiness, and antihistamines are helpful if you have copious runny nose or itchy eyes.

BOTTOM LINE: Emphasize prevention to avoid colds- good nutrition, frequent hand-washing, perhaps some extra Vitamin C and Zinc, and of course, the flu vaccine.  If you get sick anyway, remember green nasal discharge does NOT equal need for antibiotics!

And she's...SAFE!

There has been quite a bit of media attention surrounding Gardasil, the vaccine for the prevention of cervical cancer- does it cause blood clots? miscarriage? shock? death? Well, the 2 year safety study of Gardasil is out, and the verdict is...Gardasil is safe.  Four independent reports on the vaccine's demonstrate safety and specifically the reports show no link between the Gardasil vaccine and potential problems such as blood clots, allergic reactions, strokes, seizures, and Guillain-Barre syndrome. 

What good does this vaccine do? Gardasil provides immunization against the two HPV (human papilloma virus) strains that cause 70% of cervical cancers, and the two strains of HPV that cause 90% of genital warts. Is that a big deal? Ask the families of the nearly 4000 American women who died of cervical cancer last year, or the 11,000 who were diagnosed with invasive cervical cancer. Ask any of the one million  Americans  each year who have to suffer the physical and emotional pain of being treated for genital warts- they'll tell you this is a great vaccine.

Why do some people fear the Gardasil vaccine will promote promiscuity? Did they complain when their child received the hepatitis B vaccine on day two of life? News flash- hepatitis is also transmitted via sex (or IV drug use, but I don't think vaccines promote drug use either.)

BOTTOM LINE: I believe Gardasil can virtually eliminate cervical cancer for our daughters' generation, and greatly reduce the trauma and drama of genital warts. Its safety is well documented, and yes, I will give it to my own daughters. 

Diabetes awareness month

November 2008 is national Diabetes awareness month. So, what should you know about diabetes? Let's start with the basic types. Type 1, or juvenile onset, diabetes is caused by an absolute deficiency of insulin, which is why the treatment involves insulin injections. The type of diabetes that is in the media these days for its rapidly growing numbers is type 2, or adult onset, diabetes. Type 2 diabetes is a different ballgame- here, the problem is a resistance to insulin or a decreased production of insulin. Insulin is the key that opens the doors to cells,  allowing sugar to come from the blood and move into the cell to be used as energy. When that door wont unlock (because of resistance to insulin) the sugar levels build up in the blood and eventually cause damage in many parts of the body- the eyes, kidneys, nerves, blood vessels and heart.

What are symptoms of diabetes? Being hungry all the time, thirsty all the time,  having frequent urination, having an unexplained sudden weight loss or developing fatigue are the classic symptoms, but many people have no obvious symptoms. If you are overweight, especially if you have a family history of diabetes, go and see your doctor and get tested for diabetes. A simple fasting blood test  will tell the doctor whether or not your blood sugar is elevated. 

Want to find out more? Go to Diabetes.org, the website for the American Diabetes Association.

BOTTOM LINE: An estimated 23.6 million Americans have Diabetes, and 5.7 million of them are undiagnosed. Diabetes can be treated and possibly even prevented with early intervention, so stop worrying or wondering if you have diabetes- get to your doctor and find out! 

Can't sleep? Try this...

Insomnia. We've all had the occasional night or two when no matter what we try, we simply cannot fall sleep. Usually those sporadic nights have an identifiable stressor- a test, a job interview, or maybe it's related to travel. For theses infrequent situations, I have no problem with my patients taking a sleep aid (prescription or over-the-counter.) 

Chronic insomnia, however, is a whole different ball game. Every night becomes a challenge and by 3:00am you're beginning to panic realizing there is no way you'll be able to function well the next day. People fall into patterns of heavy caffeine intake in the morning to "get them going", then a "pick me up" afternoon coffee or soda, and then as bedtime approaches, a glass or two of wine to "relax and wind down" from the day. Most people recognize caffeine is a stimulant (and therefore disrupts sleep, even if consumed hours before bed). Alcohol, though a sedative, may help people relax and fall asleep, but realize that it disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.

Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. Regular exercise is a wonderful way to release tension. Did you know exercising 30 minutes daily yields the same amount of mood enhancement as a low dose of an antidepressant? (Don't exercise just before bed, though, because as noted above, that adrenaline release will keep you up!)

Create a bedtime routine. If you have children, you know how important this is, and it works for adults as well. Take a warm bath or shower, appeal to your senses with relaxing aromatic bath soaps or gels, and then GO TO BED. Do not pass GO and collect $200. This means no stopping to unload the dishwasher, fold clothes, check email or watch television. If you want to read or watch t.v., do it before your shower. Get in bed, close your eyes, and consider some form of relaxing breathing or meditation. 

Cover your alarm clock. Check it three times before you cover it if you need to, but if it's covered, you'll break that habit of waking up at exactly 2:17am each night. Yes, you might wake up, but if you're not seeing the clock, it's easier for your brain to go back to sleep because you're not gearing up all the emotions that come with seeing that dreaded early morning time.

BOTTOM LINE: For the once a month sleepless night, go ahead and use a sleep medicine if you'd like, but when you've developed a pattern of needing sedatives every night and stimulants every day, recognize the habits that are aggravating the problem and make some healthy changes! If you're still not seeing improvement, talk with your doctor because it may be a sign of an underlying issue such as sleep apnea, restless leg syndrome, or depression.

From Indi-GES-tion to GERD!

Okay, we grew up calling it "indigestion" or "heartburn" (remember the peptobismal commercial?), but thanks to drug companies and the media, we now have patients coming in with the chief complaint of "GERD"- Gastro Esophogeal Reflux Disease. Not only do they say they have "GERD", but that they'd like a prescription for a purple pill, because it's cheaper than paying for the over-the-counter version. 

So, what causes GERD? Pain comes from the stomach acid sloshing back up into the food tube (the esophogus), because the muscle (sphincter) that usually squeezes down to keep the acid in the stomach is relaxed too much. What relaxes that sphincter? Well, think about when you've eaten way too much food at a nice restaurant, and you're "stuffed". What are we trained to do? People smoke ciggarettes, have an after-dinner drink of alcohol or coffee, and grab a peppermint on the way out the door. Nicotine, alcohol, caffeine and mints all relax that sphincter, allowing food and acid to go backwards up into the esophagus and making us feel less like our stomach is about to explode. 

The problem is that the stomach lining is prepared for acid, because it has a mucus coating over it, while the esophagus has more skin-like covering, and acid is damaging to it. When the acid "burns" the lining in the esophagus, you feel "heartburn", aka. GERD. 

So, yes, there are pills on the market that reduce or neutralize the amount of acid- from the inexpensive antacids (TUMS), to the mid-range (Tagamet) H2 blockers to the expensive proton-pump inhibitors (Prilosec). All of these medicines work, and for the occasional episode, pick your favorite pill.

However, for chronic symptoms, instead of taking a pill to reduce acid every day, (risking side effects such as decreased calcium absorption and subsequent osteoporosis) why not address the cause of the problem?

BOTTOM LINE: If heartburn has become a part of your everyday life, make changes that will stop causing acid to go the wrong direction: limit or eliminate nicotine, alcohol, caffeine and excessive mints (for those chronic breath mint poppers out there) instead of chasing them with pills.

Fix it NOW, Doc!

Fast food medicine- that seems to be what people want these days. In all of our society, we have instant gratification. If you call John, and he's not there- call his cell phone or text him.  Many people answer their cell phones in public bathrooms, or worse, in the middle of a pelvic exam (seriously!) Snap a picture of your child, and immediately, they run to your digital camera to see it. 

Sadly, people are demanding this same instant fix in medicine, and doctors are providing it. Got heartburn? Grab the purple pill. Can't sleep? Your glass of wine didn't relax you enough? No worries- take a sleeping pill. Too tired in the morning? Slam back a Starbucks. Caffeine and alcohol causing heartburn? Back to the purple pill! And...repeat.

Let me give a ridiculous example to illustrate my point. Say you decided it was fun to pick up a rock and hit your knee repetitively (work with me, here.) Not surprisingly, your knee begins to hurt. You go to the doctor, and he or she prescribes a pain pill. Is this going to solve your problem? No, of course not! The problem is NOT the pain, the problem is you hitting your knee with a rock. 

So, why is it any different when you go to your doctor with heartburn, and you get a prescription for an acid blocking pill instead of education to at least temporarily wean off caffeine,  eliminate alcohol and nicotine, and avoid ibuprofen? (Hopefully, you'll get both, but I think we all know most people will pop the pills, get relief, and continue the habits that caused the problem.)

BOTTOM LINE: We have been trained by the media and our lifestyles to expect a quick and easy fix. Let's dig deeper and stop shopping for fast-food medicine. My next several posts will address common problems that we tend to band-aid with pills instead of lifestyle changes.

It's impossible to eat that many fruits and veggies!

Okay,  before we move on to another topic, I thought I'd write one more entry on healthy eating. In the prior post I suggested you try improving your diet by focusing on eating 5-10 servings of fruits and/or vegetables each day. Often this advice is met with the response that with a hectic, working, "real" life that includes kids with different after-school activities, this is impossible. Well, I have that life, too, so I thought I'd give you some specific examples of how it IS possible! Here is what a typical school day in our home looks like:

First, the kid menu. Our two daughters have different preferences, so I'll list them both:

BREAKFAST: ( Kid #1) oat squares & Silk milk and a banana; drink: water 

(Kid #2) Toast (white wheat) with spray butter & bowl of blueberries; drink: Silk milk (kids are lactose intolerant, this is no slam on regular milk)

LUNCH: (Kid #1) Ham on white wheat bread, mandarine oranges, a cut up apple, and two homemade cookies (or one of the 100 kcal pre-packaged cookies)

(Kid #2) PB&J sandwich on white wheat bread, snap peas and mandarine oranges, cookies as above; plus she has a morning snack at school which is usually grapes or a cut-up apple

AFTER SCHOOL SNACK: (Kid #1- still at school because of post-school activities)  Fiber One Bar (chocolate is her favorite) or a Chewy granola bar

(Kid #2- at home) - often we make a smoothie- usually a banana, frozen strawberries and vanilla yogurt

DINNER: Chicken (baked nuggets if we're in a hurry), applesauce, broccoli (the bag that you throw in the microwave for 3 minutes.)

DESSERT: vanilla  frozen yogurt served over a sliced banana with a dollop of Cool Whip on top

ME:

BREAKFAST: vanilla yogurt with a serving of thawed frozen raspberries and 1/8 c Bran Buds (cereal) and a tablespoon of Cool whip  (if I'm in a hurry ) OR a scrambled egg with some onion, mushrooms, & tomato tossed in (I'm too lazy to make an omelette, so I throw the veggies in first with some olive oil, and when they are soft in a couple minutes, I add in the egg.)

SNACK: every work day, I take two sliced apples and a small serving of cashews or almonds or a cheese stick, and I eat that mid- morning so I'm not ravenous at lunch time.

[As the seasons change, I may take  mini carrots or grapes, but it has to be something quick that I can throw in a ziplock bag or tupperware container . I use one of those apple slicers that look like a wagon wheel to make it easy to cut up the apples.]

LUNCH: At work- two servings of salad or whatever vegetable might be available and one serving of the entree; if I'm at home, my standby currently is to heat up the skillet, add a tablespoon or so of olive oil, and toss in cut up onion (usually half of a large onion), shredded carrots (I love these, so roughly a cup), mushrooms (three or four), and whatever else I've got that appeals to me that day- some broccoli, snap peas, or zucchini, for example- and then some black beans (love the organic HEB brand) and some brown rice (around a cup). (I make the rice one day, and then stick it in a tupperware container in the fridge for the rest of the week). If we had chicken or beef the night before, I'll toss in some of that for extra protein.

After school snack with the kids: Love the smoothies!

Dinner: I try to put a green salad or at least a sliced whole tomato as an extra veggie; I aim to have a fruit and a veggie for the kids along with the main dish. This is very often applesauce for the fruit, and steamed broccoli or carrots for the veggie. 

Dessert: Our version of the banana split OR a Skinny Cow ice cream sandwich OR a glass of wine!

BOTTOM LINE: Go back and do the math- it IS possible to get in the 5-10 servings of fruits and vegetables per day IF you give it priority, think about it in the grocery store, and use the quick and easy products- frozen fruit, single serving applesauce/peaches/fruit cups or carrots/celery, or the pop in the microwave bags of broccoli, green beans, or mixes with cauliflower & carrots.

I can't lose weight, no matter what I do!

At least two or three times per week, my patients tell me that they can't lose weight, no matter what they try. Often, they feel their metabolism or hormones are to blame. They would like me to test their thyroid levels and other hormones. 

Well, for every one patient who legitimately is severely low thyroid or has their hormones "out of whack", there are a hundred who come back with completely normal lab values.

 So, how do I, as their physician, try and help these patients when it would be harmful to prescribe thyroid medicines or appetite suppressants? Many physicians fall back on the old standby of saying "there is no metabolic explanation for your problems." As true as that is- and I certainly do tell patients this- that is NOT all there is to say.

Ultimately, we all know that losing weight means burning off more calories than we consume. What I try to make clear to people is that they need to take ownership of what they are putting in their mouth as well as how many calories they are burning off. It is human nature (proven in study after study) that we will OVERestimate our exercise and UNDERestimate our calorie consumption. The only way to truly assess this is to log what you eat- and I mean MEASURE it and log it as the day goes along; do NOT rely on your memory, or you'll forget the handful of chips or M&Ms that you grabbed from your friend's house/desk, PLUS log in the amount of exercise- count minutes and/or miles- and MEASURE it. Patients tell me all the time that they walk 2-3 miles in a half hour, but never break a sweat. Hmm... I don't think so. Try it on a treadmill.

There are a dozen easy, free calorie counters on the web that will help you catalog your ins and outs daily- pick one!

OR... try this: simply count your servings of fruits and vegetables each day. You need 5-10/day. A serving is roughly what you can hold in your hand. So yes, a big person (big hand) gets a bigger serving than a kid. A huge banana, for example, is likely two servings.  An apple- usually one; a handful of berries or grapes- one. A huge lettuce/tomato/carrot/cucumber salad might be four or five servings. 

BOTTOM LINE: fill up on fruits and vegetables, ten servings per day, and the protein, fat, and carbs that round out your plate (should be only one quarter of a round plate) will still likely add up to fewer calories than you need, and the weight WILL come off.

P.S. The only people who maintain weight loss in meta-analysis studies exercise daily. Yes, that would be every day, seven days per week. It's not magic, it's habit. And yes, walking counts.