A Word About New Year's Resolutions

Merry Christmas and Happy New Year! Can you believe we've reached the end of 2009 already? Well, it's time for New Year's resolutions, and I have a suggestion. Instead of creating a huge "to do" list this year, choose ONE WORD that represents something you'd like to focus on for 2010. Write it down and stick on your fridge (or computer home page, or wherever you will see it every day.) In our family, each New Year's Eve our daughters create a small poster for each member of our family with our word printed in large letters and decorated with appropriate symbols. We then post those four words on the wall of our stairway for the year, where everyone can be reminded of their resolutions daily as we trek up and down the stairs.
For example, my word for 2009 was HEALTH- big surprise, right? But it meant not simply medical health, but spiritual, mental AND physical health. Some days that word pushed me to exercise when I didn't feel like it, and other days it challenged me to prayer. In previous years, my words have been "patience", "peace", "simplicity", "family", "finish" and... did I mention "patience"? (I have to focus on "patience" every few years, so it bears repeating. My kids think it's funny because I have "patients" at work and need more "patience" at home!)
I have found that having this one word resolution is far more effective more me than the shopping list of resolutions that I used to espouse each year. The word becomes my theme for the year, almost a mantra for me. I love that with one word, it is a positive statement (rather than quit this or that, or lose weight, etc.)
Thanks to the Austin reporter who many years ago challenged our city leaders to try this single word resolution and shared their experiences in a New Year's column. I confess I've long since forgotten the reporter's name, but the tradition lives on.
BOTTOM LINE: Choose a ONE WORD RESOLUTION for 2010- perhaps HEALTH!!

The GIFT of HEALTH

'Tis the season of giving, and many of us are trying to find the perfect gifts for our friends and families. Before you choose gift baskets loaded with wine, chocolate, and other delicious goodies, though, stop and think. Is this the right gift for your friend who is struggling with her weight or your brother who has high cholesterol and "borderline" diabetes? Well, maybe not, but hey, it's the holidays, right? Doesn't everyone deserve a little treat? And they LOVE chocolate...
Well, yes, I agree that everyone deserves a treat, but is it really a treat if we're giving them something that harms their bodies or works against their health goals? If your friend is fit and healthy, knock yourself out with edible treats with a clear conscience. BUT... if they are NOT, why not focus on gifts that encourage health? Mind you, I'm not suggesting sticking a bow on a bag of carrots, either. How about fun workout socks or a new top? Buy matching pedometers for you and a buddy or two for some friendly competition or at least mutual encouragement. How about a gift certificate for a massage or manicure or pedicure? Or a new healthy cookbook? Out of money (and who isn't?) Make a gift certificate for a outing to a park or walk around the lake or a bike ride. Be creative!
I would be remiss if I also didn't put in a pitch for charitable giving this year. Our non-profits are struggling, too, so consider them as an alternative if you have friends or business associates with whom you typically exchange gift baskets. Our local Hospice, for example, has a program where you can purchase an angel ornament for $25- your gift recipient gets the ornament, Hospice gets the funds, and everyone gets the spiritual health gift of helping others! (http://www.hospiceaustin.org/site/pp.asp?c=bdJPITMyA&b=1556229)
BOTTOM LINE: Think twice before sending out edible treats to ALL your friends and family this year, and show you really care by giving gifts that promote physical, mental or spiritual health! Happy Holidays!

Mammograms and Self Breast Exams

The new United States Prevention Services Task Force guidelines came out this week saying we should no longer ROUTINELY order annual mammograms on 40-49 year old women. What?? I am a 40-something year old female with no family history of breast cancer, so this impacts me not only as a provider, but as a patient. Do I want an annual screening mammogram? Well, yes, I do.
I have had too many patients and friends my age and younger get breast cancer, and have already lost one amazing friend to this disease. AND I have had 3 patients find their own breast cancers through self-breast exams, so I also will continue to instruct my patients on this technique, despite the recommendations to discontinue this process. All three of these women detected cancers early enough to have complete cures with minimal surgery/chemo.
Know that there are completely conflicting opinions on this subject (like most every topic in medicine!) We obviously view this recommendation through our very select vision of our patient populations and our specialties. The ACOG (American College of Obstetrics and Gynecology) and the American Cancer Society are dead set against changing our current practice- but remember, they (and I) are coming from seeing real women in their 40s fight breast cancer- and some do not win. When you are sitting around reviewing outcome studies and looking at statistics, it is far easier to be objective, because you are not thinking of "Shannon" but simply looking at numbers.
Are some women being "harmed" by false positive mammograms, resulting in extra cost, mental anguish and unnecessary procedures (biopsies, further imaging)? Certainly. This is what the task force is trying to reduce, and it is an important point to consider as we decide how to best spend our health care dollars. However, on an individual basis, I'd rather do superficial "harm" by false positives than miss the early cancers we might detect and CURE.
Remember, though, that these are GUIDELINES, not edicts, and physicians are encouraged to make individual decisions based on their full knowledge of the patient and her extended history.
BOTTOM LINE:
The art of medicine is exactly that- not black and white treatments and diagnoses, but many shades of grey. I choose to continue to teach self-breast exams and encourage annual mammograms starting at age 40, and hope our research continues to yield better options for early detection and treatment.

Flying High

As I type to distract myself on this way too bumpy flight, I thought I’d share some health-related flying tips. With all the emphasis on flu these days, I’d be remiss not to start with the basic advice that you should NOT fly if you have a fever or a productive cough (or other flu symptoms such as headache, sore throat, and body aches.) That being said, there are many times that you may need to fly when you have mild cold or allergy symptoms, and there are a few tricks that may be helpful.
The one time that I actually recommend OTC products such as nose sprays like Afrin is if you have a stuffy head/nose/ears and need to fly. Make sure to put it in ziplock bag for security, but then use it when you are seated on the plane to reduce ear discomfort upon takeoff. Gum, mints or any beverage will help clear your ears as well.
I also suggest sucking on the zinc lozenges- any variety- I happen to like the ones combined with vitamin C. Zinc oral dissolvable products have been shown to reduce acquisition of respiratory viruses. Unfortunately, simply taking a zinc supplement that you swallow has not been shown to provide equal benefit.
If you have no contraindication to taking aspirin, a baby aspirin taken the day of your flight will reduce your risk for blood clots that can occur with prolonged sitting. Try to get up every hour or two and walk to the bathroom- that will help, too.
Nervous about flying? Talk to your doctor about a short-acting mild sedative or sleep aid (if the flight is long enough.) No need for embarrassment, as fear of flying is very common. I’d estimate I get this request close to once per week!
Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable. My children and I are not wearing one now- and no one around us appears ill.
BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

Let's Get Physical(s)!

With apologies to Olivia Newton John, I do want to encourage everyone to “get (a) physical”- schedule a complete exam with your family physician! Since this is my birthday month, I am reminded that many of my patients choose to have their annual exam around their birthday, which I think is a great way to be consistent and to remember to prioritize your health. What better gift can you give yourself?
Why bother having an exam if you have no complaints? Well, the whole point of a complete physical exam is to look you over from head to toe and do preventative health care. So many diseases are silent- high blood pressure, diabetes, hyperlipidemia (high cholesterol), or even cancers such as melanomas, breast, cervical and colon cancer. Let your family doctor learn your family and personal health history, so she can best direct your physical exam and blood work to address your risk factors.
Please don’t wait until you lose those extra 20 pounds or lower that blood pressure of sugar level before you go in! The last thing we want is our patients being afraid we will judge or criticize them. What we family docs do want is to partner with our patients to give them tools to lose that weight or lower that blood pressure or sugar safely. Some times, yes, that means starting medicines, but that absolutely does not mean you will be stuck on that medicine for life. Often starting blood pressure or diabetes medicine helps patients feel better- more energy, less headaches- which then enables them to exercise more and have a more effective weight loss program. The goal is to improve your diet and exercise enough that you no longer need the medicine, and that makes for a truly positive annual exam next year!
BOTTOM LINE: Check your calendar, and if it’s been over a year since your last physical exam, pick up the phone and call your family doctor to schedule one!

Step Away from the Pumpkin!!

Okay, I should have posted this on October 1st, but here we are staring at Halloween this weekend, so here goes! Let me repeat- "Step away from the pumpkin!" How many of us started purchasing those convenient sized Halloween candies and filling and REfilling our countertop, desk, and break room candy dishes the day they started selling them at the grocery store? I can assure you that they popped up in my office OVER a month ago (I swear they start selling Halloween candy the day school starts these days...)
Now, I always maintain that there is no "bad" food- even my tempting Reese's cups. So what's my issue? When treats and sweets are sitting out, especially in bite-sized offerings, it is very easy to fall into the habit of grabbing one or two every time you pass by. Before you know it, you've added several hundred calories per day, and you're well on your way toward gaining the 7-11 lbs that most Americans add during the holiday season. Of course, if at the same time you've added in an extra hour of aerobic activity each day, it's all a wash. BUT...remember, this is the same season when we run from one activity to the next and unfortunately many people cut back on exercise- tough combo!
So, enjoy some fun Halloween candy, but make some healthy snacks and set those out instead of the pumpkin next week. AND, don't feel the need to polish off all the candy! Homeless shelters and food pantries often welcome your extra bags of candy to pop in a sweet treat in their offerings. Did your child manage to cover the entire state on her tricks and treats? Consider a few days of feasting, then put or give away the rest. Some families invoke the Halloween witch who arrives the Friday after Halloween and replaces left-over candy with a holiday book or other non-edible treat. My "trick" is to buy only one bag of candy that I cannot resist (which I buy on Oct. 30th), and make the rest of the Halloween give-aways fun stickers, pencils, toy skeletons, etc.
BOTTOM LINE: Enjoy Halloween, dress up, play and be safe- but break the candy cycle and try some healthy fall treats instead!

Cough, cough, cough...

Well, it was bound to happen- can't blog about the flu twice and not end up with it, right? Did I get it from our daughters? Doubtful, with the time frame. The incubation period for H1N1 is 1-7 days, typically in the first 4 days. But we're exposed at work (obviously, they come to see us!), the grocery store, and everywhere else. And yes, I wash my hands obsessively! How bad was my case? It's all relative, of course, but I would say "moderate" as I was wiped out in bed for 3 days with 102* fever, headache, body aches, sore throat and the COUGH from BEYOND!! Unfortunately the timing was such that I was speaking at the AAFP (American Academy of Family Physicians) the week following my illness, and though the fever was long gone, the cough only got WORSE! Of course, since I was surrounded with over 4000 other physicians, I was privy to many opinions and suggestions, and I'll tell you, I tried them ALL (with thanks to my peers, especially for the unique home-made concoctions, although sadly, nothing was a miracle cure that I can pass on to you.)
So, what do you do with a cough that wont go away? This is the point of today's blog. "Cough" makes the top ten list every year for reasons to visit your doctor. After many upper respiratory viruses, coughs will linger... for up to SIX weeks! A cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!
What can your doctor do? First of all, they do need to rule out any secondary infection such as a pneumonia. More commonly, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.
BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!

Flu tests- Fact and Fiction

How do you know if your flu is the H1N1 strain? Is there a quick test in the doctor's office?
Well, yes and no. Most primary care offices now have rapid flu tests in their offices that can tell you if you test positive for type A or type B influenza. If indeed you test positive for type A, at this point in the United States, you most likely have H1N1. 99% of samples of known positive type A flu that have been sent to the CDC are testing positive for H1N1. The difficulty is that the rapid flu tests are very specific (meaning if it is positive, you definitely have the flu) but not too sensitive (meaning if you do have the flu, there is a good chance - up to 30%- that the test will not show it.)
So, please understand that flu is primarily a clinical diagnosis. This means if you have high fever, intense headache, sore throat, cough, and body aches, and your doctor doesn't find evidence of any other disease (like strep throat or pneumonia), your doctor will likely conclude that you have influenza- whether or not she has the "proof" of a positive rapid test. It is also no longer necessary to send every positive type A flu test on to the CDC for confirmation that it is H1N1.
The good news is that H1N1 is proving to be primarily more mild than initially feared, and now treatment (meaning antiviral medicines) are only recommended for high risk groups (pregnant women, patients with poor immune systems as in cancer or HIV disease, young children under 5 or adults over 65, people with chronic diseases or people who are hospitalized.)
BOTTOM LINE: See your doctor and get tested if you think you have the flu, but understand the limitations of our current testing. Most importantly, remember GOOD HAND WASHING and STAY HOME if you have a fever!

Is that the FLU??

Picture your child miserably sick, teeth chattering, shaking chills, complaining of a sore throat, body aches, cough and headache. When you touch her forehead, she is burning up- sure enough, her temperature is 104.8*! As your brain is trying to process all this, she suddenly tries to jump out of bed and push past you but starts vomiting before she ever leaves her room. What is this? What should you do??
Well, this is no imaginary scene, but one I simply can recall from a few nights ago in our house, when our 12 year old daughter's flu symptoms first showed up...at 2am (of course ;0) What did I do? Well, with a fever that high, the first thing I did was to give her some liquid ibuprofen. (I picked liquid so it would be absorbed more quickly, and because she was more likely to gag and vomit again if she tried to swallow a pill. And yes, I got the ibuprofen in her before I cleaned up the mess.) We put a cold, wet washcloth on her forehead and I read to her (as a distraction) for the next half hour while the medicine was kicking in. By 3am, her temperature was out of the scary range, and "just" 102*.
What I want to emphasize, though, is not the care of a high fever. I want to make it clear the difference between a common cold and the flu. A cold can cause headache, stuffy/runny nose, and sore throat, but generally does not cause intense body aches and high fevers. The flu is not so subtle! It often comes on suddenly, and the flu victim typically feels (and looks) like they've been hit by a Mack truck, with serious aches and pains in their muscles, bad headache, intense sore throat worse with swallowing, high fever, and often a cough.
So, what did she have? The flu. What type? Presumably H1N1 as 99% of type A influenza being tested right now is H1N1, and she had repeated exposure to friends & classmates with confirmed type A. She became ill on Saturday, missed 3 days of school, and is now 7 days later she is feeling back to normal, although easily fatigued.
BOTTOM LINE: Recognize that a stuffy nose, low grade temperature (99*) and sore throat are uncomfortable but very unlikely to be the flu. High fever, chills, headache, cough, sore throat and body ache at this time is most likely influenza- see your doctor and try to limit your exposure to others to slow the spread of this year's flu!

A BETTER cleansing diet

"So if I don't need colonics to cleanse my body, what can I do to get rid of all the toxins in my body?" Are you sure you are ready for my answer? If you've seen me as a patient or know me personally, you already know my answer...
If you are really ready to work hard to increase your energy levels and improve your health, then the "cleansing" diet you want is simple- stick to fruits, vegetables, and a protein source at every meal and snack. Eliminate processed foods. Skip anything with high fructose corn syrup and every other additive or chemical that you cannot pronounce.
Drink WATER- add a lemon or lime slice for a change of taste now and then. If you are serious about "eliminating toxins", give up caffeine, alcohol and artificial sweeteners, too!
How long do you have to stick to this SUPERCLEANSE diet? Start with one day, and see if you can't last several days. If you really want to jump start a weight loss program, commit to a whole week! This is not a very low calorie diet that requires medical supervision, and it is not dangerous in any way.
Do I think you need to live on this forever? Well, you'd certainly be healthy if you did! I do this periodically, but I love baking cookies and having my occasional Coke too much to commit to it permanently.
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!

Doc, do I need to stop...?

How much is too much? Well, it depends. Are we talking about alcohol? Tobacco? Cigars? Sweets? The occasional recreational pot use? (For the record, if it’s illegal or tobacco, I think any amount is too much!) There are many definitions of substance abuse, but I have a favorite one that a wise attending physician taught me during medical school. He said that when patients ask him if they need to cut back on something, he would reply, “ If I tell you that you absolutely cannot have it for the next thirty days, what would you say?”
It’s really a great gut check. If your doctor tells you no wine with dinner for the next month, and you feel an immediate panic or protest, perhaps you’ve become too dependent on that habit. Now, before everyone tells me that we believe a glass of red wine per day enhances your health, let me say that as long as you have no medical issues precluding alcohol (liver issues, medications that interact with alcohol, etc.) I happily agree! BUT, what we think is healthy is a 4 oz glass of wine. When is the last time you poured yourself only 4 oz in a lovely red wine glass? And do you stop at one?
The point of this blog entry is not at all to pick on wine at dinner, which happens to be my own favorite vice, but to point out that it’s healthy to occasionally step back and look at our indulgent habits and see if we’re becoming too dependent upon them.
BOTTOM LINE: It’s TOO MUCH if the thought of giving it up for a week produces anxiety!

Normal aging or Alzheimer's?

July 4th evokes deep emotions within Americans, as we reflect on our many freedoms in this great country. This holiday has an additional significance in our family. My mother endured Alzheimer’s for nearly twelve years, and gained her freedom from this physically and emotionally sapping disease on July 4th, 2004. While our family was deeply saddened by our loss, we were relieved that she was no longer suffering the daily frustrations inherent with severe memory loss.
Many people are fearful that they are developing Alzheimer's disease. Do you forget why you walked in a room? Can't find your keys or the tv remote? Couldn't think of an old friend's name when you ran in to them at the store? RELAX- none of these episodes are unusual for a healthy, busy adult. Typically these things happen when you are stressed and simply not paying much attention to your task at hand.
What is concerning, then? Forgetting directions to the grocery store where you always shop; missing multiple appointments because you confused times/dates; being unable make change or figure out tips (when you could before) or not being able to name common objects (like a watch or a shirt.)
If you think you are having significant memory issues, please go and see your doctor! There are many causes of memory loss that are correctable, and even if you do have early Alzheimer's disease, we have good medicines that really slow the progression of disease.
Bottom Line: Memory loss with Alzheimer's Disease can be distinguished from memory changes with normal aging; if you are concerned, go see your doctor!

Farewell, Farrah- From Charlie's Angel to our REAL HPV Angel

We all were desperate to have Farrah's hairdo, complete with gorgeous waves and "feathers". Farrah's character- JILL- (yes, I loved that!) was our icon of beauty back then. Which of us would have predicted this stunning actress's final performance would be the real story of her painful struggle and death from a not-s0 glamorous disease- anal cancer.

Ninety percent of anal cancers are thought to be caused by HPV, the human papilloma virus. Smoking is also a significant risk factor, and the highest rate of anal cancers occurs in white females and black males. HPV is transmitted via direct, skin-to-skin contact, often through intercourse. There does not need to be anal penetration to develop HPV infections (warts or cancers) in or around the anus.

The good news is that we now have a vaccine that protects against two strains of HPV that cause 70% of cervical cancers. A bonus to the vaccine is that it will help protect against other cancers also linked to HPV such as anal and penile cancers. Would Farrah still be alive and thriving if Gardasil had been available 30 years ago? Possibly. BUT, not if she chose not to get the vaccine.

BOTTOM LINE: I hope Farrah's death and her willingness to share her story despite the awkward nature of the topic and the intense personal strain will motivate her fans to vaccinate their children against HPV. In that way, Farrah Fawcett will become a REAL angel for another generation.

Disney Delerium

Wow, our summer is full speed ahead! Our girls' dance troupe was thrilled to perform at Disney World's Downtown Disney stage last week, which meant four days of park hopping craziness with half the sleep and twice the heat. I believe Disney must be not only the "happiest place on earth", but one of the most challenging family destinations.

How many families have kids who all have identical likes and dislikes when it comes to an amusement park? Usually one likes shows, another likes the characters, another ONLY wants to do the "thrill rides" that give mom vertigo, and one develops a fear of darkness and loud noises. Unless you've been lucky enough to have a parent for every child (ie., able to divide and conquer), this creates a wonderful opportunity to work on compromise. Except that everyone is tired, hot, hungry, and cranky by mid-afternoon.

My completely unsolicited advice? Be at the gates when the park opens, with fully fed (if not fully awake) kids. Cheerfully rush in with the other Disney Commandos, and you will likely be able to hit a dozen of your favorite rides in the first two hours. Do the "kid swap" where a kid that does not want to do the ride only has to stand in line with the gang, but then is allowed to wait with an adult rather than be dragged kicking and screaming (as we saw, believe it or not, on Small World) on a ride that terrifies them. Then, as the lines swell, slow down and grab food and drinks, and do the shows. If possible, take an afternoon break and go back to the hotel for a swim.

It's easy to get caught up in the desire to stay at the park because of how much you paid, but is it worth it if the kids are whiny and miserable? Enjoy it in chunks, and relax.

Bottom Line: Remember you are at amusement parks for FUN and family memories. Stay flexible, and don't force the "FUN" on a terrified kid!

Is it summer yet?

In our house, we're finally down to the last week of school- yea! Both kids and parents (not to mention teachers!) are all really, really ready for summer. Even adults who continue to work full time throughout the summer have a sense of anticipation for some lazy summer days. Everyone should get outside and soak up some liquid Vitamin D sunshine- but not so much as to invite a sunburn!

Time flies faster each year (gee, our parents were right about that) and summer is no exception. If you don't set some family rules for summertime, before you know it your kids will be sprouting roots on the couch, permanently attached to their iTouch/laptop/other handheld electronic device.

The good news is that when electronics are time restricted, kids are amazingly creative with their "extra" time. From creating dances to painting rocks or playing board games, their are a million activities that kids don't have time for during the school year, yet should have plenty of time for in the summer.

The AMA, AAP (Amer. Academy of Pediatrics) and the AAFP (Amer. Academy of Family Physicians) ALL agree that the MAXIMUM amount of total daily screen time should not exceed 2 HOURS.

So, remind your kids they have a watch, or get them a stop watch so they can keep track of their own screen time. TV shows are easy to count, but get that clock running when they plop down with their lap top or iTouch...

Bottom Line: LIMIT SCREEN TIME this summer, and you'll find your kids enjoying a larger variety of activities and stimulating more corners of those wonderful developing brains!

From Dr. Seuss to Rick Riordan and Percy Jackson- why you should READ to your BIG kids!

Our girls are 10 and 12- just finishing 4th and 6th grade, which means (at our kids' school) that both will officially be in middle school next year. People are often surprised if it comes up in conversation that I still read to our girls. "Aren't they a little old for that?" they ask. Absolutely NOT! We're not reading Dr. Seuss these days, but immersing ourselves in adventures of Harry Potter or Percy Jackson, or stepping back in time as we read an American girl story.

When do I find time? Honestly, if we did it after school, their activities would often pre-empt it. If we did it at bedtime (we've tried this) I fall asleep! So...we simply start the day roughly 20 minutes earlier. It used to be 10 minutes, but we find we are so immersed in the stories that we needed more time. The dog and I head up stairs and land on the bed of whichever girl's turn it is, recruiting the other daughter along the way. The girls slowly wake up as I read aloud the next chapter (or whatever 20 minutes ends up amounting to in the book), and by the time everyone needs to get moving towards dressing and breakfast, we're all fully awake and generally filled with at least mental energy as we file downstairs, talking about what will happen next.

I cherish this time with the girls. Sometimes they want to take a turn reading aloud, but often they prefer to close their eyes and absorb the story. In their scary world of instant gratification, they at least have learned the joy of anticipation as we strictly enforce the "no cheating and reading ahead in OUR book" rule.  As we have followed several series- early on with the Magic Treehouse series and lately especially the Percy Jackson and the 39 Clues books by Rick Riordan- our girls have had the fun of following characters over time. They are growing up along with the characters, and look forward to the next book being released by their favorite authors.

BOTTOM LINE: Your kids will NEVER outgrow the joy of reading books together- and the resulting conversations keep getting better and better! 

Women's Health Week 2009!

What perfect timing for the U.S. Dept. of Heath and Human Services to declare "Women's Health Week 2009"- starting with Mother's Day!  Following up April as STD Awareness month, now we focus on all aspects of women's health- physical, mental, and spiritual. Are you a "superwoman" trying to do all and be all for everyone? Looking to excel at home, at work, and in the community? Well, first of all, realize there are only so many hours in the day. While I'm delighted if you are not spending those precious hours simply glued to a screen (including this one!), I do want to emphasize that many women put their own health dead last in their "to do" list- and that is NOT good. 

Why not use this week to take inventory of your health? Are you due for a complete physical with your family doctor? Did you remember to go and get your mammogram after your last exam? How long has it been since you followed up on your high cholesterol? And what happened to all those fruits and veggies that you intended to focus on during 2009?

Check out the Women's Health Week website at http://www.womenshealth.gov/whw/about/ for some great suggestions to start addressing all these concerns. Don't forget about your mental health, either! It doesn't have to be formal therapy to help. Sign up for a fun, heart-rate stimulating class like a tap dance or martial arts class. Grab a friend to do it with you, and you're more likely to follow through.

BOTTOM LINE: Pick at least one positive activity for your health (or that of your favorite female) this week, and make it happen! And guys, your week is coming up along with Father's Day, so don't sneak away...

H1N1/Swine Flu- is it "Aporkalypse" now?

Will we remember May 2009 as the beginning of the "Aporkalypse"? Will Swine Flu, now known as H1N1, cause global panic? The media coverage of this flu outbreak this week has created widespread concern and in some cases, panic. Our kids had cancelled dance recitals, soccer games, and band competitions as school districts and UIL leaders began to close schools for after hours and weekend activities. Is all this really necessary?

Well, I certainly hope this is all overkill. We need to recognize that the CDC is doing their job, and by their criteria, even though the actual numbers are small, there are enough separate countries and regions with cases of this flu that H1N1 does indeed qualify to be called a "pandemic".  Time will tell us in the next couple of weeks just how virulent this virus is in humans. Right now we know the virus can still be killed by two antiviral medicines, which is great news. We know that there is evidence of mild disease as well as severe. What we don't know yet is how much of the influenza A that we physicians have been diagnosing this year is really H1N1- we didn't start LOOKING for this virus until last week. 

Hopefully, most of the cases of H1N1 will prove to be mild, with patients healing even without any antiviral medicines. We need to realize that our "regular" flu is a serious disease EVERY year, and even in 2009 we have had over 800 deaths per week in the United States from this annual hazard. Ever wonder why primary care physicians are such fans of the flu vaccine?

Good basic prevention is ALWAYS in style. Wash your hands in soapy water for 20 seconds before meals. Use hand sanitizer. Use the wipes on the grocery cart at the store. If you have a fever (temp >100.5), sore throat, runny nose, cough, and body aches- see your doctor. This is a time for caution, not fear. Let's not contribute to our health care expenses by going to the emergency room with the common cold.

BOTTOM LINE: The jury is still out on how severe the H1N1 Virus will become. Let's use common sense and soapy water, and remember to get your flu vaccine every year to help prevent "regular" influenza, a known killer disease.

Healthy Teens, a Music Video, YouTube and STDs??

What can healthy teens, a music video, YouTube and STDs have in common? The 12 Days Of April- aka. "GET TESTED!!" Wonderful teens Catherine "Cat" Butler, Kat G., Nate & Connor McLauchlan all agreed that posting a video on YouTube that featured teens singing about STDs might just be an effective way to reach their peers with an important message. Huge thanks to Dona LeBlanc for her beautiful voice and creative playscape, as well as to her son, Matt for his participation in our dress rehearsal and creative costume additions. Kudos to Richard Lampert, our videographer and computer expert, for his time, talents, and humor. Thanks to Coni for her artwork, and to all the teens' parents for having open minds about letting their kids help other teens with an awkward topic!

So why SING about sexually transmitted diseases? Well, why not? Songs creep into your brain and often crop up years later when something triggers a memory. Picture this-in the middle of a frat party in December, the 12 Days of Christmas starts playing, and instead of "Five Golden Rings" the reminder "Most STDs are SILENT- GET TESTED!" pops into a few mildly intoxicated brains! How great would that be?

Click this to see video: http://www.jillgrimesmd.com/audiovideo-12days.html

BOTTOM LINE: We've got to think out of the box to find new methods to teach people the facts about sexually transmitted diseases so they can make educated choices and preserve their health and fertility. 

Turn Off Week!

Okay, how ironic is it to enter a blog on "turn off week"? Because really, I hope you're not reading this- at least not THIS week! April 20-26th has been designated as "turn off week" to remind families that we really need to be conscious of screen time. What counts as screen time? TV, computer games, WII, email, twitter, facebook- you name it! If it involves a screen of any sort, it counts.

Does this mean you shouldn't check your email or do computer-based homework this week? Our reality is that we rely on our computers for important messages from work or school, and many run their calendars this way, so it's not practical to insist on cold turkey. However, let this be a week where you try to minimize your computer time to actually required interaction, and try NOT to use the computer for entertainment. Pull out a board game or jigsaw puzzle. Grab your helmet and hop on your bike or rollerblades. Take your dog for a walk. Mobilize the family and walk to your favorite local dive for Saturday morning breakfast. 

We need to set the example in our homes that we ENJOY interacting with other humans! Too many kids think play dates mean going over to a friend's house to play video games. Believe it or not, if you turn off the electronics, kids are amazingly creative in their play- BUT, you've got to set the rules.  Screens are not inherently evil or bad, but like everything else in life, they require moderation. Use this week as a springboard towards a more active and interactive lifestyle.

BOTTOM LINE:  Let's use this week to reconnect with our families and friends face to face- not through a screen!  For more information on turn off week, go to http://www.tvturnoff.org/ 

"Passover" the Easter candy!

Happy Easter! And happy Passover, as well. I hope everyone had a wonderful time with their families during these holidays- even if there were occasional squabbles or tears over who ate the bunny ears or who found more hidden eggs. And now comes the hard part...what do you do with ALL THAT CANDY? Let me suggest that the answer is NOT to spread it out over the next week or two, allowing yourself to grab some chocolate with each pass through the kitchen. Before you know it, the calories will erase any hard work you've done since those New Years resolutions have kicked in. Instead, how about donating them to your local homeless shelter (or wherever you know they might be needed.) I'm not about wasting food, but I also realize that candy kept in the house ends up frustrating weight loss goals!

BOTTOM LINE: Enjoy the holidays, treats and all, but give it an end point and jump right back into focusing on MORE fruits and veggies each day!

STD AWARENESS MONTH!!

It's no April Fool's joke that over 20 million Americans have HPV (the Human Papilloma Virus), one in five Americans over the age of 12 have genital herpes, and over 4 million Americans annually catch gonorrhea and chlamydia, which can lead to chronic pelvic pain, pelvic inflammatory disease, and infertility. We spend over $15 billion annually on medical costs directly from STD, so let's start some health reform HERE! If you see someone wearing a green "cause" ribbon this month, they are promoting the CDC (Center for Disease Control) STD Awareness Month.
This is a wonderful opportunity to open a conversation with your teen about some of the risks of physical intimacy. Even if your family promotes abstinence, you need to be certain that your child understands that herpes, HPV, syphilis and even pubic lice ("crabs") can be transmitted by direct skin to skin contact- no "sex" of any kind required! This is how virgins can still catch STDs- a bizarre concept, I know. Additionally, even though it will likely be an awkward discussion, be sure that your teen understands that oral sex can transmit STDs, and in fact, is a very common way that people catch genital herpes. There does NOT need to be a visible cold sore present on the "giver's" mouth for this to happen!
BOTTOM LINE: Let's take advantage of this STD Awareness month designation to make certain that our friends and families learn the facts about STDs and go get tested if they are at risk! Check out the CDC's website for more info. http://www.cdcnpin.org/stdawareness/sam.htm

Silent but deadly

Chlamydia is now the most commonly reported notifiable disease in the United States, with annual cases reaching over a million for the first time in 2006, and now the recently released 2007 statistics show an increase to 1.1 million. Chlamydia is actually very easily treated and CURED with antibiotics, so what's the big deal? Well, the big deal is that you have to know it is there to treat it, and Chlamydia is silent in half of men and 75% of women! Chlamydia will happily remain in your reproductive tract, setting up shop and potentially scarring your tubes and impairing your fertility for years if not treated. It is estimated that if we physicians started screening every woman who is sexually active, we would annually prevent 60,000 cases of pelvic inflammatory disease, 8,000 cases of chronic pelvic pain and over 7,000 cases of infertility! Talk about saving heart ache, pain, and not to mention countless health care dollars!
So, what's the myth? The myth is that you will KNOW if you have an STD. The FACT is that most STDs are silent, and Chlamydia is one where silence is deadly.
BOTTOM LINE: If you have had a new sexual partner, please go to your physician and ask to be tested for all STDs, especially Chlamydia. Do NOT wait for symptoms to worry about STDs!!

Summer lovin'...

Happened so fast! Okay, I'm still on a "Grease" theme, but hey, the music fits the topic! So, what's next? HPV- the Human Papilloma Virus. Did you know over 20 million Americans have active HPV infections as I type this? That over a million Americans have genital warts at any given time? HPV is VERY COMMON. The good news is that now we have Gardasil, which will protect young women against both genital warts and cervical cancer. The bad news is that people are nervous about giving their daughters the vaccine. Remember, we give all babies the hepatitis B vaccine in the first day of life. Hepatitis B is spread through IV drug use and sex, but we give to everyone so we can prevent the end stage disease, which is liver cancer. Similarly, while it's great to prevent genital warts, the larger purpose of Gardasil is to prevent cervical cancer. The safety studies on Gardasil are in (see my earlier post "and she's safe") and so yes, I will be vaccinating my daughters.
So, what's the biggest myth about HPV? I'd have to say that people believe you have to have sex to catch it. HPV is spread from direct skin-to-skin contact- no sex of any kind needed. Condoms can't cover all the area that can harbor HPV, so they can't fully protect against it. Genital warts can show up anywhere that there was direct contact- from the upper thighs, to the anus, to the standard "private parts", and they are no fun to have treated. Having said that, don't wait to come in if you think you have a wart, because the smaller and fewer they are, the easier they are to treat!
Second biggest myth is that genital warts turn into cancer- NOT TRUE! The types of HPV that cause 90% of genital warts do NOT cause cancer.
BOTTOM LINE: HPV is VERY COMMON in the United States. I recommend Gardasil (and no, I'm not on Merck's payroll in any way, shape or form!). Warts do NOT turn into cancer, but untreated silent HPV might- get those Pap smears!

"Tell me more, tell me more..."

Was it love at first site? Okay, that's a Grease reference, for those of you who may not recognize it. Can you believe John Travolta has thrilled another generation of girls- and this time, HE is a MOM?? Gotta love Hairspray...
But I digress! What I want to talk about this month is STD myths. While I could tell you to go buy and read Seductive Delusions for all the answers, I find that people frequently ask me to "tell them more". So, for the next few blog entries, I'll try to hit the highlights on some of the major sexually transmitted diseases.
Herpes, from it's sheer numbers, must go first! Somewhere between half and 75% of Americans test positive for herpes, meaning that they carry antibodies to herpes as a result of being infected- whether or not they get blisters. It is believed that 90% of people with genital herpes, for example, are completely unaware that they have it. While that is GOOD news for them (they are lucky that they don't experience painful blisters) it's BAD news for their unknowing partners who might contract herpes from them. There is no correlation with the severity of disease from one partner to the next, even though it is the same virus. Put another way, you may break out once per year, but the partner you gave it to might break out every month! Not the gift you want to give. The biggest myth about herpes is that people believe cold sores are NOT herpes, and perhaps that is why they do not believe that oral sex can transmit herpes.
BOTTOM LINE: Herpes is COMMON. It is spread whether or not you know you have it, whether or not you can see any blisters. Herpes is VERY OFTEN spread from one person's mouth ("cold sores" or "fever blisters") to another person's genitals through oral sex.

STDs and "GOOD" kids

Do these belong in the same sentence? STDs and GOOD kids?? Yes, they do, on many levels. People ask me why on earth I wrote a book about STDs. I wrote Seductive Delusions for multiple reasons, but what spurred me over and over again was every time I diagnosed a young patient (male or female) with a sexually transmitted disease and they gasped in shock and through tears and disbelief saying "there's no way that's possible- I haven't even HAD sex!" Whether they had participated in oral sex or simply had physical intimacy with direct skin contact but no intercourse, these young people THOUGHT they had "drawn the line" soon enough to avoid disease. Instead, they ended up with herpes or HPV (the wart virus) and I have to tell them that we have only treatments for outbreaks but no cure. Their moment of passion resulted in a lifelong disease.
As parents, physicians, and educators of all types, we have got to do a better job teaching our youth about the real risks of physical intimacy. STDs are not hidden in some dark corner of our society! Let's use language they understand, and put a familiar face on these diseases. Up to one in four young American adults have genital herpes, and over 20 million Americans have active HPV. In 2006 and again in 2007, we had over 1 million cases of Chlamydia (which is TOTALLY curable if found, but is silent nearly 75% of the time in women and 50% of the time in men! Untreated, it can lead to chronic pelvic pain and infertility.) Please read my ten tips for talking to teens about STDs for addition information (go to my home page on JillGrimesMD.com.)

BOTTOM LINE:Don't assume all youth practicing "abstinence" are free from the risk of sexually transmitted diseases. Let's give our intelligent but hormonally driven youth all the facts they need to keep their bodies safe!

Resolutions still going??

Happy Ground hog's Day! Don't know if we'll have more winter or not, but regardless, it's time to check in with your New Year's Resolutions. Are they working? If not, why not?
Let's take the healthier eating resolution first. We've finally cleared out the holiday candy, and now here we are in Girl Scout Cookie season and Chocolate Pig Out Day (aka Valentine's Day) is around the corner! Does this mean you shouldn't support the scouts? Of course not!! But consider buying ONE box for yourself, and a couple boxes for your favorite local charity or food pantry. If you're seriously counting calories, ask your sweetheart for a personal training session gift certificate (or even a manicure certificate) rather than that box of Godiva chocolates. Keep focusing on eating MORE fruits and veggies, and healthy eating will become part of your life instead of an onerous "resolution".
And what about exercise? Did you join a gym, but now you're not going? If you did, find a friend and commit to one another to go. Reward yourself when you DO go- but make it a non-edible reward! Buy a new workout outfit or treat yourself to a romance novel or humorous book- whatever works for you, but doesn't ADD calories. Keep track of your exercise in a VISIBLE place- your calendar (on the computer or in your kitchen- whatever one you rely upon will work) and reward yourself at the end of the month.
BOTTOM LINE: If your healthy resolutions are working- WAY TO GO and KEEP IT UP! If not, figure out why, modify them so they WILL work, and get back at it!

Lose 30 lbs in 30 days!

Okay, please tell me you know that the only way to lose 30 lbs in 30 days is via a gastric bypass operation! This post is certainly NOT to convince everyone to sign up for surgery, but to make it crystal clear that advertisements that suggest this type of weight loss are all ridiculous! Of course, we'd all like to believe that weight loss could occur that fast, but let's look at the reality. It takes a deficit of 3600 kcal (calories) to lose ONE pound. Period. There are no short cuts (excluding temporary water weight shifts.)
If you simplify the math by rounding down to 3500 kcal and dividing by 7 days in a week, it takes a deficit of 500 kcal/day to lose a pound per week. Now, if you're snacking on a bunch of candy (271 kcal in a snickers, for example) or drinking frequent sodas (roughly 150 kcal/can), it can be simple to eliminate 500 calories per day, but if you're already making healthy choices, focusing on a 250 calorie daily deficit (which equates to a half pound weight loss per week) might be more realistic. Before you decide that a half pound per week weight loss isn't "worth it", realize that in one year, you're looking at 25 pounds coming off!
Of course, coupling fewer calories consumed along with exercise (more calories burned) is really the way to go. Again, realize that small efforts "count". An easy rule of thumb is that walking a mile burns around 100 calories and takes only 15-20 minutes. So, if you simply give up one Coke (or latte, or...) and add walking one mile per day, you'll be looking at a healthier, thinner you in 2010 by up to 25 pounds!
BOTTOM LINE: It's calories in/calories out that count- to the tune of 3600 calories per pound. Set your goals realistically, and watch your health really improve this year!

Realistic resolutions!

Happy New Year! Welcome to 2009. Let me challenge you to make THIS the year that you finally prioritize your health...for the FULL year (and hopefully beyond.) Almost everyone makes the annual resolution to lose weight and start exercising, but how many people are still focusing on this by the time February rolls around?  

This year, why not set yourself up for success? Create accountability for yourself around the time your motivation might begin to wane. Schedule a physical with your physician- for late February, or maybe March. Book  a few personal training sessions, and consider spacing them out to once or twice a month if finances are tight. Sign up for a race- it can be a walking 5K or a full fledge triathlon- but the point is to focus on a specific goal. Conquer that goal, and set another one!

Try to commit to specific, concrete changes. "I want to lose a bunch of weight" is much less helpful than "I will eat a minimum of 5 servings of fruits and veggies per day". 

Involve friends. Chances are you have one or two close friends or neighbors who would be delighted to commit to walking around the block together. Walking and talking seems much less like required exercise, and more like a stress release.

BOTTOM LINE: Look at your life and pick one or two very specific lifestyle modifications that will make a difference long term, and consciously decide what accountability you need to make them stick. Here's to a healthy year!