Monday, May 30, 2011

Happy Memorial Day, 2011!

Happy Memorial Day! We give special thanks today to every man and woman who has served in our armed forces, allowing us so many freedoms here in the United States. Let's take a moment from our busy lives to reflect on those freedoms that we take for granted...including the right to vote (are you participating in your local elections as well as the national ones?) and freely worship. Reach out and thank a current or former member of the military today.

From the medical perspective, we see our veterans returning from tours with numerous serious and challenging "battle scars"- from the instantly obvious traumatic amputations, to unusual parasitic diseases and skin rashes, to the far more penetrating post traumatic stress disorders. Of course, many men and women never make it back at all, and their families are left to carry that heartache.

BOTTOM LINE: I'm thankful to live and work and raise a family here in the United States. God Bless the USA!

PS. As you head out to picnics and other outdoor celebrations, don't forget the sunscreen- regardless of the number of clouds in the sky. Melanoma is a deadly skin cancer, and it's numbers are on the rise. More on this tomorrow.

Monday, May 23, 2011

Swimmer's Ear- Home Remedy

Here in Texas we are nearly done with school, and thoughts are veering away from finals and towards days filled with swimming, boating and all kinds of water activities. Austin boasts terrific natural swimming spots, including our lakes and our famous spring-fed Barton Springs pool, where the refreshing water stays at a cool 65 degrees even when we are baking in 100-plus temperatures. Not surprisingly, we tend to see an increase in swimmer's ear infections (otitis externa), which can not only be painful, but can limit your water fun. The good news is that prevention works extremely well, and even when that fails, you may not need to head straight to the doctor. The solution is EAR DROPS.

What drops do we use? We make our own home brew of half and half, alcohol and vinegar. (Yes, rubbing alcohol and generic cooking white vinegar.) To be honest, I like the convenience of the over-the-counter little bottle, so I actually buy one and pour out the contents, replacing it with our home remedy. An extra tip is to set it outside (in the shade in Texas) where it will warm up a bit before you put drops in your ears, so it's not cold and irritating.

This mix will actually work both for prevention and for treatment, if you forgot to use it ahead of time. Nine times out of ten, this will be all you will need! The vinegar kills the fungus, and the alcohol dries up any moisture that remains.
If you are an ear-wax-builder-upper, you may need to flush your ears periodically (such as once per month) using an infant bulb syringe and luke warm tap water, to remove packed in ear wax prior to putting in the home brew drops.

BOTTOM LINE: As always, an ounce of prevention is worth a pound of cure, but remember vinegar/alcohol ear drops for swimmer's ear and you'll be set!

Friday, May 20, 2011

The Perfect Diet Pill

Ready to sign up? I think we're all looking for that pill that let's us skip exercise and eat whatever we want, but still allow us to lose weight effortlessly- and oh yes, with no side effects. Sigh. I hate to disappoint you, but no such pill exists. I often think patients believe we doctors are hoarding this mysterious pill somewhere, keeping it for our own use! But seriously, if there were such a pill, there would be no overweight or obese doctors, right? And look around...doctors struggle with their weight as much as the next person.

What IS out there, and why don't we use it more? The main drug still on the market for weight loss is phentermine. The common brand names are Adipex, Fastin, Obenix, and Oby-Trim. Phentermine is a very effective appetite suppressant. It is a stimulant (similar to amphetamine) and can be addictive. It doesn't magically speed up your metabolism, it simply suppresses your appetite so you consume fewer calories. In the past, it was combined with another diet medications (fenfluramine and dexfenfluramine) but this combination turned out to potentially cause pulmonary hypertension- a very serious and possibly fatal lung disease. By itself, however, phentermine is usually well-tolerated, though it has it's own list of side effects, and it cannot be taken along with many antidepressants. Phentermine is thought to raise blood pressure, increase heart rates, and increase your risk for heart disease. A study published last month in Obesity, however, suggests that these cardiac effects may not be significant, or in fact, may not be there at all. While this was not our highest quality study, its numbers (300 patients) and methods are enough for us to take note.

So, if you don't have heart risk factors (beyond obesity) and you are not taking an antidepressant, should you rush to your doctor for a phentermine prescription? Probably not. If you need to jump start a weight loss program and you are ready to really improve your diet quality and quantity along with pursuing a solid exercise program - maybe. It's worth a discussion. However, you need to know from day one that most people REGAIN the weight when they go off the drug. Again, not magic, just they quit suppressing their appetite so they are more hungry, and they eat more.

I rarely prescribe phentermine, probably less than five patients per year. My personal standards are that the patient needs to be seeing a registered dietician and demonstrate that they are exercising daily for a least a month. I see the patient back in one month, and will not prescribe phentermine for more than two months. This is not a "cure all" drug, but in selected patients, it can be a wonderful jump start towards better health.

BOTTOM LINE: If you feel overriding hunger is truly keeping you from losing weight, open the discussion with your doctor about considering a prescription appetite suppressant.

Thursday, May 19, 2011

How are the Poor Obese?

When did it become the norm that poor people are obese? Right now, 1 in 3 Americans are obese, and nearly 2 in 3 are overweight or obese. Throughout history, the poor have been HUNGRY...and thin. Meat has become cheaper than grains and vegetables, while we super-size and sugar everything. Check out the CDC's latest info on obesity in America for some shocking statistics...

Remember when going to the ice cream store meant picking out a single scoop of your favorite one of 31 flavors? Now the ice cream is simply the base, and we put multiple toppings of fudge and CANDY on top of our multiple scoops. In simply the past decade, fast food sales climbed from $107,147 BILLION to $164,836 BILLION dollars per year. Hmm...what if we spent some of those BILLIONS on health promotion, instead?

Obesity has numerous health consequences: Type 2 Diabetes, heart disease, high blood pressure, stroke, cancers (such as colon, breast and uterine), liver disease, sleep apnea and joint problems (especially knee and hip.) Our estimated obesity-related medical costs as a nation are $147 Billion annually. The obese INDIVIDUAL spends at least $1400 more on their medical care than a normal weight person.

BOTTOM LINE: Stop looking for the perfect diet, diet pill, or most amazing gym, and start making common sense small changes, like focusing on eating MORE vegetables and fruits and getting MORE active!

Saturday, May 14, 2011

A Step (or Pedal) in the Right Direction!

Good news! Americans are slowly but surely getting MORE mobile. Research studies utilizing national household travel surveys from the last decade reveal that we walked on average 9 miles more than we did back in 2001. We also biked about 5 miles more. I'm pleased to see that 8% are walking 30 minutes per day- that's my "magic number" for daily exercise, because 30 minutes of getting your heart rate up each day will give your heart, brain and body a boost. In fact, 30 minutes of daily exercise helps improve your mood as much as a low dose of an antidepressant!

I find it interesting that 75% of walking trips and 50% of biking trips in 2009 were purely a mode of transportation (to the store, school, see friends, etc.) rather than for the pleasure or intent of exercise. The wonderful part is that you get the same benefits of exercise, regardless of your intent when you are in motion. With gas prices going up through the roof, I hope we will see a continued trend that bicycling will be used in place of cars for short travel distances.

Why not take a step in the right direction and make a commitment to walk or bike to at least one nearby destination instead of driving? Perhaps your family could walk to a neighborhood yogurt shop or diner, or you could bike to the grocery store for those one or two forgotten items.

BOTTOM LINE: Congrats, America, we're starting to move MORE- keep it up! And please...WEAR HELMETS & visible clothing!

Wednesday, May 11, 2011

Top Two Secrets for Permanent Weight Loss

As the seasons change, and bathing suit season is staring us right in the face (or other, more sensitive body image spots), many of us are focusing on what we can do to make some positive and permanent dietary and lifestyle changes. Yesterday, I mentioned several successful strategies used by folks who have kept off over 60 pounds for many years. In my practice, the two most important strategies include eating breakfast each morning and exercising daily. Let me expand on these two points for a moment.

First of all, breakfast. Yes, your mom probably taught you that you must "put fuel in the tank" and that breakfast is the most important meal of the day. Guess what? She was RIGHT! When you get up in the morning and charge into your day without true nutrition (coffee does NOT count as breakfast), your body assumes there must be a food shortage and goes into conservation mode. To maximize your metabolism, you simply need to eat. Does it need to be a hot, four course meal? Nope! How about a cup of yogurt, or a banana with some peanut butter, or cereal with berries? In a hurry? Grab a granola bar (and a banana or other piece of fruit, in a perfect world.) It never ceases to amaze me that I have at LEAST one patient per month come in with impressive weight loss since their last office visit, and they tell me that the ONLY change they made was to start eating breakfast!

Okay, how about that daily exercise? Really, EVERY DAY? Yes, again. I prefer to think about it like brushing your teeth. Do you wake up each day and struggle with the decision of whether or not to brush your teeth? Do you really enjoy brushing your teeth? I'm guessing the answer to both of those questions is "no". Exercise should be the same deal. Again, it doesn't have to be fancy, just consistent. Pull on your sneakers & head out the door for a brisk walk, or flip on your tv and join in on an exercise program. If you start each day with a quick 30 minutes of some type of aerobic activity, I'd bet you'll find not only a much higher rate of consistency, but extra energy and a better attitude.

BOTTOM LINE: Commit to EATING BREAKFAST and DAILY EXERCISE to keep those extra pounds off for good!

Tuesday, May 10, 2011

How Do You KEEP the WEIGHT Off?

Many people lose the SAME 10, 20, or even 50 pounds over and over again. How frustrating is that? What can you do to PERMANENTLY lose weight, so you're not fighting that same battle? The first answer is obvious- stop DIETING. When you go on a super restrictive DIET, certainly you will lose weight, but if you never really look at your eating patterns and exercise habits, you are doomed to repeat the cycle.

I always encourage my patients to make changes they can live with for the REST of their lives. Typically this does not involve permanently eliminating ANY particular item from their diet- whether it's chocolate, butter, or even soda. Should you limit these high calorie items? Sure! But really, if you focus on MORE fruits and vegetables and water, then truly, you'll begin to notice you ARE eating less of these higher ticket items.

There is a wonderful website dedicated to people who have not only lost more than 30 pounds, but KEPT THOSE POUNDS OFF for at least a year- the National Weight Control Registry. In fact, the average weight loss is 66 pounds, and they have kept it off an average of 5.5 years! Both men and women are enrolled, with the average ages being 49 and 45, respectively. About half lost the weight on their own, while the other half joined programs. What do they have in COMMON?

1. 94% INCREASED their activity level, most commonly by WALKING
2. 78% EAT BREAKFAST daily.
3. 75% WEIGH themselves once per week
4. 62% Watch less than 10 hours of TV per week

BOTTOM LINE: If you want to stop battling the same pounds, take a look at the success stories of people who have KEPT their weight OFF, and see what simple changes you might be able to make to keep YOUR weight off.

Wednesday, May 4, 2011

World’s Best Mother’s Day Present (Even After the Fact)

What if I told you it was possible for you to give a present to your mother (or arrange for your kids to give a present to their mother) for Mother’s Day that had four characteristics: (1) it costs only a few pennies, (2) it takes little effort for most people to create it, (3) it had a high probability of making her cry (in a good way) and (4) it would be one of the things she’d be sure to grab in the (hopefully unlikely) event of a house fire? Interested? Well that gift is to write her [or arrange for your kid(s) to write her] a gratitude letter.

Gratitude letters are usually around 300 words in length, but can be as long as you’d like. (Kids in elementary school might write briefer letters and/or draw pictures instead.) The letter is in the first person (i.e., “you are so loving in how you treat me when I am sick” not “my mom is so loving when I’m sick”). To be more personal, write it out by hand. The letter should express only positive thoughts and feelings and should not include direct or indirect statements regarding your mom’s failings or opportunities for growth.Try to include examples of specific things that your mom has done or said that cause you to feel gratitude; these examples can be recent or from a long time ago. When it’s time to share the letter it’s best to read it to her (kids might rotate doing this one-on-one on Mother’s Day); don’t chicken out and hand it over for her to read. You may start to tear up or get emotional. That’s okay (you'll probably find you're not the only one). When you’re finished give it to your mom. Allow the positive moment to linger as long as she’d like (i.e., some of us, though we enjoy it, may start to feel a little uncomfortable with the intimacy that can emerge); in other words, your mom should decide when to end the moment or change the topic. (If you are reading this after Mother’s Day don’t let that stop you from trying it!)

You can also find a lot of satisfaction in writing gratitude letters for others, in your family or otherwise, towards whom you have unexpressed gratitude, be it ancient or recent. The experience is usually very positive, and often to a surprising degree.

BOTTOM LINE: Surprise your MOM or ANYONE you love with a "gratitude letter", and I'll bet YOU will be delighted as well. Thanks to Dr. Palmiter for today's guest blog entry.

Dr. David Palmiter is a practicing clinical psychologist and psychology professor in Scranton, PA. He is also the President-Elect of the Pennsylvania Psychological Association and the author of Working Parents, Thriving Families: 10 Strategies that Make a Difference His blog can be found at

Mother's Day Gifts- Get Ready!

Mother's Day is coming this weekend, just as we are polishing off the last chocolate eggs from the Easter basket. Hmm...sounds a bit like Halloween and also Valentine's Day, right? Why is it that most of our American holidays focus on CANDY? Mind you, I love chocolate, but the truth is that I have been popping beautiful pastel peanut M&M's into my mouth each time I pass through my kitchen and hear the Easter candy bowl calling my name.

At the same time that we are fretting about trying on swimsuits and fitting into summer clothing, we are working to "finish up" the Easter candy. Kind of counter productive, isn't it? So, first of all, let's give away the rest of the candy (if it's still sitting around.) Secondly, let's pamper Mom with gifts she'll enjoy that promote her health- physical, mental or spiritual.

So, what do moms like? Are you feeling rich? Offer her spa certificates or maybe a gym membership. Not quite so loaded? How about a simple manicure (usually around $15) or a lovely smelling candle or body lotion, or a new exercise outfit? Totally broke? No worries- go for HOME MADE; a simple meal (that MOM does NOT have to prepare OR clean up), cleaning her car inside and out, or jumping in and doing "her" jobs for the day, like a load of laundry or walking the dog.

If you REALLY want to touch your Mom's heart, check back tomorrow see what my guest blogger, psychologist David Palmiter,PhD, thinks is the PERFECT gift for Mom or anyone you truly love...

BOTTOM LINE: Skip the chocolate this year and celebrate MOTHER's DAY with a health-promoting gift!

Monday, May 2, 2011

Working Parents, Thriving Families- Possible? YES!

Time is flying faster and faster these days...If you have kids, you realize that the month of May is fast becoming as booked as December. Band recitals, track meets, sport tournaments, dance shows and all conceivable types of end of year banquets merge together with semester and year-end finals, packing overflowing stressors onto already busy families. If you feel like your family is crammed together on a giant version of a hamster wheel, running frantically and getting no where, then I've got the first book for your summer reading list: David Palmiter's Working Parents, Thriving Families: 10 Strategies that Make a Difference.

The best part of this "edutaining" family self-help book is that it is literally laugh-out-loud funny, so it is not a chore to read. Face it, the last thing an overextended parent needs is a dry psychology text- unless, of course, you suffer from insomnia. David brings to life common, potentially emotionally hazardous situations, and then OFFERS PRACTICAL SOLUTIONS. From coaches manipulating unequal playing time on team sports, to kids requesting violent video games, to challenges of single/divorced parent dynamics, this book offers concrete, proven effective strategies that you can add to your emotional toolbox.

Who should read Working Parents, Thriving Families? Every busy parent who has a robust sense of humor! If you are looking for a serious book on academic parenting theories, this is not it. If you are looking for a book that can seriously help you learn (or even simply better prioritize) positive family interactions and parenting skills, then grab your NOOK or Kindle and order it now, or grab a hard copy at amazon or your favorite local bookstore. Whether you're having one of those exhausting "what IS my kid THINKING?" weeks, or simply enjoy learning new nurturing skills, I think you'll enjoy and benefit from reading Working Parents, Thriving Families.

BOTTOM LINE: Crazy-busy lives with over-extended parents AND kids have become the norm. Stop racing and create some "special time" with your kids today.

PS. It's MAY- a new month- CHANGE THOSE AIR FILTERS (especially here in Austin, the Oak was out of control!)