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!!