Low-Fat vs. Low Carb Diets- the Results are In!

Here is a terrific study for the forty-somethings, recently published in the Annals of Internal Medicine. The Study is titled: Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet; A Randomized Trial. The trial took around 300 people in their mid-30s to mid-50s, and placed them all in a COMPREHENSIVE BEHAVIORAL TREATMENT for weight loss. Half the group consumed a low-carb diet with unrestricted fat and protein, and the other group ate a low-fat diet (<30% calories from fat.)

Their weights were measured frequently, but the end goal was weight loss maintained at two years. Interestingly enough, BOTH groups had the same amount of weight loss- a whopping 24.2 pounds at one year, and a respectable 15.4 pounds were kept off at two years. Both groups had improvements in their blood pressure and lipid levels (cholesterol), and the low-carb group maintained higher HDLs (the GOOD cholesterol that goes around the bloodstream and takes away cholesterol plaques) even at the two year mark.

Now, these participants started off "healthy"- no diabetes or scary cholesterol levels, but all were obese by BMI (body mass index) criteria. Not everyone finished the study, but those that did complete it had great health benefits.
Take home message for you?

BOTTOM LINE: Feel free to choose "low fat" or "low carb" if that helps direct you, but changing BEHAVIORS (see the "MORE" posts!) including more physical activity and more healthy food choices of fruits and vegetables are the most important component of ANY diet!

HEAL your HEELS!

Just started a new exercise program, and now your feet hurt? Ouch! Could be plantar fasciitis, which often is triggered by a sudden increase in activity, or by new shoes. What are the symptoms? Classically, there is intense heel pain that is WORSE after rest. If you wake up to go to the bathroom and those first few steps hurt like crazy, then gradually ease up, chances are that this is your diagnosis.

Whatever you do, do NOT ignore this one! The worst thing you can do for this is to grin and bear it, and simply “work through” the pain. That approach can extend the natural course of this problem from weeks to many months. The problem is small tears and inflammation within the long ligament on the bottom of the foot. There may or may not be a heel spur on the bone, but the real problem is the inflammation in the ligament. The goals of treatment are to decrease that reaction.

Solutions? Ill –fitting shoes often cause or exacerbate this problem. Put aside your high heels and pointy toes, and temporarily switch to shoes with a strong, less flexible support. I recommend buying heel donuts or heel cups (which are nonprescription) first, and if you are upright out of bed, you are WEARING SHOES WITH THESE INSERTS. This is not a time for bare feet or flip-flops! Icing the heel after activity and anti-inflammatory medications may help as well, though in practice, I have not seen a great deal of improvement with those modalities alone.

Here are a couple exercises that might help:
1. In bare feet, sitting down, using your big toe (one leg at a time) write out the alphabet, first in lower case, and then in upper. Repeat with other foot, even if it is pain-free (for prevention!)
2. Set a towel in front of a chair, and use your toes to steadily scrunch the towel, pulling it towards you. Again, repeat with other foot.

It may take a few weeks to see results, and consistency is the key! Please see your family doc if you are not improving.
BOTTOM LINE: Got heel pain? Try these simple modifications and see your doctor SOONER rather than LATER!

With a CHERRY on Top!

Okay, before I leave the topic of benign skin lesions that worry people, there is one more that I should add: Cherry Hemangiomas (cherries, for short). These are super common across all races, but most obvious in light-skinned people. They are inherited in an autosomal dominant pattern, which simple means if you've got 'em, you are going to pass them on to your kids every time. They used to go by an awful name- senile hemangiomas. Glad we're now more politically correct on this one!

What are they? Tiny little bright red spots on your skin, that sometimes grow to maybe the size of an eraser on a pencil. I tell my patients that they are a birthday gift from God, because we tend to get more as we age (much nicer than calling them senile spots, right?)

They are formed by a proliferation of tiny blood vessels. As such, if you run over one with your razor as you are shaving, you can expect some significant bleeding, so be careful!
Happily, though, that is the worst thing these guys do. Cherries do not turn into cancers, nor cause any other issues beyond cosmetic.

Of course, not all bright red spots on your skin are cherry hemangiomas, so check with your doctor if you are concerned.

BOTTOM LINE: Don't worry if you notice you are sprouting more little red spots with each passing year- it's just God adding a "cherry" on top!

A Scary Mole? Or not...

I think we have done a good job educating the public about melanoma. Most people wear sunscreen religiously if they are going to be outside for an extended period, and more are remembering to wear hats. People are in tune to notice dark black moles, especially any that are growing or changing, and often know the ABC’s of melanoma. (Asymmetry, Border, Color, Diameter, Evolving)

One side effect of all this education is that more people are coming in to ask about a mole on their body that they or their spouse has noticed. Frequently we have reassuring news for them, which is that the “mole” that they are afraid of is simply a seborrheic keratosis- SK for short.

SKs run in families, and tend to increase in number as we age. They are so common that most people will have at least one in their lifetime. SK's pop up most commonly on your chest, back, shoulders, face and abdomen. They are brown, black, or pale, raised and waxy or scaly, and look like they are stuck on, as though they can easily be scratched off. They can “itch and be ugly” (to quote my old dermatology teachers) but only very rarely become dangerous. If they are bothersome, a treatment with liquid nitrogen will typically make them go away. The bad news, however, is you are likely to make more. Check out the Mayo Clinic's pictures of SK's.

BOTTOM LINE: Do not hesitate to go to your family doctor or dermatologist and get your moles checked out- it's not all bad news, and many are easily treated if they bother you!

Oh, My Aching Knees!

Do your knees ache and bother you? Have you seen your doctor yet, or are you holding off because you're afraid the only answer is surgery? Well, fear no more, and head in to your family doctor! The vast majority of knee pain that we see in primary care is not a blown-out knee with surgical needs, but more chronic use/overuse injuries and knee cap tracking issues.

Adolescents during growth spurts can develop pain just below the knees that comes and goes, and is worse with squatting, using stairs, or jumping-all these activities put strain on the site where the patellar tendon attaches, and can cause a condition called Osgood-Shlatter's lesion. The treatment here is REST, not surgery...though many sports-minded adolescents WISH the answer was a quick surgery!

Women of all ages (more than men, but not exclusively) are prone to a condition called chondromalacia, where the under surface of the knee cap begins to look like crab meat- all flaky and ragged, instead of polished and smooth. What are the symptoms? Pain in the front of your knee, especially after prolonged sitting, is the classic one, sometimes referred to as the "theatre sign". The noninvasive treatment for this is physical therapy and home exercises to build up the medial quads, such as straight leg lifts.

Of course there are numerous tendon strains, cysts, and inflammed bursas (the bags of fluid that cushion between the bones and ligaments.) Most of these respond to anti-inflammatory medicines and physical therapy, or possibly a simple drainage procedure done quickly in the office.

Finally, let's not forget the mature knee, that is aching and stiff from arthritis. Yes, surgeries can help, but they are not the only solution we have to offer! Again, physical therapy, anti-inflammatory pills, or different types of simple injections into the knee joint with either steroid or other therapies.

BOTTOM LINE: Don't suffer in silence (or whine loudly to your family and friends) if you have knee pain for fear the only answer is surgery- go see your family doctor, sports medicine doctor, or local orthopedic MD and find out your options!

Football Players- Drink Up!

In Texas, we've started back to school (our kids actually started a whole week ago!) Despite the "fall" activities, we are still having enormously HOT days in August, and down here, they wont disappear any time soon. A recent study published in the CDC's weekly MMWR (Morbidity and Mortality Weekly Report) shows that heat related illnesses during practice or competition is a leading cause of death or disability among high school athletes, and that heat illness is most common in pre-season football practice.

What can we do to avoid this? Athletic programs need to emphasize hydration before, during, and after sports activity, as well as following guidelines regarding heat-acclimatization. This means taking two weeks to build up duration and intensity of exercise (as well as degree of padding) to gradually increase tolerance. Additionally, it means consuming 200-300 cc of liquid (water preferred) every 10-20 minutes of practice.

BOTTOM LINE: Especially in the south, where we LOVE our FOOTBALL, let's make sure our players are WELL-HYDRATED as we start into football season while the temperatures are still in the red zone!

Salmonella Outbreak- Check Your EGGS!

There is a nation-wide recall of eggs due to an outbreak of salmonella that has spanned across the United States this summer, causing hundreds of cases each week. What are symptoms of salmonella food poisoning? Fever, diarrhea and abdominal cramping that starts anywhere from 12 hours to 3 days after eating contaminated eggs. Salmonella is passed to humans when we eat raw or undercooked eggs that have been infected.

When might you ever eat raw eggs? Well, most of us prefer them cooked, but there are some circumstances that we don't think about such as sneaking cookie dough from the bowl when we are baking homemade cookies, or licking the batter for cakes, or swiping some meringue or mousse. Salad dressings (like Caesar) or sauces may have raw egg as well.

Which eggs have been recalled? Get ready, it's a bunch: Lucerne, Albertsons, Mountain Dairy, Ralph's, Boomsma's, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms, and Kemps were originally recalled, and now the list also includes Albertsons, Farm Fresh, James Farms, Glenview, Mountain Dairy, Ralphs, Boomsma, Lund, Kemps, and Pacific Coast. Ask your local grocer if their eggs were included, to be certain.

If you get diarrhea, do you need antibiotics? Probably not, if you are healthy. However, elderly, very young, or immune-compromised people are at higher risk of severe symptoms, and may need antibiotics.

BOTTOM LINE: Be aware that we have had a nation-wide Salmonella outbreak, so check with your favorite grocery store, stop sneaking cookie dough, and COOK YOUR EGGS thoroughly before you eat them!

You've Got (Healthy) Mail!

I'll bet you've received some cute e-cards for your birthday or other special occasion, but did you know that their are e-cards for your health? Check out the Center for Disease Control's website (CDC) They've got cards for holidays (firework safety for July 4th, for example), back to school reminders about school safety, flu vaccine reminders, and yes, e-cards to tell your partner you've been diagnosed with an STD. I especially love the e-cards to share with your female friends to remind them to get a mammogram- check it out!

What do I think about this method of telling partners when you've caught a sexually transmitted disease? Honestly, I think it's great. Many people do not bother to tell their partners that they have been diagnosed with an STD, because they are too embarrassed, especially if it is not in the context of a committed relationship. Using an e-card can even be anonymous (though one would hope that you could narrow down who sent it to you!) I also like that e-cards link you directly to reliable information and treatment facilities, which again, should encourage people to follow through and be treated and tested, so the cycle of spreading disease can be broken.

BOTTOM LINE: Check out the CDC website above and send someone YOU love a healthy e-card to show them you care about their health.

I'd Like a Pill to Fix This...

Fast food medicine from a "doc in a box" seems to be the order of the day. We demand instant gratification. We text people because we don't want to wait for them to get out of a meeting. Worse, people answer these texts- while they are driving, and SHOULD be focused on the road.

Not surprisingly, people are demanding this same instant fix in medicine, and doctors are providing it. Got heartburn? Grab the purple pill. Can't sleep? Here's 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 with it ten times per day (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.)

We've got to tackle this problem from both sides, and look for true solutions- not Band-Aids! Patients- ask your doctor if there are exercises or other behavior modifications that would help fix your problem before you try a prescription medicine. Please try NOT to ask for the pill that you saw on a commercial last week. Doctors- we need to spend the extra few minutes to offer these solutions, rather than grabbing our prescription pads immediately.

BOTTOM LINE: Many medical problems can be solved (and most improved) without taking a prescription, so make sure you understand the CAUSE of your medical issue so you can actively be part of the solution!

Yea! Chocolate is still "Good for you"!

Ah, there must be women out there doing research (or at least men who love us), because we continue to see attempts to prove that chocolate is good for us! There is now another study that shows "moderate" consumption of chocolate- 1-2 servings per week- reduces your risk of heart failure.

Now, listen closely- I did NOT say that eating an extra large Snickers bar every day will enhance your heart health- sorry! The study, entitled " Study of Middle-Aged and Elderly Women Chocolate Intake and Incidence of Heart Failure: A Population-Based, Prospective " analyzed the incidence of heart failure in over 30,000 women aged 48 to 83 compared to their average intake of chocolate. The study took place in Sweden, where their delicious dark chocolate must contain at least 35% cocoa solids (vs. 15% in the USA).

We know that dark chocolate consumption in moderate amounts has been shown to lower both systolic and diastolic blood pressure. This study suggests that the benefits extend beyond blood pressure and on to consequences of high blood pressure, such as heart failure.

BOTTOM LINE: I am happy to report that there is continued evidence that having a few servings (ounces) of dark chocolate each week may not only please your tastebuds, but perhaps also your heart! Dip a luscious strawberry into some melted dark European chocolate and ENJOY!!

When Does High Cholesterol Start "Counting"?

Calcium and heart disease are staying together in the news. Yesterday, I talked about calcium supplements. Today, I want to tell you about another study- the "CARDIA" study (Coronary Artery Risk Development in Young Adults). Basically, this study looked at young people who began the trial at age 18-30 in the early 1980's. Their blood cholesterol levels were measured at baseline, and then followed periodically for twenty years. At the endpoint, coronary calcium scores were evaluated. (These scores are from a CT scan that looks at calcium deposits in the coronary arteries- the ones that if clogged, cause a heart attack.) The question was whether or not high lipid (cholesterol) levels in your youth led to these deposits in your middle age. The answer: a resounding YES.

As always, there is a catch. This time, the tricky part is that although high calcium deposit scores are definitely associated with heart disease, it is not the same objective evidence as whether or not people with early high cholesterol levels will actually have more heart attacks. I believe, however, that the take-home message is this: we do indeed pay for "the sins of our youth"- high cholesterol levels that are UNTREATED in young people are going to lead to problems down the road.

What should we do? The jury is still out on whether or not we should be starting younger patients on lipid-lowering medications, despite numerous studies trying to evaluate this issue. We DO know that improving diets and increasing aerobic activity reduces heart disease, with NO negative side effects.

BOTTOM LINE: Don't wait till you are 40 to check your cholesterol levels- find out EARLY and make lifestyle and dietary changes to improve your numbers NOW so you can decrease your heart disease risk LATER!

Now CALCIUM is Dangerous??

Have you heard about the latest study that showed CALCIUM supplements may increase your risk of heart attacks? What's next, finding out Vitamin C makes you sick? Okay, I'm being facetious here, but let's talk about this news from a couple different angles.
First of all, here is what the study from the BMJ (British Medical Journal) says. They looked at a bunch of studies with a total of roughly 12,000 patients and assessed whether those people who took calcium supplements of 500mg or more (without Vitamin D) had more or less heart attacks compared with those who took placebo pills. There were a total of 296 people who suffered heart attacks- 166 on calcium supplements, and 130 on placebo pills. Does this mean placebos CAUSED 140 heart attacks? NO. Does it mean that calcium supplementation by itself CAUSED heart attacks? No- but it does show "an association" with heart attacks, one that may or may not be present if you add Vitamin D, which plays a role in calcium absorption, bone health, and cardiac protection.
There is NO association of heart attacks with increased purely dietary calcium intake (meaning high calcium intake through eating dairy and other calcium-containing foods). What does this tell me? Once again, we are spending a zillion dollars to PROVE THAT GETTING OUR NUTRITION FROM WHOLE FOODS, RATHER THAN SUPPLEMENTAL PILLS, IS BETTER FOR OUR HEALTH.
We've got to stop looking for a quick fix, and start improving our diets (MORE fruits and veggies, less of everything else) and increasing our exercise. Common sense AND scientific studies have proven this over and over.
In the meanwhile, realize that medicine is constantly evolving. What we preach as doctrine today may be heresy tomorrow. Look at what we have recommended for positioning of newborn babies in the last couple decades as an example- first we said on their stomachs (so they don't choke if they spit up), then their sides, and now their backs. Each time, we are SURE we have the answer. Remember that doctors used to recommend smoking to relax- how crazy is THAT?
BOTTOM LINE: Calcium supplements are unlikely to be your greatest risk factor for heart disease- talk with your doctor about your total health picture before you decide whether or not to take ANY supplement!

Finally, Good News if You've had a Miscarriage

Here is another medical topic that you probably think is uncommon until it affects you or someone you love- miscarriage. Despite the fact that statistics show somewhere between 5-10% (or higher) of all conceptions miscarry, you don't hear about it. 80% of miscarriages take place in the first trimester, and most of those occur very early-before eight weeks.

What I'd like to share, though, is a new study that brings some good news. Doctors have traditionally told patients who have a miscarriage to wait six months before trying to conceive again. A study published in the British Medical Journal (BMJ) looked at over 30,000 women who had miscarried, then had a subsequent pregnancy. Happily, women who conceived their next pregnancy within six months actually BETTER medical outcomes (less recurrent miscarriages, fewer ectopic pregnancies, and even less c-sections, low birth weight babies or pre-term deliveries) than women who's next pregnancy began six to twelve months after their miscarriage.

Why is this news important? Well, if you've had a miscarriage, I don't have to explain. The significance is not that you should rush to get pregnant again, but more that there is NO NEED TO WAIT. Many women (and men) have anxiously waited to get pregnant the first time, only to miscarry and then be told to wait for half a year before trying to conceive. That's tough for any age, but if you are already in your late 30s (and therefore already have an increased risk of complications associated with having kids), waiting six months is not only emotionally draining, but increases your other risks as you "age". (Mind you, I have MANY friends who had babies even in our early forties, so I'm not judging, here!)

By the way, please recognize that miscarriage can be very emotionally painful- express sympathy but try to avoid phrases like "what happened?" that the mom may hear as "what did YOU do?" We think most early miscarriages are due to chromosome issues, not from something the mom did, didn't do, ate, drank or otherwise initiated.

BOTTOM LINE: New medical evidence shows that there is no physical need to wait six months after a miscarriage before trying to conceive again, so go right ahead whenever you are emotionally ready!

Need a Vitamin B 12 Shot?

Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!

The $7 Million Case of Herpes

Before I leave the topic of STD transmission and lawsuits, I want to share another case. This one took place in California last year, and involved a 56-year old woman catching genital herpes from a 77-year old man. Basically, he had a twenty five year history of genital herpes outbreaks, yet did not disclose this history nor did he wear a condom. He is a very wealthy man, king of a hair product empire, and well-off enough to give his girlfriend a BMW as a gift (which she was allowed to keep, along with the $7 million.)

Now, I do not know all the details of this case. Was his quarter of a century battle with herpes recent, or in his remote past? If he had worn a condom, would that have made a difference? If you get herpes from someone who is a college student (rather than a multi-millionaire business man), how much will you be awarded?

Here is what I think is important:
1. Please note the AGES- 77 and 56!
2. Note that he had a recurring disease for over 25 years- these are not trivial infections...
3. This is a smart, educated, very successful man with full knowledge of his disease, yet he chose not to disclose.
4. Condoms cover only part of the anatomy, and herpes is spread through direct skin-to-skin contact, so condoms HELP but do not 100% prevent herpes.
5. He was indeed, held LIABLE.

BOTTOM LINE: To REPEAT YET AGAIN, STDs can occur across any age, race, gender, or socio-economic boundaries- Buyer BeWARE!

Kiss and Tell?

Yesterday's post (regarding how a dentist was successfully sued for $1.5 million for giving his girlfriend a sexually transmitted disease) apparently generated quite a bit of water cooler discussion. What if he didn't KNOW he had HPV? Should he still be held liable? How can you PROVE someone gave you a specific disease?
The truth is that the only way to KNOW 100% for sure that someone gave you an STD is if you have never been physically intimate with any other person before your current partner- and that includes any form of intimacy that can occur with your pants off. Kissing on the mouth can certainly pass herpes, but in general, kissing, hugging, holding hands and other forms of intimacy that occur with your pants on are "safe".
Viral and bacterial infections often show up within a few days to weeks of exposure, but the sneaky part is that many of them can silently hang around for weeks, months, and even years in some cases. Obviously, if you are with partner A today, and with partner B several months later, then break out with an STD a few weeks into the second relationship- the picture is cloudy. Certainly, odds are better that it is the recent partner, but bacteria and viruses don't come with identification labels (though that would be so helpful!)
The other confounding feature is that symptoms from these infections tend to come and go until the infection is diagnosed and properly treated. In the interim, many people assume they are "cured" because their blister or discharge or discomfort goes away. Unfortunately, that is exactly when they are likely to pass the disease along to another partner.
So, the jury in this case had much to ponder, but the preponderance of evidence strongly suggested this man did, in fact, give his girlfriend BOTH genital warts AND HPV that caused pre-cancerous changes to her cervix. And, for the record, the evidence was strong enough to hold up under appeal.
I hope this high profile case will generate more honest discussions between partners, as well as make people think twice (on both sides) before they kiss and do NOT tell!
BOTTOM LINE: STDs are often SILENT, so expect your partner to get tested before he or she can "prove" his or her disease-free status!

GLAMOUR Reports $1.5 Million Lawsuit for STD!

Have you seen the September issue of GLAMOUR? Well, look closely at the article: "I Sued My Ex for Giving Me an STD- and I WON!" It's a fascinating case, actually. In short, a guy and gal got together. The girl had done "due diligence" in revealing her past sexual history, and had asked him about his. He reported NO history of STDs and said he, in fact, was in a "dry spell" and hadn't been with anyone in a long time. What's next?
Girl believes guy. Girl sadly develops genital warts AND abnormal Pap smears that are pre-cancerous. (To be clear, these are both caused by HPV, the Human Papilloma Virus, but represent infections by TWO DIFFERENT strains of HPV, as warts do not turn into cancer.) Back to the story- meanwhile, guy has-oops- impregnated another girl during the not-so- dry spell...
Now, the girl who caught the HPV is in law school, and not only knows her rights, but wants to be certain to protect any future women this guy chooses to be less than honest with, so...voila! Lawsuit.
Here is the best part: Girl WINS lawsuit, including an appeal, for $1.5 MILLION!
You can read part of my opinion about the case on page 338 of the magazine, but here are a few more thoughts:
1. People LIE about having STDs- it's embarrassing, they don't want to be rejected, and they think they wont get "caught."
2. Completely HONEST people may not actually KNOW that they have a disease, because so many are SILENT.
3. Perhaps we need some new media-worthy "catch phrase" for people to ask to see proof that their potential partner has been recently tested for ALL STDs- "Show me the papers"? "Papers before clothes?" "Proof, not promises?" "Reality before Romance?"
4. You cannot tell by LOOKING who has an STD. (This guy was a medical professional- a dentist- perfect case in point!)
5. IF you give someone else an STD, you CAN be found liable in a court of law. KNOW YOUR OWN STATUS as well as asking potential partners their status.
6. STDs are COMMON and cross all racial and socio-economic boundaries- don't be fooled into thinking that beautiful, rich, popular people are disease-free!

BOTTOM LINE: You CAN and WILL be held liable for giving someone a sexually transmitted disease. If you are not practicing abstinence, GET TESTED and swap results with any future partners BEFORE you are intimate.

Still Can't Sleep?

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 a change in time zones. For theses occasional 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 2:00am you're beginning to panic about how you'll be able to function in the morning. Patterns emerge of heavy caffeine intake in the morning to "get going", then an afternoon "pick me up" coffee or soda, followed by a glass or two of alcohol to "relax and wind down" from the day. Most people know caffeine is a stimulant, but did you know even morning coffee can impair your quality of evening sleep? Alcohol, though a sedative, may help people relax and fall asleep, but realize that it,too, disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.
1. Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. 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!)
2. 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.
3. 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 still 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.
4. Consider an underlying medical issue.Medical causes of chronic insomnia include an underlying issues such as sleep apnea, restless leg syndrome, thyroid disease, anemia or depression. Make an appointment with your doctor to discuss it!

BOTTOM LINE: For the occasional sleepless night, go ahead and use a sleep medicine if you'd like, but if you're taking a sedative every night and stimulants every morning, recognize the habits that are aggravating the problem and make some healthy changes!

Just for the Women- Period.

Okay, today I want to talk about periods- menstruation- so this is for the women. Periods, like bowel movement patterns, are unique to each individual. In the textbooks, periods occur every 28 days, and last for a week. In reality, there is more variation. When an adolescent starts having periods, they are often very unpredictable for the first six months to a year. At that point, most young women establish a pattern that they can recognize and therefore predict when their next period should arrive. Some may be as short as 21 days, others beyond 30, but what is important is recognizing what your pattern is. Consider the modern calendar- a period tracker app- for your phone to figure out your cycle.

Are terrible cramps okay? Well, no- absolutely not! First of all, we have several medicines that might help, from ibuprofen and its cousins to using the contraceptive pill to help decrease the amount of cramping and blood loss. Additionally, for women who have pain outside the range of "normal", we begin to be concerned about endometriosis, a condition where extra tissue that belongs inside the uterus may have migrated outside of the uterus into the pelvis, and be stuck on the intestines or fallopian tubes, causing pain especially at ovulation (mid-cycle.)

Please do not suffer in silence! If you have "terrible periods" that make you miss school, work or fun stuff, make an appointment with your doctor! There are many ways your doctor can minimize your pain and help your life to NOT revolve around your menstrual cycle. Additionally, if it's PMS symptoms that drive you nuts (bloating, headaches, mood swings, and breast tenderness), there are simple behavioral modifications like quitting caffeine, increasing your calcium intake and increasing aerobic exercise that will help.

BOTTOM LINE: TALK to your doctor if you have questions about your period, and know we have many more answers beyond Midol or "the Pill".

Back To School Already??

Argh! Where did the summer go? Well, summer is nearing an end, and now we have the back-to-school rush. Our office is filled with last minute sports physicals and the mountain of forms that come attached. Please call your kid's physician now (if it's not already scheduled) and remember to bring in the school's paperwork with you to the visit, to save both you and us time and effort.

Why do we make you come in? First and foremost, because kids grow, bodies change, and we need to SEE them to be able to accurately assess them! Whether they are at risk for being overweight, have developed asthma or allergies, or simply started having periods- we need to know so we can appropriately treat them! Most schools require a doctor's note for even routine, over the counter medicines for headaches and cramps. Before we okay that, it would be nice to know more details- are the headaches turning into migraines? How frequent are they? Does the medicine upset your stomach? Etc. On the business end, yes, we charge for this. Not to be crass, but would you ask your pest control service to fill out forms certifying your house was termite-free without expecting a charge? It does take time and effort to check immunization records and fill out forms, so part of the business of medicine is that our offices expect payment for that time.

If you've got a child entering 7th grade, be aware that this is a mandatory vaccination year- Varicella (chicken pox), the meningitis vaccine, and a tetanus booster (Tetanus, Diptheria and Pertussis, TDaP). Got someone starting kindergarten? The new requirements include a hepatitis A series (2 shots) and Varicella. If you live in Texas, here is the press release that details these changes: http://www.dshs.state.tx.us/immunize/school/schoolchangesmemo.pdf

Every parent knows how hard it is to get back into the school routine, and that includes waking up EARLIER than summer for most. Please do not let your kid have that "last week of summer" excuse to stay up and sleep in even later! A week or two before school begins (which is NOW, in Texas) start cranking back bedtime and rising earlier. Sleep cycles are not happy when they are abruptly disturbed! Do it gradually, and the teachers will thank you, plus your mornings will be far less grumpy once the school bell rings!
Enjoy the last bit of summer and good luck for the upcoming school year!

BOTTOM LINE: Get those ducks in a row, and remember medical forms and sports physical requests can overwhelm doctors offices this time of year, so get yours scheduled now if they are not on the books yet!

The REALITY Behind Sex-ED

Today I am excited to share that my book, Seductive Delusions: how everyday people catch STDs, has been officially adopted by the North East Independent School District (NEISD) in San Antonio, Texas. The NEISD is the 8th largest district in Texas, and home to over 66,000 students. The Superintendent, Dr. Richard Middleton, recognizes that sex education is a challenging and often controversial topic, but with the shocking statistics of sexually transmitted diseases- especially in our teens- is excited to offer a new approach.

The NEISD has a wonderful program called Big Decisions, and they tackle multiple issues facing freshmen and beyond- from nutrition education, to digital citizenship (internet saavy/etiquette), to- yes, STDs and sex education. The teachers are excited to break away from boring statistics and dry textbooks to the reality-based stories in Seductive Delusions. Classroom discussions will not be putting students to sleep this year!

My book shares stories of successful young men and women as they are diagnosed with an STD. There are no steamy sex scenes nor bad language to further embarrass anyone. I should be clear that each story represents hundreds of patients that I have seen (that's the whole problem- this is COMMON!!) and I chose names that were the most popular baby names from 18 years ago, so the names would be super common, as well. What you WILL see is the conversations that take place behind closed exam room doors across America each day, including what to expect during each step through the discussions with the medical staff, the exam, any procedures, possible prescriptions and even emotional reactions as the patient processes the implications of the diagnosis.

This morning on KVUE Daybreak, we discussed this for our local viewers. Check it out on: http://www.kvue.com/home/The-reality-behind-sex-education-99929109.html and take a look at your school's approach. Let me know what's new in your community!

Grow Your Own!

Don't worry, I'm talking about TOMATO plants, here! Why bother growing your own? Wow, I can list a million reasons- starting with it TASTES better, and ending with it costs less AND there are no pesticides, but let me tell you my favorite reason. I love growing tomatoes because our daughters will EAT them. Period. Yep, that's the biggie!

I think I was in college, trying to impress a boyfriend, the first time that I actually choked down a tomato in a salad. Ironically, our kids are growing up hearing me ask at every restaurant "with EXTRA tomatoes on the salad, please". I truly love tomatoes now. How did we end up with home-grown?

Well, it's kind of funny. Our girl scout troop made tiny terrariums to start growing different types of spices and tomatoes. We made them outside on our deck. Our daughter decided to plant only tomatoes- "for Mom". They grew like weeds, and in a couple months, they were over three feet tall, starting to bear fruit, and needed to move outside. We moved them outside, where they promptly died within a week (very sad.) BUT-here's the kicker-apparently, seeds from the scout planting session must have blown off the deck and into our landscaping in our back yard, unbeknownst to us. Lo and behold, mixed in with our planted lantana, was several huge tomato plants, covered with tiny tomatoes! Well, we dug out the lantana, left the tomatoes, and as I type, we have nearly thirty tomatoes on the vine! These hearty plants grew with complete benign neglect, as we had absolutely no idea they were out there! Gotta love Austin weather.

At any rate, since "we" grew these plants, our girls were proud of them and decided to taste them. I'm happy to report that they now enjoy running out back at dinner time to gather up some fresh tomatoes for everyone's salad- not just Mom's!

BOTTOM LINE: Get kids to expand their palates by letting them grow some food or spice plants- even in pots on the windowsill!

PS. Happy August 1st! As with every first of the month, I want to remind you to CHANGE YOUR AIR FILTERS!