Watch Out for SKIER's TOE!

Ever been skiing (or playing soccer, or tennis) and noticed your toenail had turned black and incredibly painful at the end of the day? Was it black in just the base, or all of the nail? This is a very common injury from skiing, and in fact, is often referred to as a "skier's toe".

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big (so your foot slams back and forth) ski boot. These can hurt like crazy, by the way! As the tiny amount of blood builds up under the nail, the pressure escalates and the toe throbs.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.)

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does NOT occur if your shoes/boots fit correctly!

BOTTOM LINE: Make sure your ski boots and socks fit properly to avoid getting skier's toe, and if you DO get it, seek treatment as soon as possible!

Neti Pots- Helpful or Harmful?

In Austin, we feel often like we are the allergy capitol of the world...and we are approaching CEDAR season. One of the homeopathic remedies that works very well for patients with chronic sinus congestion is a Neti pot. Have you heard of these? Basically, they look like little genie lamps, and you use them to pour water into you nose and "flush out" your sinuses. I know- it's not for everyone. That being said, I have many patients that swear these daily washes have minimized their previously awful allergy symptoms.

The public health department in Louisiana has issued an important reminder about Neti pots this month, because their state had a second death this year from an amebic brain infection introduced to the victims via their sinus flushes. While drinking tap water that contains this ameba would not cause an infection in a healthy person, using that same tap water to flush your sinuses does have potential to cause serious infection.

While these infections are VERY rare, this serves as a good reminder NOT to use tap water if you are flushing your sinuses. Use only distilled, sterile, or previously boiled water as your irrigation solution, plus be sure to fully rinse and dry your device after each use.

On the PLUS side for sinus irrigation, a study published in September of this year showed significant improvement in quality of life for kids with chronic rhino sinusitis (nasal congestion & sinus pressure) when they had used daily sinus flushes for at least 3 weeks, whether the solution was purely saline (salt water) or saline plus an antibiotic. (See Safetty and efficacy of once daily nasal irrigation...)

BOTTOM LINE: If you have chronic sinus/allergy symptoms, talk to your doctor about whether daily sinus flushes could be beneficial for you, and remember to always use sterilized solutions!

WAIT! Weight...

Okay, this is a quickie blog entry, but here's the deal: I can count on one hand the number of patients that I have seen this month that have NOT gained weight. Yes, the average American gains around 10 pounds between Thanksgiving and New Year's Day, but this is not something we should be proud of! It is also a "tradition" to put weight LOSS at the top of everyone's New Year's Resolution list, right?

So, do yourself a favor, and simply pull out the scale today and step on it. And look at the number. This is NOT to chastise you or to make you feel bad, but to give you a quick reality check. If you are part of the majority who has been happily indulging in little extras at work, school, and parties this season, just be AWARE of that- and try not to add on between now and the end of the year. Kick up your exercise a notch, and remember these few party tips:

1. Eat something healthy before you go- grab a Honey Crisp apple (they are in season and delicious!) or a salad, or whatever healthy choice you have handy. Just do not walk in STARVING.

2. Start with a glass of water when you walk in to the party. Hosts love to hand out wine or champagne as you enter, which is lovely, but ask for a glass of water "to start".

3. At a buffet, fill your first plate with healthy choices, THEN go back and have your dessert sampler.

BOTTOM LINE: Let's step on the scale TODAY so we are NOT increasing our..."bottom line".

Headed to the Mountains for the Holidays?

Are skis mittens and lift tickets wrapped up and placed under your Christmas tree? Ski season is in full swing, and for those of us who aren't lucky enough to LIVE in the mountains, it's time to start planning our annual pilgrimage to the high lands. On the medical front, know that one unexpected and unhappy surprise of a mountain vacation can be the development of symptoms of altitude sickness.

When does it start?
-usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?
-MIld to moderate:Headache, decreased appetite or nausea, insomnia, and lightheadedness
-Severe: All of the above plus vomiting and shortness of breath

Treatment?
Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

PREVENTION:
Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
If you have had altitude sickness previously, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains take your breath away- plan ahead to prevent altitude sickness!

Afraid to Fly?

Do you have travel plans for the holidays? 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 emotionally convinced I would die in a plane crash and orphan my child (despite the logical part of my brain telling me it's far more dangerous to drive on Saturday nights.)

So, what can 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.

I mentioned yesterday that you might want to talk with your doctor. What can she offer? 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.

Does Your Holiday Travel Include a Flight?

As the holidays are upon us and travel plans are ramping up, I thought I’d share some health-related flying tips. Since flu season is under way, 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 over-the-counter 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 to take it through 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- whatever helps you to swallow repeatedly.

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 (and much more often this time of year!)

Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable.

BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

7 Ways to Leave Your Smoking Habit

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! New Year's Eve is approaching, and QUITTING SMOKING is the single most important thing you can do to improve your health. In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

A WEIGHTy Issue- Quitting Smoking!

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: As we approach New Years, move QUITTING SMOKING to the top of your list and know that weight gain is NOT inevitable.

Gifts that Keep On Giving

'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. In this tough economy, 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) Or Meals on Wheels, where $25 provides ten meals plus services. There are so many wonderful charities who can stretch your donation dollars!

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!

Too SAD for the Holidays?

While everyone around you is humming Christmas songs, pulling out their Hannukah decorations or making ski vacation plans , are you left feeling sad? Perhaps it's not the holiday blues, but SAD- Seasonal Affective Disorder. This depressive disorder was formally named only a few decades ago, in the 1980's. It affects over half a million people each winter, including some symtoms in up to a third of patients seeing their primary care physicians during this season.

Who gets seasonal affective disorder? It's most common in women (3:1 over males) and young adults 20-30 years old, but it is seen in across the board. January and February are the most common months that SAD is diagnosed.

What are the complaints? Often fatigue, weight gain and recurrent illness are the primary issues, rather than simply "sadness".The simples range from a mild case of "winter blues" to serious depression.

What is the cause? There are different theories, most of which are linked to hours of sunlight. There is disruption in our circadian rhythms as well as decreased seratonin secretion during winter months, and of course, less Sunshine vitamin (Vitamin D).

Prevention? Light therapy (using full spectrum light bulbs in your home and work) or consciously spending more time outside in the sunlight can help prevent S.A.D. Of course, moving to a more southern location can help, especially if you are far north, but that is not typically feasible for most people.

Treatment? Light therapy, anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's are also used), and Vitamin D replacement (if low) all have shown effectiveness in improving symptoms.

BOTTOM LINE: If you recognize a pattern of feeling sluggish every winter and perking up in the spring and summer, talk to your doctor and see if together you can change "S.A.D." to glad this year!

PS. Happy December 1st! Change those air filters!!

Thankful for Special Holiday Dishes

Getting ready for Thanksgiving? I know I am. Today I was searching for my mother-in-law's fabulous fresh yam and green bean recipes, so I can begin to make some of "her" dishes. However, I am SO grateful that she is still here on earth to be on hand as I prepare them, because her quantities are usually measured by phrases such as "just enough", and "till it looks right", and "well, it depends!"

Isn't it amazing how dependent we've become on prepared mixes or at a minimum, google'd recipes? Truthfully, in the kitchen I tend to alter the vast majority of recipes that I use, even the first time. I substitute apple sauce for oil, or change up flours to make things gluten-free, or create some other "healthy" modification. When it comes to family traditions, though, I usually defer to the high-fat, full calorie version, which is FINE. Not EVERYTHING we eat needs to be pure nutrition! It's perfectly fine within the confines of healthy living to splurge on treats now and then. The trick is to remember that every day or week should not be "that" special occasion!

I have learned from my patients (by doing 24 hour dietary recalls) that what people believe is an unusual day is often a frequent occurrence. Do you grab fast food before every soccer practice or music lesson? Well, I'm guessing that is EVERY Tuesday (or whatever day or dayS your kids have that activity.) Look at your schedule now, and recognize those days that present a challenge every week, and then PLAN AHEAD. Sandwiches, slow cooked meals, and even "breakfast for dinner" might be healthier choices.

BOTTOM LINE: Enjoy your traditional holiday treats this season, but recognize patterns of unhealthy choices in your everyday schedule and make pro-active changes to improve your health!

Women's Breast Friend!

Today I was totally inspired by the Susan G. Komen Race for the Cure. Our daughters and I were part of a cheering squad at the two mile marker of a 5K race. What an amazing site to behold! Thousands of pink-bedazzled runners, joggers, walkers, strollers and even a few wheelchairs happily plowed through downtown Austin early this morning. The costumes are reasons enough to come and cheer on these participants- pink boas, tutu's galore, crazy headwear and hilarious t-shirts top the list.

The slogans ranged from "Big or Small, Save them All!" to "Save Second Base" and many versions of "Save the Ta-Ta's". Breast cancer survivors wore special dark pink shirts emblazoned with "survivor" down the front- and I can't begin to guess how many hundreds of survivors were sprinkled within the throngs of racers. Every survivor wore a large smile and a fierce, triumphant spirit that made all of us stand up a little straighter and appreciate our own measure of health.

Perhaps the most touching scenes were the families and groups of friends carrying pictures and banners of their dear ones who couldn't beat breast cancer. "Gone but never forgotten", and "You're our Angel" signs and shirts unified these participants, many clearly still keenly bearing their loss. How amazing that they are honoring these angels by helping raise money for breast cancer research to spare others the pain they know too well.

Race for the Cure is one of several foundations that hold races around the country to raise money for medical research. If you are looking for a way to start exercising, I promise you that signing up to WALK in races like these (where the time doesn't matter, so you don't have to be up to running to participate) will make exercise fly by as you surround yourself with such positive energy and zest for life.

BOTTOM LINE: Congratulations to all the participants in the Susan G. Komen Race for the Cure, and let's continue to support all cancer research!

What is BMI?

Yesterday, I mentioned that discussing your BMI with your doctor might be a less emotionally charged way to discuss your weight. Terms like "overweight" and "obese" tend to make us all shut down and stop listening, but it is really important to understand whether or not your weight is becoming a medical issue. The BMI is your "Body Mass Index", and it is a reflection of your relative body fat. Note that I said "reflection"- the BMI is NOT a precise measure of your body fat percentage.

BMI is simply calculated by using a person's weight and height. Specifically, BMI equals your weight in pounds multiplied by 4.88, divided by the square of your height in feet. There are charts to look at and on line calculators as well. Click on this link to the U.S Dept. of Health & Human Services' BMI calculator to see what YOUR BMI is today.

Now that you've got your number, what does it mean? Well, if you are less than 20, you are underweight. If you are between 20-25, you are considered healthy, or "normal" weight. Please pay attention if you are in the 25-29 segment, because you are overweight! If you are >30, you fall into the medical definition of obesity.

Why did I bold face that 25-29 segment? Because in my clinical experience, no one with a BMI of 30 or more is surprised that they weigh too much. However, I would estimate that over HALF of my patients who fall in the "overweight" category are shocked that they have a medical issue with their weight. After college, people often put on a couple pounds per year, very slowly creeping that scale. During that time, they may only go up a size or two in clothing, especially if they are buying more expensive clothes (which tend to run larger and larger.) Before they realize it, they weigh 20 or 30 pounds more than is healthy, yet they don't "feel fat". I don't care very much about cosmetic issues with weight, but I care deeply about increased risk of diabetes, heart disease, low back and joint pain, all of which come into play when your weight goes up.

BMI's are not flawless. If you are an "ARNOLD" with tons of huge muscles, your BMI will be falsely elevated. If you are elderly and frail, chances are good that your BMI underestimates your body fat. In general, however, the BMI is a great tool to assess your weight.

BOTTOM LINE: Take a moment and calculate your BMI, and take an honest look at your weight: 1/3 of Americans are overweight, 1/3 are obese, and only 1/3 are normal or underweight, so the odds are stacked against you.

Why Don't Doctors Talk about Weight?

I have often heard people complain that their doctor did not tell their spouse to lose weight. (While I could do a side blog on why it is that people have this complaint more about their spouse than themselves, I will pass on that aspect today.) The CDC reported that in a recent Disease Control and Prevention survey, only 42% of obese patients were advised by their health care providers to lose weight. Interestingly, those who WERE counseled to lose weight were more likely to be actively trying to do so.

Why don't doctors tackle this more often? Obviously, there are many reasons, but let me list the top ones that immediately come to mind.

1. TIME- Doctors are all frustrated with less and less time with our patients. Weight loss conversations are rarely brief (and often loaded with emotional baggage) so doctors may avoid the topic purely from lack of time.

2. FEELINGS- Doctors are human (mostly) too, and we don't want to insult or hurt people's feelings. No one seems to be offended by high cholesterol or blood pressure, but universally people are defensive and/or hurt when say they are overweight or obese. Certainly, our society has made fat a four letter word.

3. MIRRORS- If your doctor is overweight, he or she may consciously avoid discussions of weight (why can't you lose your weight, doc?) or subconsciously avoid the topic because of their own frustration with the issue.

4. EXPERTISE- Not all physicians receive equal training in nutrition, so we have different comfort levels in direct counseling. Having said that, know that we can refer to our wonderful colleagues- our registered dietitians- who specialize in nutrition.

So, on your next office visit, why not ask your doctor about your weight? I think the least stigmatized way is to ask about your BMI- your body mass index. What's a BMI? More on that tomorrow...

BOTTOM LINE: Obesity should not fall into the "don't ask, don't tell" category- ask your doctor if you are at a healthy weight!

Holiday Weight Gain...Again!

Click! Step away from the Halloween candy. I repeat, step AWAY from the Halloween candy!

Okay, how many times have you walked past the leftover candy and snagged an extra treat today? It is so easy to keep it around just to "finish it off". I'll bet you're even down to the candy you don't even really like, yet you pop one in your mouth because, well, it's there. How do I know? Because I just ate a mini-Snickers, which is my least favorite candy. The Reese's cups were gone last week.

All kidding aside, please take stock of your health TODAY. We are already well into November, which is the heart of "stuff yourself silly" season. Treats and sweets abound, as well as extra adult beverages at every celebration- and those pack on the calories as much, if not more than the edible delicacies! At the office, we are already seeing the extra weight creeping up. The average American gains nearly 10 POUNDS during the holidays. And then what does everyone do? We make a New Year's Resolution to lose weight.

This year, let's be PROACTIVE! Start on that new exercise program right NOW! Take the stairs instead of the elevator. Park a little further away when you go to work or shop. Fill your party plate with healthy choices and eat them first before you head to the dessert buffet. Every bit you do now will make those New Year's Resolutions much easier.

BOTTOM LINE: Do not wait for New Year's to start thinking about improving your health!

CDC Now On Board for GARDASIL for BOYS

This week the Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend that 11-12 year old boys be vaccinated against HPV (the Human Papilloma Virus)- hooray! Girls have NO monopoly on genital warts, which affect over one million Americans each year. They are COMMON. Sadly, in my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Genital warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with transmission rate of up to 65%. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

The Gardasil vaccine immunizes recipients against the two strains of HPV (6& 11) that cause 90% of genital warts. Additionally, Gardasil protects against the two strains of HPV that cause the majority of cervical cancers. While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common.

Gardasil was approved for use in males over two years ago, but the public has mainly been aware of the use in females. I'm glad the CDC and ACIP are on board, and hope that with increased education, we can help protect the next generation against HPV-related diseases.
BOTTOM LINE: Gardasil- it's not just for girls! Talk to your family doctor about immunizing ALL your kids.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Teen Sexting- the Harsh Reality

If you have a teenager (or if you ARE a teen), please take a few minutes and read this New York Times article: A Girl's Nude Photo, and Altered Lives The gist of the story is that an 8th grade girl sent a nude photo of herself to her 8th grade boyfriend on her cellphone. After they broke up, that boy forwarded the picture to another girl, who labeled it rudely and passed it to her contacts, encouraging every recipient to pass it on. Within hours, this naked photo was seen by thousands of people, including everyone at their school and numerous other schools as well as off into cyberspace.

As a parent, I can only begin to imagine the devastation. Three children were arrested and prosecuted, and could have been held for child pornography charges, complete with the permanent label of sex offender. All this in 8th grade- age 14. How does this happen?

I regularly speak to adolescents about sexually transmitted diseases. Regardless of their social, economic and religious status, what they tell me is that oral sex is NBD- no big deal -(90%) and anal sex isn't really either (50%). They don't "count" these activities as "real sex" and are unaware that these activities are risky for virtually every sexually transmittable disease- especially herpes. While the 40-plus crowd is gasping, let me rephrase- adolescents are very, very desensitized to sexual issues.

As such, it doesn't shock me that sexting (sending sexually explicit messages and/or pictures) is increasing. With that feeling of privacy and anonymity that an electronic device instills, combined with sexual acts being NBD, why wouldn't they feel comfortable sending these messages?

As parents, we have to deal with our own discomfort on the subject, and start having frank discussions with our kids about ALL forms of sexual intimacy- including oral sex, anal sex, and sexting. Please note that I am not saying you can't choose to promote abstinence based on your faith. I AM saying that if you define sex as traditional intercourse, you are leaving the door wide open for these other forms of intimacy...and the kids are walking right through that door with full belief that they are maintaining their virginity.
This is exactly why I wrote Seductive Delusions, which shares stories of "good kids" catching STDs, often despite their "virginity".

BOTTOM LINE: Educate yourself first, then push aside your embarrassment and start talking with your teen.

Doctor, this COUGH won't go away!

Did you know that a lingering cough is one of the most common reasons people head to see their family doctors? With most "colds", after you get past the headaches, and stuffy nose part, you find yourself coughing. Sometimes it's a minor "clear your throat" type of cough, while other times, it's the crazy fits of coughing that keep you from sleeping.

Is there anything that can be done for a cough that wont go away? Absolutely, and that is the point of today's blog. "Cough" literally 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. If you are a week into your symptoms, and suddenly you feel a ton worse and develop a fever, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses. More commonly, though, 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 News: 2011 Season

Flu season can be a scary, challenging time for all of us, especially the last two years, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1. In fact, each year the flu vaccine has three parts, including an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

There are two types of vaccines offered- a live vaccine, which is a weakened version of the virus (this is the nasal spray vaccine) and a "killed" vaccine, the traditional injection. I often hear patients say they "got the flu" from the vaccine, but that is impossible from the injection because those viral particles are NOT ALIVE- they can NOT cause disease. It takes about two weeks for your body's immunity to kick in after the shot, so plan ahead, especially if you are traveling.

In the 2010-2011 flu season, which peaked in early February 2011, was less severe than the pandemic flu season the year before, but still had very significant impact on our population. While most people infected have a miserable several days to a week of symptoms, there were over 300 deaths confirmed to be from influenza, including over 100 pediatric deaths (average age around 6 years.) This is not a disease to be ignored.

WHO should get the flu vaccine this year? The CDC recommends that "EVERYONE 6 months of age and older should get a flu vaccine as soon as the 2011-2012 vaccines are available." And that is NOW! Don't worry about the effects wearing off before the end of flu season, by the way, because the effects last throughout the whole season.

When is flu season? Though typically we say October to January, it really starts with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!

My Halloween TRICK for Treats

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Before you toss that bag of yummy Halloween candy in your grocery cart this week, recognize that Halloween is still four weeks away. Will that bag still be around at the end of the month? Come on, now, you know if you are buying it now, you are going to be eating it sooner than later. So, let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little chocolate candy bars- how many calories does just one have?"

Okay, you asked, so here are a few of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!

Testing, Testing, 1, 2, 3

Teens have MANY questions about Sexually Transmitted Infections (STI's). One of their most consistent themes is "do my parents have to know?" Typically, that is followed up with, "my mom would kill me if she found out..." Teens- rest assured, though your parents may not be thrilled, in 15 years of practice I have NEVER seen a truly bad outcome from a kid telling their parent that they are sexually active. Believe me, as a parent, we'd rather have the discussion about your sexual activity BEFORE you have a viral STD like HIV, herpes or warts, and BEFORE you get pregnant. So, back to the questions:

1. Do I have to tell my Mom if I had an STD? In the state of Texas, anyone can be tested & treated for STDs without parental consent. However, if your parent is paying the bill (using their insurance) the doctor cannot lie and say they are treating or testing for something else- that is fraud, and the doctor can lose their license. I would strongly encourage anyone living with their parents to share this information- your parents love you & you will get through this together.

2. Can I get tested without a doctor ordering the test, like from an online source? Yes, there are multiple labs that allow you to order STD tests yourself. You can typically choose a single test you might be worried about (like your new partner tells you they have genital herpes) or a panel, that includes multiple tests. The key here is this: if your test is POSITIVE, meaning that you do have an STD, that lab cannot treat you. You are instructed to take the results to your physician for further treatment.

3. How much does it cost to get tested for "everything" if I pay cash? This has a huge range of answers, depending on where you go for testing and how much income you have. Online tests average around $30 per test, with a full panel being roughly $200. Community clinics and Planned Parenthood offer reduced rate testing, and some places offer free HIV testing. Please do not let cost stop you from seeking testing or treatment- timing is critical!

BOTTOM LINE: There are multiple options for STD testing that will allow anonymity, and work with your financial situation. Get yourself tested!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Q&A

More questions I hear from teens...
Which Sexually Transmitted Diseases can be cured? Trichomonas (a parasite), crabs (public lice), gonorrhea & chlamydia (both bacteria) can all be completely CURED if caught early and treated. If gonorrhea & chlamydia sit around for months or years untreated, they can cause permanent damage that leads to infertility or pelvic pain- and though the infection can still be cured, the damage to the genital tract cannot.

Which STDs can NOT be cured? Right now, we have treatments but no cures for the viral diseases: HIV (which causes AIDS), HPV (the human papilloma virus), Herpes (both oral and genital) and Hepatitis A, B & C.

When should I get tested- after how many partners? In a perfect world, you really should be tested after intimacy with any new partner. Since most STDs are silent, the only way you can no for sure that you will not be giving a new partner disease is to go and get tested.

How do they test for these diseases? A simple urine test can be used for gonorrhea, chlamydia, and trichomonas. A blood test is required for HIV, syphilis, hepatitis, and herpes. Pap tests with DNA testing check for different strains of HPV. Pubic lice can be detected by simple visual inspection, sometimes aided with looking at a pubic hair under a microscope.

More on testing tomorrow...too many questions for one post!
BOTTOM LINE: Let's answer teen questions about sex and STDs!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Questions- Brazilian & "Crabs"?

Continuing my theme of questions that teens ask me about STDs & sex education...here are a few on the pubic region:

1. Can you get genital acne? Acne on the buttocks is common, but most “acne” in the pubic area is from infected hair follicles from shaving.

2. What are crabs? “Crabs” are pubic lice. They are different than the lice that people get on their head. “Crabs” prefer pubic hair, underarm hair, beards, eyebrows & eyelashes. Head lice stay on the head, and do not cause sexually transmitted disease.

3. Can you get crabs if you don’t have any pubic hair? Yes, because the pubic lice can still reach the hair follicle. However, there is definitely a decreased incidence of crabs in women who remove their pubic hair. At least one study has found a decreased incidence of pubic lice since the popularity of the "Brazillian" in the UK.

4. Can you get STD’s from sleeping in dirty beds? Yes, you can catch crabs (pubic lice) from linens or towels, though the majority of cases are passed during sex. No other diseases are transmitted via linens or clothing, however. Crabs are actually the most infectious of all the STDs- meaning that from one direct contact, you have the highest chance of catching a disease from an infected partner (> 90% with pubic lice.)

BOTTOM LINE: Teens have tons of QUESTIONS- let's get them accurate answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

Teen Sex Questions

I really enjoy teenagers. NO, that is not sarcasm, and YES, we have our own at home! Pre-teens & teens have always been my favorite group to work with, as a physician or girl scout leader or school volunteer. I love seeing how much potential they have, and more importantly, seeing THEM recognize their own strengths, and figure out how to most effectively use those talents to ultimately shape their future career choices. I think many adults make the mistake of talking down to teens, dismissing their heartaches, homework loads and stresses as trivial in the scheme of life (which, in fairness, is often how they look from our vantage point.) The reality is that their stress level is enormous, and that even if it is "puppy love" or "just a middle school test", these challenges are the greatest they have faced so far in their young lives. I believe we as adults can give perspective, but it is important not to minimize what they are going through.

All that being said, one of my educator roles is talking to youth about sexually transmitted diseases. I have been speaking to teens on this topic for roughly three years, and every time, I require the participants to write down a question at the end of my talk. I give them index cards (so they all look the same) and have them directly hand me the cards, so no one sees what anyone else has written. Not surprisingly, there are some common themes, though it might surprise you that I am primarily talking to straight A, service-minded, "good kid" student leaders. I thought I would spend the next several blog entries sharing some of their questions (and my answers) so both teens and parents can see what is being discussed. I'll start today with some questions about pregnancy:

1. Does birth control work?
Yes, but it is not foolproof. Oral contraceptives (the pill) are 99% effective when they are taken correctly- at the SAME TIME, every day; no skipped pills. Combining the pill with condom use as well is highly recommended. Remember, condoms alone are only effective 11-20% of the time, but adding them to the pill decreases the chances of conceiving as well as offering some protection against STDs.

2. Is it better to use two condoms at the same time, “doubling up”, in case one breaks?
NO, absolutely not. Using two condoms at once actually decreases effectiveness (due to sliding and breakage.)

3. Can you get pregnant without intercourse?
Usually not, but if semen enters the vagina, which can happen with “outercourse” or in the process of anal sex, it is possible. Young girls are very fertile – that is the take home message.

BOTTOM LINE: Talk with your teens about STDs, LISTEN to their questions, and help them find the correct answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

If You Take "The Pill" to Avoid Pregnancy- READ THIS!

Are you taking generic birth control? There is a PACKAGING ERROR that has reversed the order of the weekly pills, which significantly decreases the contraceptive effectiveness (translation- you can get pregnant more easily.) Qualitest Pharmaceuticals is recalling multiple lots of the following pills:

Cyclafem 7/7/7, Cyclafem 1/35, Emoquette, Gildess FE 1.5/30, Gildess FE 1/20, Orsythia, Previfem and Tri-Previfem

To find out if your generic pill has been affected, click on the link above to check your lot number, or head to your local pharmacy and ask your pharmacist if your prescription is included in the recall.

This is a great opportunity to talk about birth control effectiveness. When used correctly, oral contraceptives are considered to be 99% effective. If that is true, why do we hear about so many cases of women getting pregnant while they were on the pill? The primary reason is that many people forget to take it. Skipping a day, especially the first day of the cycle, greatly increases your risk of ovulating (and therefore, your risk of conceiving.) Additionally, it is important to take the pill at the same time every day. Taking it "when you get up" does NOT work if you sleep in on weekends! Fluxuating your time by minutes is no big deal, but by HOURS is NOT okay. Additionally, other medications can decrease the effectiveness of the pill, particularly antibiotics or antifungals (like oral medications for yeast infections.) Whenever you receive a new prescription, ask your pharmacist if there is a potential interaction. Finally, do the math- if the pill is 99% effective, but you have millions of women taking it, by sheer numbers there are going to be a significant number of pregnancies from that 1%.

BOTTOM LINE: Birth control effectiveness is maximized by taking the pill at the same exact time every day, and being aware of possible decreased efficacy with other medications. If you take a generic pill, make sure it is not part of this nationwide recall.

Having Trouble Taking All Your Medications?

Today I'd like to say a few words about medications. Often physicians need to prescribe multiple medications for the same patient. One is each morning, another twice a day, a couple are "as needed" and yet another is recommended at bedtime. One must be taken with food, and another is restricted to an "empty stomach". Before you know it, our patient is supposed to take a half a dozen pills per day- at different times, and with different restrictions- and then we wonder why they are "noncompliant"!

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.

Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

FIRE! Are You Prepared?

The last week has been a challenging one for Central Texas, as FIRES have consumed the majority of Bastrop (still only 70% contained) and several other communities have lost many homes. The landscape looks like a war zone, with burned grounds and few standing brick fireplaces remaining. The scope of the devastation is mind-boggling- not just homes destroyed, but businesses and many livestock as well as family pets. People are suffering financially, emotionally and physically.

There are always lessons to be learned in tragedies such as this, so today I'd simply like to encourage everyone to make sure their smoke detectors are working. Do you check the batteries on the first of each month? Do you have a "fire plan" for your family?

Many of our patients have shared their stories of the 30 seconds they had to run and grab their most cherished possessions before they evacuated their homes. Some grabbed financial papers (deeds, titles & mortgages or insurance papers), many grabbed computers, and all who were able grabbed photos. Thanks to the bravery and efficiency of our central Texas firefighters, very few human lives were lost despite the magnitude of these fires.

What is the medical fall-out? Obviously there will be emotional trauma. Happily, computerized prescription records at pharmacies allowed us to easily refill patients' medications lost in the fires. What we are seeing the most right now, though, is upper respiratory irritation. The smoke particles in the air are creating allergy-like symptoms with nasal congestion, headaches and coughs. Remember to use a decongestant (phenylephrine, like Sudafed) if you are stuffed up, hydrate with extra fluids to keep the mucus thin, and schedule an appointment with your family doctor if your symptoms are not improving.

BOTTOM LINE: Fires can happen EVERYWHERE. Make sure your home has a working smoke detector, and check that battery every month (when you check your air filters!)

Black Spots & Blurred Vision- Sometimes a Simple Fix

Have you ever stood up quickly and seen black spots in front of your eyes? The room sways and you might think you are going to pass out, but then it all clears in a few seconds. What's going on? The medical term is "orthostatic hypotension". When you change from lying down or sitting to standing, your blood pressure should increase enough to keep blood flow constant to your brain. When the pressure is not adequate, that's when these symptoms of blurred vision and lightheadedness occur.

What makes it happen? The most common cause for an isolated incident of this in a healthy person is DEHYDRATION. Think about the process like a garden hose filled with water and held upwards. The less water in the hose, the more pressure it will take to push the water to the top, right? You have to squeeze in on the sides of the hose more, or increase the pressure pushing up to get the water to flow upwards. Your blood vessels work the same way, so if your blood volume is depleted from dehydration, voila- not enough blood makes it to your head! The good news here is that simply increasing your water intake will fix the problem.

This process can also be the result of faulty "squeezing" mechanisms, which can occur in diseases like diabetes or Parkinson's disease. Medications can also be the culprit, especially blood pressure , antidepressants and pain pills. How can your doctor test for this process? Often simply taking your blood pressure sequentially in lying, sitting and standing positions will give us the answer. If your systolic pressure (the top number) drops more than 20mm Hg or bottom number drops more than 10mm Hg when standing compared with sitting, you've got orthostatic hypotension. Sometimes more sophisticated testing is required, but the vast majority of the time, these simple office readings are enough.

BOTTOM LINE: If you are getting lightheaded or having temporary blurred vision when you stand up, grab a glass of water- drink it- and call your doctor to schedule an appointment to figure out the cause & cure for your symptoms.

Beware the Scorpions!

With temperatures still skyrocketing here in Texas, many unwanted critters are showing up in our homes as they seek water and shade, which means more exposure to pests such as scorpions. It never ceases to amaze me how they rear up in full attack mode as I lean forward to kill them...and that each and every time it scares me enough to hesitate before I strike.

So, what do you do if you (or a friend or family member) is stung by a scorpion? First of all, don't panic! Most of the time, a scorpion sting is like a bee sting- pain, burning, mild swelling and maybe numbness locally, that will resolve fairly quickly. If you live in Texas, we are fortunate that our scorpions, scary as they can look, are not severely poisonous. If you live in New Mexico or Arizona, watch out for the dreaded bark scorpion, which can cause more serious reactions such as severe swelling, shortness of breath, shock and even death. If you are stung and your symptoms rapidly escalate, go directly to an emergency room.

For the majority of stings, however, first aid will do. Wash the area immediately with soap and water. Ice and elevate the area if possible. Remove any rings, bracelets, watches or other constrictive accessories. If you are starting to swell up, take a diphenhydramine (benadryl) tablet/capsule. Topical steroid wont hurt, and might help a bit. Ice the area for about ten minutes.
A non-scientifically proven, but much recommended home remedy is to very quickly apply a paste of meat tenderizer (with papaya extract) and a bit of water directly onto the area that was stung. This seems to alleviate the pain more rapidly, and at worst case, it is not harmful. Finally, check the date of your last tetanus shot- if it is more than 7 years ago, go get a new one.

BOTTOM LINE: If you are stung by a scorpion in Texas, wash it with soap & water, apply ice, take some benadryl and see your doctor if symptoms escalate (or if you are behind on your tetanus booster.)
PS. Happy September 1st! You know what to do- change those AIR FILTERS!

Thank You, Glen Campbell

Many diseases have the face of a celebrity- we think of Michael J. Fox for Parkinson's, or Katie Couric (on behalf of her husband) for colon cancer. Although President Reagan had Alzheimer's, I don't think there is as strong of a link there. Alzheimer's is the disease we don't want to talk about. It's just too uncomfortable, right?

Well, hat's off to singer Glen Campbell & his wife. Mr. Campbell gave a televised interview last night to openly talk about his experience of memory loss and his diagnosis of Alzheimer's Disease. I loudly applaud his public acknowledgement of this relentless disease. I hope that his singing tour will bring increasing awareness to this incredibly common disease. Right now, over 5 million Americans suffer from Alzheimer's disease. I love that Mr. Campbell is highlighting how music memory is something that is preserved...often beyond when the person suffering the memory loss no longer recognizes their family. I have bittersweet memories of singing Christmas carols with my mom- her not skipping a beat nor stumbling on words that I couldn't recall- and she only knew me as a "nice friend," not her youngest daughter.

What's my take-home message here? If you have a loved one with Alzheimer's memory loss, and you struggle to get them to interact with you, consider a song. Old commercials, school fight songs, traditional carols, hymns or anthems are all good choices. I have found in my personal experience that often once the person begins singing, it often "gets the juices flowing" enough that they are able to carry on a conversation (where they were not interested or able when you began your visit.)

BOTTOM LINE: Hitting a communication wall with someone struggling with Alzheimer's? Try a tune!

PS. I recommend sites like ElderSong- a wonderful source for music geared to trigger memories! ( I have no financial interest in this company, but have purchased many sing-along CDs and videos from them.)

25 Grams of Fiber? Yes, You Can!

"But Doctor, there is NO POSSIBLE WAY that I can eat 25g of fiber in one day!"

I hear this response frequently when I am talking to my patients about a high fiber diet. Yes, we recommend eating 25g of fiber daily. No, it is not impossible! In truth, most Americans average way less than 10 or even 5g of fiber in their daily diet, but that is a reflection of all the convenience food that we consume. If you have coffee & a donut for breakfast, burger & fries & soda for lunch, and spaghetti & meatballs & buttered white rolls for dinner, you don't need a calculator to figure out your fiber was <5g! The good news is that it's really not hard to bump up that fiber. Here are some "tricks" to raise it:

1. Focus on fruits & vegetables (yes, it always comes back to this!) Nearly every serving of these will be at least 2g of fiber. An apple or pear~4g, berries~4-5g, banana~ 3g, broccoli ~3g, carrots ~2g, and corn or a baked potato~ g. Obviously if you get your 5-10 servings of these per day, you've got your fiber covered before you add in ANY bran muffins!

2. Choose whole grains for your breads, pasta & rice (brown)- that will add a few grams of fiber per serving (check the label!)

3. Pick a high fiber cereal that doesn't taste like tree bark, and rotate that in to your diet as both breakfast cereal and snacks (toppings on yogurt or as "croutons" on salads.) Bran Buds, for example, pack a whopping 12g of fiber in 1/3 of a cup!

4. If you like tortillas (and who doesn't?) check out some high fiber choices for your breakfast tacos (instead of toast)- Mission Carb Balance, for example, has tortillas with over 10g of fiber each!

5. Include nuts & beans (think hummus!) in your diet, too- 1/2 c of most beans will be 6-8g of fiber.

High fiber diets help prevent (or treat) constipation, lower cholesterol and triglycerides, and improve your gut health. There is no need to subsist on stale high fiber bran muffins to easily maintain the recommended 25g of fiber per day. Even if you are gluten-free, you can see how this is truly "do-able".

BOTTOM LINE: Push up your vegetable & fruit servings and choose whole grain complex carbs, and soon you'll be on your way to better health through a high-fiber diet!

Should I CLEANSE my colon?

Yesterday I was talking about constipation, so naturally today follows with a discussion of a "home remedy" for that very problem. Patients often ask me to prescribe something to "CLEANSE their COLON". Typically they have seen an infomercial that suggests that we all are walking around with an extra five to ten pounds of gunk lining our colons, and if we simply buy their miracle product, we will have sparkling clean colons and look a sexy ten pounds lighter. The ad even shows pictures of before and after colons to "prove" their case.

Well, as much as I would love this simple fix, it is not true. Think about it. If you are anywhere near the age of 50 or have friends or parents in that category, you hopefully know people who have had their recommended screening colonoscopy (to look for colon cancer.) Every colonoscopy patient remembers the dreaded "bowel prep" where you typically drink a yucky sweet and salty prescription beverage and then poop until you are passing only clear liquid from your bowels. (As an aside, it's not that big of a deal- simply a couple hours of mild discomfort, compared with the benefits of colon cancer screening and early detection.) Without a doubt, your weight is often down a couple pounds the morning of your procedure, but this is pure water weight loss. Within a couple days, your weight is right back to your baseline. There is no question that your bowels were sparkling clean (check out the pics from the gastroenterologist who performed your procedure), but you have not permanently removed "years of buildup".

Once again, if it sounds too good to be true, it probably is. If doctors knew of an easy way to lose weight without diet and exercise, do you think there would be overweight doctors out there? Heck, we'd take it ourselves before we prescribed it for our patients!

BOTTOM LINE: COLONS do not need to be "cleansed". They DO need to be scoped at age 50 to screen for colon cancer (sooner if you have a family history or other concerns). Let's fill them with a high fiber diet and they will be "cleansed" as much as they need.

Poop or Get Off the Pot! (AKA. Constipation Clarification)

Forgive the expression, but it's tough to think of a catchy title to talk about CONSTIPATION. That being said, constipation is a really common complaint- from toddlers to toddering elders. When I talk to patients about constipation, the first thing I do is to establish what is NORMAL for the patient. Often folks are surprised to hear that "normal" does not equal "daily" bowel movements. If you go once every few days and have no abdominal bloating or discomfort, then you are NOT constipated, that is simply YOUR "normal". Others have several bowel movements each day, and again, that is "normal" for them if there are no associated uncomfortable symptoms.

So what IS constipation? Constipation is "unsatisfactory defecation" with relatively infrequent and/or painful passage of stool. Typically this means less than three BM's per week, too much time straining (or hanging out reading) on the potty, or a sense that there is either bloating in your belly or that after you go, you feel like you still should poop more. Women suffer from constipation twice as much as men (likely in part from our hormonal swings that may affect the gut.)

Please don't ignore constipation, because there are many medical conditions that can slow the gut and cause constipation, such as diabetes, low thyroid hormones, pregnancy, metabolic disturbances (like low potassium levels), to name a few. Additionally, medications such as blood pressure pills (calcium channel blockers especially), antacids, antihistamines, antidepressants and pain pills also can slow the bowels.

The vast majority of the time, however, constipation is simply the result of a poor diet. Three things are needed to move your bowels: FIBER (goal 25g/day), MOVEMENT (walk, run, skip, bike- whatever works, just get up and move!) and HYDRATION (more water.) Caffeine is a gut stimulant, which is why people often poop right after their morning java, but too much caffeine dehydrates you and actually slows down the process. What's the goal? Whatever frequency is "normal" for YOU, and no abdominal discomfort. That being said, I rarely see a patient who truly averages 20g of fiber per day in their diet (not from supplements) who does not have "comfortable" daily BM's.

BOTTOM LINE: If you've had no change in your diet, medications or activity level, and you notice your bowel movements have become painful or less frequent, go and get checked out at your family doctor.

Lactose Intolerance & Chocolate Milk...the Conundrum

Does your child tell you they CAN drink chocolate milk, but their stomach hurts after drinking "regular" milk? I'll share that when I told MY parents this, they laughed and thought I was simply asking for more sweets. As an adult, I was often puzzled that certain milk products did not agree with me, while others did. People asked if I was allergic to milk, or whether or not I had lactose intolerance...and I simply said that I do not like milk, because I didn't know the answer.

So, here it is. That kid that can down chocolate ice cream but not skim milk may indeed be lactose intolerant, and she is telling the truth! Lactose intolerance refers to the inability to digest lactose (the main milk sugar). Lactase lives on the inside surface of our intestines. Symptoms typically appear 30 minutes to 2 hours after consuming a product that contains lactose. The degree of symptoms produced (abdominal bloating, cramping, gas and/or diarrhea) depend on several variables:
1. The amount of lactose consumed
2. The level of lactase enzyme present
3. The SPEED of gastric emptying- the faster the gut transit, the worse the symptoms

Higher fat content will SLOW gastric emptying, which reduces the symptoms, so voila! There is your explanation for the chocolate milk. Of course, adding lactase in the form of a powder or capsule will also reduce the symptoms.

Who gets lactose intolerance? 80% of Blacks and Hispanics, nearly 100% of Native Americans and Asians, and roughly 15% of Caucasians develop it. Symptoms usually appear later in childhood or even as an adult. Also, anyone can transiently develop lactose intolerance after a serious bout of diarrhea, because that temporarily strips off the lining of the gut (which houses the lactase). Avoiding dairy products for a few days typically takes care of this type of intolerance.

The easiest way to tell if you have lactose intolerance is to eliminate it from your diet, and see if your abdominal complaints disappear. Remember, though, to read labels carefully, looking for "milk sugar, whey, or curd" as well as plain "milk". Note, too, that many prescription and OTC medications also use lactose as a base. Typically, however, even a lactose intolerant person is fine with SOME lactose (roughly 12 g) so it is not necessary to eliminate lactose 100% to see results.

If you are lactose intolerant, remember you will still need calcium to protect your bones, so talk with a registered dietician to be sure you are getting all you need.

BOTTOM LINE: Lactose intolerance is all about degrees, not simply "yes, you have it" or "no, you don't". Try a simple lactose elimination diet for a few days if you are concerned about abdominal complaints and think you may have lactose intolerance.

Back to School Check Ups & Vaccines

Where did summer go? We are still having consistent 100-plus degree days here in Texas, but our kids start back to school next week already! In my office, however, we are well aware it's "back-to-school" time, as everyone is realizing that they've got school and sport physical forms to fill out, and our seventh graders are due for vaccines. Please call your family doctor RIGHT NOW and get your kids scheduled for an appointment!


Many people wonder why we prefer for kids to come in to fill out these forms, so I thought I'd take a moment to explain. First of all, kids GROW. Yes, I know this is not news to you, but when the last time we saw "Justin" was 6 months ago, before his growth spurt, if we use his height and weight from that visit, we'll be off by a couple inches and a dozen pounds. With the childhood obesity epidemic we are facing, these vital signs become even more important. I'd much rather talk to "Jessica" about food choices when she is a few pounds overweight, than waiting a year or more and then face telling a teenage girl she is 20 lbs overweight.

This "annual" exam is a wonderful window of opportunity for your physician to talk to your adolescent about all kinds of preventative issues- from helmets and limiting screen time, to diet & exercise, to dating & driving risks. Often kids will listen to their doctor, when their parent has preached the same speech to deaf ears. Feel free to give your family doctor a heads up if you have concerns about your child's behavioral, dietary, or peer choices so we can direct our education.

Finally, be aware that our immunization schedules are always changing. For example, we are now giving the meningitis vaccine and the chicken pox vaccine booster along with a tetanus shot for incoming 7th graders. (We used to wait till kids were headed to college to give the meningitis vaccine, and the chicken pox booster was only recently added in.) The immunization series for HPV (human papilloma virus) is also available for this age group.

BOTTOM LINE: Back to school preparation INCLUDES a doctor's visit for your child (unless she's recently had a checkup). Sign up now and bring those school & sport forms WITH you when you go!