Happy Memorial Day!

Today we celebrate the memory of all the hundreds of thousands of courageous men and women who have given their lives for our country, and for the pursuit of freedom in other countries. What an amazing gift we have received!

I wish we voted on Memorial Day, as I believe we'd have a much greater turn out...what other country freely and loudly complains about their government (local and nationally) and then doesn't show up to vote?? But I digress...

I would like to use today's theme to transition into some blog entries on MEMORY. Memory itself is an amazing gift, and one we typically take for granted until we notice something missing. Memory is not only about the past, but is the key to hope of future events as well.

Dementia- memory loss- affects over five million Americans today. As our society ages, those numbers will escalate further. If you do not have a family member or friend affected by dementia yet, you are unusual- count your blessings.

Bottom Line: Today, on Memorial Day, let's be grateful for the precious gift of memory.

Get Cooking! (Another Summer Suggestion)

In our BORED list earlier this week, I didn't have space to include COOKING. Summer is a wonderful time to encourage your kids to participate in the family meal plan, as well as learning to cook. It's easy to fall into the routine of hot dogs, burgers, fries, and pizza, if you are not paying attention. Kids in general love to cook, and with no homework to tie them up, they're free to help out in the kitchen. Teach them how to safely chop up vegetables, or create a salad (even if they don't like salads yet, they can pitch in during the preparation.) Supervise them tossing ingredients into a slow cooker in the morning, and then they are proud they prepared dinner.

Another summer suggestion is to make sure every day's diet includes five to ten servings of fruits and veggies. Fruit smoothies are delicious, and especially refreshing in the summer. Toss a banana in the blender, add in a cup of yogurt and a handful of frozen berries, and you're all set! Right there, you've got a couple fruit servings.

Grab some melons- I'll bet a watermelon will disappear in a heartbeat! I challenge everyone to set out a platter of cut up melon, strawberries and grapes in front of some teens and see how long it takes for them to inhale it. Add some cheese and whole wheat crackers, and you've got a healthy lunch.
BOTTOM LINE: Include the kitchen in your summer fun!

Heartburn or Broken Bones?

Okay, I'm interrupting my summer tips with this "breaking" report. The FDA has issued a warning regarding proton-pump inhibitors (PPI's) which are medicines that stop acid production such as Prilosec, Nexium, Prevacid, etc. Six of seven studies showed that people, especially those over 50, who take these medications- whether they are the over the counter version or prescribed- for over a year or in high doses, have increased risk of fractures in their hips, spines, and/or wrists.

So what does this mean? Do you have to choose heartburn or broken bones?

Of course not. What it means is that these drugs, like every other class, have potential side effects. We need to use them judiciously, and not as a band-aid for a long term problem. GERD is typically caused by behaviors that can be modified: caffeine, alcohol, and nicotine are at the top of the list. Consider switching gradually to decaf, decreasing your alcohol intake, and quitting smoking instead of routinely grabbing your acid pill every day.

BOTTOM LINE: All medications have side effects; please review ALL of your medications with your doctor and see which, if any, can be reduced or eliminated if you are willing to make some behavioral changes.

OMG, IDK what to do without a screen!

So...keeping with the theme for the week, we're talking about summertime suggestions. If you limit screen time to two hours per day, what do you do for the other waking hours? Well, here's the good news, as a parent it is not your job to fill in all the blanks! I have always found kids to be amazingly creative and resourceful, when given the chance (or, okay, I'll say it- when they have no other choice.)

EARLY this summer, ask your kids to sit down and brainstorm, creating a list of at least a dozen (preferably more) activities. This is your "I'm bored" list! Post it on the fridge, and when someone says they're bored, refer them to the list. It works beautifully!
So, what might go on the list?

The obvious, first- READ A BOOK! Happily, this can be ANY book, not only the potentially required summer reading.

Board games always come next in our house. Clue, Monopoly, Sorry, and many more are fun, but get shoved to the back of the game closet during the school year. Don't forget checkers, chess, scrabble and Bananagrams!

Card games are another category- UNO, war, spoon, rummy- the list goes on and on.

Girls often enjoy a "salon" afternoon- pulling out every color of nail polish and giving each other pedicures and manicures.

Crafts may require parent supervision, but many do not. Finger knitting, rock painting, paper air planes, bracelets, key chains, bird houses...

Don't forget "sport" options- basketball, soccer, volleyball, or swimming. Pull out flashlights at night and enjoy a game of flashlight tag for "big" kids.

BOTTOM LINE: Have your family create a BORED list, and you WONT be bored this summer!

Screen Time Limits

Okay, it's summer, and my first suggestion was to RELAX. Does that mean vegging out in front of a screen? How much tv, videos, computer, iTouch, iPad, and iEverything is TOO much? Not surprisingly, I have an opinion, and so do the American Academy of Pediatrics, the American Academy of Family Physicians, and the AMA. "Too much" is more than TWO HOURS per day.
Does that sound like a bunch? It does to me, but sadly, the average American kid may have over six hours of screen time per day, by the time you add in all the different media sources.

Does this mean you should never allow your kids a movie marathon day? Of course not. However, unsupervised, many kids would choose to spend their whole summer in front of a screen. Set up the rules at the BEGINNING of the summer, so you're not forced to break a bad habit. Your world does not need to revolve around this schedule. Simply help your kids to be aware that if they want to hang out and watch movies, play Wii, computer games, or text their friends all of one afternoon, they should plan NON-screen activities for the next day.

Another option is to make a rule "no screen time before 4:00pm"- that wouldn't automatically limit screen time to two hours, but it would certainly encourage everyone to find other activities during the day...even if they sleep late.

BOTTOM LINE: Limit TOTAL screen time to TWO HOURS per day.

Almost Summer!

Wow! We're in finals week in our home, looking at summer officially beginning next week- yea! I can hardly wait for the break in homework and hectic schedules. No, it's not MY homework, but helping kids maintain focus or quizzing them for spelling certainly involves me, and I am the head chauffer for dance four days per week.

At any rate, we all welcome summer! So, I thought for this week, I would focus on some summer suggestions. Today's suggestion is deceptively simple- RELAX!! I think we have all become so programmed to cram in a million activities, that we tend to over-schedule our kids, even in the summer. By the time you include a camp or two, family vacation, service opportunities and sports obligations, your calendar looks as packed as the school year!

Make sure there is enough down time scheduled in (yes, I find if I don't block out some days/weeks, they will all fill up!) for your kids to actually say they are BORED. I think I can literally count on one hand the number of times our kids have complained of boredom, which tells me we have been too scheduled.

No kids to worry about? Well, you went to school for many years, so I know you still remember the joys of summertime. Look at your calendar, and see where you can schedule in some summertime relaxation. You're never too old for SUMMER!

BOTTOM LINE: Enjoy some real "lazy days of summer" this year, and rejuvenate!

Weighty Issues

The American Academy of Family Physicians is ramping up our patient awareness of individual responsibility and health choices. As family doctors, we certainly are well-positioned to take the lead on community education, as well as prioritizing preventative care with our patients. Has your doctor addressed your weight issues? Do you wish (kind of) that she would?

You may wonder why more doctors do NOT address their patients being overweight. Well, let me share a few (misguided) reasons. Primarily, doctors want to help their patients, but do not want to be perceived as rude or judgmental. Additionally, many doctors are overweight themselves, so it's a bit easier to turn a blind eye towards this particular issue. Physicians fear if they bring up this subject, they may be in for an extended visit that will put them running behind the rest of the day. Additionally, insurance companies do not want to reimburse us for nutrition counseling, and with our overhead expenses, we have to mindful of the bottom financial line. Finally, many physicians feel at a loss for what they can offer their patients.

I hope any doctors not actively addressing overweight & obesity issues will read the latest issue of AAFP NEWS NOW and see how I and many other FPs are tackling these obstacles. Feel free to forward this link to your doctor and open up the lines of communication for your health!
BOTTOM LINE: Ask your doctor about ALL your health concerns, including those 10, 20, 50 or more pounds you want to lose!

Pretty Toenails for Summer

Have you been sandal shopping yet? Well, here in Texas, it's already sunny & hot, and the kids are nearly out of school- we're ready for summer! Many of my patients ask my opinion about pedicures as they prepare for sandal season. So what do I think?
Overall, I am okay with pedicures. Make sure they use disposable blades and sterile equipment, and discourage too much "cuticle" work. If you have markedly yellow, thick nails, then I would suggest that you stick to the pedicure technicians smoothing out your calluses and consider leaving nail polish off for awhile (weeks to a couple months) while you treat the toenail fungus. The home remedy that I recommend for yellow nails is Vicks Vaporub applied to a naked nail each evening (even if you apply polish each morning- remove it nightly.)
Doing your own pedicure with a home foot bath? Remember to clean out the bath with a bleach solution between uses.
Last but not least, cut your toenails strait across (not curvy, like fingernails) to help avoid ingrown nails.
Bottom Line: Enjoy your pedicures (within limits) as you prepare for sandal feet!

The Fearful Flyer

Do you have travel plans this summer? Any fear of flying? If you do, you are not alone. Many people, especially since 9/11, are very nervous flyers. I know that I never had any issues about flying until I became a mother, at which point suddenly I was convinced I would die in a plane crash and orphan my child.
So what should you do? Well, there are many choices, but suffering in silence should not be one of them. First off, arm yourself with the facts that you are over thirty times more likely to have a fatal car accident than die in a plane crash. Most of the fear is not rational, however, so if the facts don't calm you, keep looking.
Plan ahead- create a diversion packet for yourself with an engaging book, music, or DVD. Get noise-canceling headphones (or at least good earplugs). It's amazing how when you can close your eyes and not hear the plane noises, you can relax much more easily.
Avoid stimulants like caffeine and decongestants- no need to ramp up your heart rate before you even get on the plane!
If you have the luxury of time before you travel, consider biofeedback, hypnosis, or meditation training.
What can your doctor do for you? We have several choices, actually. For long flights, I will frequently prescribe a "sleeping pill" such as Ambien or Lunesta. Some patients do very well with medicines that simply control your heart rate, such as metoprolol (a beta-blocker). Others with more intense anxiety respond well to a rapid and short acting sedative such as Xanax.
Bottom Line: Fear of flying is common- plan ahead and talk to your doctor if you would like to consider a medication to lesson your stress.

Happy Birthday to the Pill

Did you know that "the Pill" is 50 years old? Hard to believe it's been around for so long. Of course, the pill today is nothing like our mother's "pill". The estrogen hormone content of our oral contraceptives today is almost half of the amount in the original formulas. Today we use the pill for much more than birth control, and its benefits are numerous.

Painful cramps, irregular periods, PMS, acne and anemia (from heavy periods) can all be helped by taking an oral contraceptive. Not everyone on the pill is taking it to prevent conception. In fact, in my practice, I would estimate that roughly a third of my patients on the pill are purely taking it for medical reasons.

What else should you know? Primarily, that it must be taken consistently, and at the same time every day. People who take the pill "when I go to bed or when I get up" are rarely consistent, and if the time fluxuates by several hours on the weekends, for example, they may become pregnant if they are not using another form of birth control. Also, if you take an antibiotic, be aware that it decreases the effectiveness of the pill.

Last but not least, remember that being on the pill in no way protects you against STDs. Enough said.

BOTTOM LINE: The oral contraceptive pill has been around for half a century, and the "new, improved" versions help with many different medical issues.

Keep Your Eyes on This...

Okay, how many dentists do you know who do NOT floss their teeth? None, right? And why is that? Because dentists all know how important it is to your oral health to do this simple, quick task.

So, the next time you visit your eye doctor, ask her what she does every day to maintain the health of her eyes. I'll bet she will teach you about LID SCRUBS. What is that, you ask? Lid scrubs simply involve gently rubbing the base of your eyelashes with a tear-free soap product to remove debris left from makeup and exfoliated skin, as well as bacteria. You can purchase jars of cotton rounds that have soap in them (similar to makeup removers) or here is a much less expensive alternative: baby shampoo.

Keep a bottle of no-tears shampoo in shower. At the end of your shower, squeeze out the smallest drop that will come out, and gently massage your eyes at the bottom of the eyelashes for twenty or so seconds, then rinse. You may find that this simple daily maintenance keeps your eyes feeling much less irritated, which is an especially nice bonus for if you wear contacts or mascara.

BOTTOM LINE: Try daily lid scrubs to improve your ocular health!

Loving St. Louis- and it's Gluten-Free!

Wow- what a city! But it really feels more like a town, because everyone is SO FRIENDLY! If you haven't visited here yet, make plans to include it on your next family vacation. What is there to do?
First, of course-The ARCH- yes, in BOLD- gotta ride the tiny pod (they call it a tram, but that implies space to me...) to the top and catch the magnificent view of the town. This will certainly cure (or cement) your fear of heights.
In the shadow of the Arch is the Old Cathedral (formally known as the Basilica)-thanks to them for playing my mother's favorite hymn on Mother's Day (Let There be Peace on Earth.)
The Zoo- can you believe it's FREE?? Trails wind around through lush foliage as you view the animals. I was impressed that the kids' meals come with a choice of a healthy sides such as broccoli or applesauce. AND you can buy FRUIT SMOOTHIES at the Zoo!
Say Hello to Spike the cat at Left Bank Books.
For the grownups, there are Casinos- who knew? Stop in at the SLeeK in Lumiere's and tell Rusty hello from me as you order up a fabulous, thick steak.
Enjoy Saturday night live broadcasts with Lance from Y98- he is "Mr. St. Louis".
I had a GLUTEN-FREE pizza to die for at Pi (like the number)- special thanks to Tuck, our perky waitress.
And SWEET news- Ted Drewes Basic Frozen Custard is...GLUTEN-FREE! (Simply ask for a clean spindle). I love this town!
Look out for Fredbird and cheer on the Cardinals.

Special thanks to Dr. Teresa Knight, my friend and amazing tour guide- you go, "Gyno-Gal"!
BOTTOM LINE: St. Louis is a marvelous town that manages to celebrate the past and focus on a healthy future at the same time.
Thank you, St. Louis!

Mom Knows Best!

Happy Mother's Day! Have you hugged your Mom yet today? If she is still on this earth, please take a minute and call her and at least give her a virtual hug if you cannot do so in person. I had a special video chat with our precious daughters today, since I am in beautiful St. Louis today. Stay tuned for pictures of my terrified face in the Arch "tram" as we ascended today!
In honor of Mother's Day, I thought I would applaud a few maternal bits of medical wisdom.
1. Chicken Soup for colds- you're breathing steam (which loosens up congestion), hydrating and NOT taking antibiotics- all the right treatment for simple upper respiratory viruses!
2. Salt water gargles for sore throats- use a BUNCH of salt (a couple tablespoons) in a glass of warm water; this makes it hypertonic and helps actually kill bacteria when you gargle.
3. Band-aids and love- a kiss and a band aid will heal 90+% of childhood injuries.
4. Don't forget to wash your hands! Enough said- washing hands helps stop spreading germs!

BOTTOM LINE: Thanks to MY Mom in Heaven, and all Moms out there for the love you give your kids.

The Perfect Diet- What Healthy Seniors Know

After doing 24-hour food histories on my patients for over 15 years, I have seen many different consistent patterns. The "unhealthy vegetarian" one that I shared earlier this week is a classic example that was a surprise to me when I first began this practice. The one I'd like to share today is my personal goal. The majority of my healthy, active "seniors" (usually 60+years old) patients fit this pattern. Of course, there are variances, but a few common themes dominate:
1. A BIG breakfast- eat your largest meal first, then a smaller lunch, and smallest portions at dinner.
2. Very little processed foods of any type
3. An afternoon snack, typically including nuts
4. A dinner that includes primarily vegetables
5. Dessert (often just a piece of rich chocolate) and/or a glass of red wine

What does this look like specifically?
Breakfast- Egg or egg-white vegetable omelette (peppers, onions, mushrooms, tomatoes +/- cheese), beans, a bowl of mixed berries, whole wheat toast, and sometimes a slice of bacon or piece of sausage, juice or milk and coffee
Lunch- chicken breast, asparagus, carrot sticks, brown rice and WATER
Snack- an ounce of cashews or almonds (often they'll tell me a number- 22 almonds, or some fixed amount) and a sliced apple and water
Dinner- a large green salad with tomatoes and other veggies and a small portion of fish, completed with a glass of wine and a chocolate truffle

Notice there are not lots of chips, no fast food, and plenty of water.
BOTTOM LINE: While there is no "perfect" diet, look at the mature people around you who radiate health and energy, and ask them to share their dietary pattern with you. Let me know what they say!

Unhealthy Vegetarian?

How can you be a vegetarian and NOT have a healthy diet? Take a look at this 24-hour dietary recall:
Breakfast: Chocolate Cheerios (yes, they exist!) with milk, coffee
Snack: Poptart
Lunch: Lean Cuisine Manicotti & Diet Coke
Snack: Microwave popcorn & tea
Dinner: Cheese quesadilla, refried beans and chips with a margarita & water
Dessert: Vanilla ice cream

Okay, we don't need to break out our calculators to add up the daily servings of fruits and veggies! This is a very typical example of an unhealthy vegetarian diet. What did I ask this person to do?
Primarily to ADD IN fruits and vegetables. Add some berries or slice a banana on those Cheerios; skip the poptart and substitute an apple; add a salad or carrot sticks to the lean cuisine entree; consider a taco salad; make it a banana split (use more banana and less ice cream!) ANY of those suggestions would improve the quality of this day's nutrition.

BOTTOM LINE: Remember that VEGETARIAN does NOT automatically = Healthy!

Pediatric Medicine Recall

Have you heard? Last week (April 30th), McNeil Consumer Healthcare initiated a voluntary drug recall because some of their products did not meet required quality standards. At this time, there have been NO REPORTED adverse effects from these medications. Apparently the drugs had variable amounts of active and inactive ingredients, as well as extra "particles" in them.
Which products are included? Tylenol Infant Drops, Children's Tylenol Suspensions, Children's Tylenol Plus Suspensions,
Motrin Infants' Drops, Children's Motrin Suspension, Children's Zyrtec Liquids and Children's Benadryl.

Please click on this link for more specifics:
http://www.fda.gov/Safety/Recalls/ucm210443.htm

What should you do if you've already given your child these medications? Relax. If your child seems fine, she is! Again, there have been no adverse events reported at this time- this was a voluntary recall.
BOTTOM LINE: Be aware of this large medication recall and check out the specifics on the link above.

Stuffy nose, itchy eyes, and sneezing?

There are so many allergy remedies out there. How do you decide what you need? Do you understand the difference between an antihistamine and a decongestant? And where does an expectorant fit in? It's often tough to figure out when to take which drug might help. Here are the basics:

1. Decongestants simply narrow the blood vessels in the lining of the nose, allowing air to pass more easily. Use these when your nose is "stopped up". Caution: do not use if you have high blood pressure, as they can potentially raise your pressure.

2. Antihistamines block the release of histamine, the chemical in your body that cause cells to swell and leak fluid, resulting in itchy eyes, sneezing, and runny nose. Use these to DRY UP (but not when you are simply "stuffy")

3. Expectorants are all medications that include guaifenesin. This drug breaks up mucus, allowing it to drain down from sinuses or be coughed up from your lungs. It wont work if you are dehydrated, so drink extra water- especially if you are also taking an antihistamine, because they DRY UP mucus and that makes it tougher to break up and clear. Use these when you have sinus and ear pressure, or if you have a cold "go to your chest." There is little evidence-based medicine to support the use of these, but clinically I have seen them help a great deal to relieve head congestion, and often avoid the use of antibiotics.

The AAFP a great website with more detail: http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/857.html

BOTTOM LINE: Don't always grab the "do everything" medicine for your stuffy, sneezy, coughy, itchy symptoms- understand which drug works for which complaint!

MAY DAY, MAY DAY!

Isn't it funny that "May Day" conjures up some very conflicting images? Do you think of children dancing around a May pole, or a plane crashing? Hmm...it's all about half-empty or half-full, I suppose.
Let's think about the positive image of children dancing, flowers in their hair, and beautiful sunshine. That image reminds me of EXERCISE, POLLEN, and VITAMIN D. Okay, I know- a bit weird, but hey, it's my job and my passion!

#1- Exercise. It's now the fifth month of the year. Have you kept up your New Year's resolution for "MORE"? (See early January blog entries). If not, or if you did, but fell off the wagon, START OVER! Make another resolution today and start moving MORE.

#2- Pollen. It's the first of the month, so change those air filters! (See Feb 1st entry)

#3-Vitamin D- Get that sunshine vitamin in your system! Most people are deficient, so add 1000IU of Vit D to your diet, or have your doctor check your level to find out if you need more.(See The Sunshine Vitamin blog entry of 3/13/10)

BOTTOM LINE: Happy May Day! Today's reminders are about exercise, air filters and the sunshine vitamin.