100 Questions and Answers about Anorexia

As a family physician, mother, and Girl Scout leader, I am always
excited to find new tools to help our youth. 100 Questions & Answers
about Anorexia Nervosa fits the bill in all categories. Dr.
Shepphird's book is a practical, informative, accurate and thorough
resource appropriate not only for medical providers, but for patients,
family members and friends of anyone suffering from anorexia.

From the obvious but important first question, "What IS anorexia
nervosa?" to the deeper probing "My daughter recently said she just
wants to lose 'a little weight' in order to feel better about herself.
Should I be concerned?" these hundred questions tackle virtually every
aspect of an overwhelmingly prevalent disease.

Perhaps what sets Dr. Shepphird's book apart the most is her
powerful integration of personal comments in every section from two
successful women who have battled anorexia. Lynn was a world-class
athlete whose victories masked her eating disorders until her poor
health ultimately ended her competitive career. Sarah is a young
college student who began her struggles with anorexia in eighth grade.
Although (or perhaps I should say instead - not surprisingly,) Sarah
excelled in dance, school, and the social scene as she strove for
perfection across the board. Her slippery slope into eating disorders
began with the "success" of losing just three pounds. These stories
truly engage the reader. In fact, my teenage daughter found herself
skipping "the other parts" and simply reading all these stories
interspersed among the Q&A.

The statistics surrounding anorexia are staggering. Anorexia has the
highest premature death rate of any mental illness and it occurs most
often in our teenagers. We're fighting societal messages that you can
never be too thin, and that skinny equals success. Adult leaders
unaware of accurate eating disorder information can easily
inadvertently worsen the self-image of their teens, especially in
weight- focused sports or mirror-surrounded dance studios.
BOTTOM LINE: Coaches, teachers, scout leaders, clinicians and parents can all benefit from
reading 100 Questions and Answers about Anorexia.

Is a TATTOO for you?

From Angelina to Jesse, tattoos are in the news. The popularity of tattoos has soared in the last decade. I'd estimate in my suburban Austin practice that somewhere between 50-75% of my patients under the age of fifty sport a tattoo somewhere on their body. Many are discreet- a simple musical note above the ankle, or a heart or butterfly tucked away in a typically clothing covered area. The twenty-somethings often prefer what is jokingly referred to as the "tramp stamp," which is the tattoo centered in the back, peeking out above their low cut jeans and thongs. Another favorite spot for women is the back of the neck, only revealed when they wear their hair "up".
Some people take their tattoos to the extreme, including full body art work that literally takes decades to complete.
What is my medical advice regarding tattoos? Well, I've seen a few nasty skin infections in fresh tattoos that end up leaving the owner with a very disappointing outcome, but with proper skin care (and antiseptic technique during its creation) most tattoos are relatively safe. But please note that I say relatively! Why? Because any time you are dealing with breaking the barrier of the skin, there can be transmission of infection. For example, though it is uncommon, we do know that there are cases of hepatitis C that have been transmitted from tattoos. Make sure the tattoo artist is not only using clean needles, but fresh ink as well!
My motherly advice includes the suggestion that you pick a location on your body that is not always visible. Neck, hand, forearms and lower leg tattoos may clash with business attire in a future job interview, and "perky" young body parts do not always stay quite so...young. I'd advise trying a few long lasting, but non-permanent tattoos (henna) before making the life-long commitment of a "real" tattoo. Remember, there is reason that you see so many ads for laser tattoo removal!
BOTTOM LINE: Single, professionally-crafted tattoos pose little (but not NO) true medical risks, and need to be considered a permanent choice (translation, do not make this an impulsive, perhaps alcohol-enhanced decision!)

Hearts a-flutter

Have you ever had the sensation that your heart was jumping around, skipping beats or "fluttering"? Doctors use the word "palpitations" to describe this feeling. Patients experiencing palpitations are often very worried that they are going to have a heart attack. The good news is that the vast majority of the time, early or skipped heart beats cause nothing more than the simple sensation of a heart "hiccup". They are not dangerous, and do NOT lead to additional problems. (Of course, you need to check with your doctor about your symptoms to be sure you are not in the percentage that has a truly concerning arrhythmia, but be reassured this is uncommon.) Now, if your "heart hiccups" are also associated with increasing shortness of breath or trouble exercising- that's a different ball game, so head to your doctor now to be checked out.
Heart attack symptoms, on the other hand, rarely involve any type of flipping sensations- instead, think more about escalating pressure and squeezing chest discomfort, as well as nausea, sweating, and shortness of breath. Palpitations, on the other hand, most often occur without any other types of discomfort, and may occur in healthy young people as well as those medically challenged.
There are numerous triggers for palpitations. The most common ones I see in my practice are decongestants and caffeine. Alcohol overindulgence is another frequent cause. Once we identify the trigger, avoidance is the simple treatment. For patients who develop persistent palpitations, there are medications available to reduce the symptoms (and therefore the patient's anxiety from the symptoms) but they are not typically necessary.
BOTTOM LINE: If your heart is flip-flopping, reduce stimulants such as caffeine and decongestants, and head to your doctor to get checked out- but don't worry that this is leading up to a heart attack.

The Sunshine Vitamin

Do you remember which vitamin we get from the sun? It's Vitamin D, and it is front and center in the news these days. We used to think that Vitamin D deficiency only existed in the geographical areas where there was less sunshine- think Seattle or or the Northeastern states in the winter. I was taught that a mere fifteen minutes per day of sun exposure to your face and arms would do the trick to supply your daily needs of the sunshine vitamin.
Surprisingly, in the past several years, studies have consistently shown that Vitamin D deficiency is widespread in the United States, even in the Sun Belt! In fact, I have been screening my adult patients in sun-filled Austin, Texas, for the last year, and I have found that only one out of ten patients have NOT been deficient!
What are the symptoms of Vitamin D deficiency? Many people know that Vitamin D is linked to bone health, and deficiency puts you at greater risk of fractures. However, there are many other potential symptoms of Vitamin D deficiency that may be subtle, can including fatigue, low energy, decreased immunity, depression, muscle weakness, cramps or altered sensation.
If it's not enough incentive to know your Vitamin D level to avoid those symptoms, consider this: recent studies show that having good levels of Vitamin D correlates with lower levels of colon, breast and prostate levels.
If your level is super low, you will need a prescription dose of Vit D replacement for a few months (50,000IU tablet once per week), but many people simply need to take an over the counter dose of 2000 IU per day.
BOTTOM LINE: Talk with your doctor about checking your vitamin D level (ask for "25 OH Vitamin D" level) and get some sunshine in your life!

Do I have Alzheimer's?

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.
CHECK OUT the Alzheimer's Association's "Ten Signs of Alzheimer's"
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!

Still Alice- a MUST READ

My mother passed away five and a half years ago after a twelve year struggle with Alzheimer's disease. Now, my father has dementia from Parkinson's disease (which for all intents and purposes looks Alzheimer's). Dementia- which means progressive memory loss- is tough on everyone. There is no "noble battle" aura like we have when people fight cancer. Friends often disappear, rather than increasing their presence. No one knows what to say. To quote my mom in a lucid moment, "It's not exactly FUN losing your mind!" Instead, our loved ones slowly, steadily slip away. It is absolutely heart-breaking.
Still Alice is a must-read for everyone, because if you don't yet have a friend or loved one suffering from Alzheimer's, odds are good that you will. Still Alice tells the story of Alzheimer's from the point of view of a young 50 year old Harvard neuropsychologist as she is diagnosed with and rapidly declines from early onset Alzheimer's. Although this is a fictional account, it is very accurate and insightful.
BOTTOM LINE: Pick up a copy of Still Alice today, read it, and pass it on.

hAPPy Birthday!

In honor of my first day being the parent of a TEENAGER, I thought I'd talk about some fun APPs. I am constantly amazed at the variety of health-related apps that my patients bring to my attention. I've already commented in a previous post about the period tracker (probably my favorite app to recommend). Several of my patients enjoy "Lose It", an app that is a basic food/exercise diary. They appreciate the immediate feedback- both from calories in ("OMG, I never knew Caesar salads had so many calories!") to calories out. Like a pedometer, people find ways to squeeze in just a few extra minutes of exercise when they see how it stacks up next to their intake. Another favorite is "Restaurant Nutrition," which gives you quick access to popular restaurant menu nutrition information. Can't sleep? Sleepmaker Wildlife is a free app for nature sounds to help you fall asleep, and there are several meditation apps that make it easier to relax, even if it's only a five minute escape.
BOTTOM LINE: Check out the free apps in the health section of the iTune store, and treat yourself to a few new techno-health aides!

Terrific Toenails

Okay, I'm definitely a fan of old-fashioned remedies that actually WORK, such as the old Vicks Vaporub on your neck/chest to help you breathe when your nose is stuffy from a cold or allergies. How wonderful that it doesn't make you sleepy or hyper while it works (unlike many of our decongestants and antihistamines.)
However, there is another use for this favorite product. Would you believe that putting vaporub on your yellow, thickened toenails will often cure the fungus causing this discoloration? Now, it does literally take months to see results, but even our expensive antifungal pills used for the same purpose take that long.
I read about this off-label use of vaporub over a decade ago, in the AAFP (American Academy of Family Physicians) journal. It was not a controlled study, and I know of no excellent evidence-based trials. I DO know that I have been recommending this benign treatment for more than ten years, and I estimate my patients' success rate around 80%!
The very best result I have seen was on my mother's toes, which had severe thinkening/discoloration, and they actually became almost normal in four months. I believe the trick was that she refrained from using any nail polish that whole time, and she was religious about putting on a smear of vaporub on her nails every night before bed.
BOTTOM LINE: Summer will be here in a few months, so consider an old home remedy for yellow toenails starting now!

VEGETARIAN does NOT equal HEALTHY!

How can eating "vegetarian" not be healthy? Is this a trick question? Absolutely NOT. When I see patients in the office, I frequently do a 24-hour dietary recall, which means I ask them to tell me every item (food and drink) that they put in their mouth the day before our visit. You'd be amazed at how often people are embarrassed (but honest!) with their replies.
What I have found is that many people who don't eat meats believe by default that their diet is healthy. However, chips, queso (cheese dip), sodas, french fries, pop tarts, and almost every dessert you can name are ALL "vegetarian"! You easily can go an entire day as a vegetarian withOUT eating a single fruit or vegetable.
BOTTOM LINE: Don't kid yourself that giving up meat makes you healthy- focus on eating FRUITS and VEGGIES to improve the quality of your diet!
PS. It's a new month, so CHANGE YOUR AIR FILTERS (See 2/1/10 blog entry)!