Can't Get Rid of that COUGH?

This time of year especially, coughs seem to stick around forever. Here in Austin, the culprit may be seasonal allergies, but overall the major cause of persistent coughs is viral upper respiratory infections- from both simple "colds" and the big, bad flu. With these infections, after you get past the headaches, and stuffy nose part, you find yourself coughing- often up to SIX WEEKS after the initial illness. 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? Yes, but 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, she does 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. For this scenario, yes, you need an antibiotic. 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!!

Feeling SAD? LIGHTen Up!

While everyone around you is humming Christmas songs, lighting their menorahs 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 symptoms 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 symptoms 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 is the treatment of choice. Anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's such as prozac are also used), and Vitamin D replacement (if low) have also shown effectiveness in improving symptoms.

What is "light therapy"? Light therapy aims to artificially increase your exposure to light during the time of year when our natural daylight is limited. Typically light therapy is performed by sitting in front of a light therapy box, which simply gives off bright light that is similar to natural outdoor daylight (rather than standard light bulbs). During the session, the person may read, write or even eat- he or she does not need to focus on the light.  Although most people with SAD will require the therapeutic intensity of a light therapy box, many people with mild symptoms will respond to simple full spectrum light bulbs replacing their normal light sources at home.

Does light therapy work for other depressive disorders? Maybe. More studies are needed as we try to find depression treatments that do not carry large side effect profiles, and light therapy is a perfect example. One such study (Controlled trial of safety and efficacy of bright light therapy vs. negative air ions in patients with bipolar depression) published this year started looking at the effects of light therapy in bipolar disorder, but this small study (44 patients) did not yield statistically significant differences. However, bright light therapy has been effectively used to improve symptoms in chronic depression, post-partum depression (baby blues), premenstrual depression (PMS) and in disorders in the sleep cycle. 

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

Flu Season 2012- Ready or Not!

While we are rushing around in December, take a moment to think about whether or not your family has received the flu vaccine this year. The CDC reports show that unfortunately, we are jumping into the season early this year, especially in TEXAS, Alabama, Louisiana, Mississippi, and Tennessee. In fact, this is the earliest in the flu season to reach this level in almost a decade (since 2003-2004). The good news is that the viruses identified with testing DO largely match the strains that are included in this year's vaccine. More good news is that they are susceptible to our antiviral medications, although I am not a huge fan of these drugs in otherwise healthy individuals.
Both types of influenza- A and B- are being documented, with the usual ratio of nearly 3:1 from A:B.

What is FLU? Influenza is not a simple cold, nor is it a twenty four hour stomach virus. The flu causes fever, chills, cough, runny/stuffy nose, muscle aches, headaches, fatigue, and sometimes involves vomiting and diarrhea (more often in kids). Colds and allergies tend to bother you from the neck up- stuffy, sore throat, headache- but don't knock you down for the count, and coughs are generally less bothersome.

How is the FLU spread? This virus is spread from infected people when the cough, sneeze or talk, via tiny respiratory droplets, and the scary part is that you are contagious a full day BEFORE you develop symptoms (as well as for about a week after you feel sick.)

How can you prevent the FLU? Get vaccinated. Get vaccinated. Get vaccinated. It's not too late for this year- get vaccinated. The flu vaccine is indicated for EVERYONE over the age of 6 months, EVERY YEAR.

Who should NOT get vaccinated? Those with severe chicken egg allergies; bad reactions to vaccine in the past; younger than 6 months; history of an uncommon disease called Guillain-Barre. If you are sick with a fever, wait till this illness is over before getting the vaccine.

BOTTOM LINE: It's FLU SEASON again- get vaccinated!

Holiday Gifts that Show We REALLY Care!

Tis the season of gift giving, and what do we see? Piles of chocolate and other treats- yummy! I love sweets as much as the next person (I hear my friends laughing and making piggy noises...yes, I know- just keep away from my gluten-free treats!)  HOWEVER, this is my annual plea to think seriously about the edible gifts that you send. If your friend is wonderfully fit and able to eat high calorie treats in moderation, knock yourself out & send the chocolate cheesecake- but if your friend has diabetes or struggles with their weight, please consider a different gift.

"But she's a foodie!" Terrific- get her a subscription to Cooking Light (love their recipes!) or splurge on Harry & David fruit baskets. The point is that we need our friends encouraging us in the right direction. We don't buy a pack of exotic cigarettes for a friend trying to quit smoking, right? Enough said.

So- what's new this year in the world of health and fitness? Only yesterday, I learned of an innovative solution for the extra-busy person who wants to prioritize workouts with a personal trainer, but perhaps travels for a living or simply prefers to workout in their own home- personal training sessions via SKYPE! Why not? Kudos to Austin's Margo Kamin, one personal trainer offering these services. Margo credits Oprah for giving her the idea to use computer technology to take her business right into people's homes or hotels. I have always recommended workout tapes/DVDs as an easy home tool, but what an extra perk to have a live trainer making up new workouts & correcting your form, in the comfort of your home (without having to clean up your house for this guest).

No money, but got friends with electronics? Instead of "playing" on Facebook, try video chatting as you both ride your exercise bikes, or simply go for a walk as you phone chat with your pal.

BOTTOM LINE: Think HEALTHY as you plan your holiday gift giving, and really show your friends how much you value them in your life!

WORLD AIDS DAY- Does It Affect YOU?

Today, December 1, 2012, is World AIDS Day. Hopefully you will see some red ribbons around that reflect more than Christmas cheer- they are symbols of AIDS awareness. Many Americans are unaware that HIV disease is still a concern, since it is no longer a common lead story on the nightly news. Ironically, our capitol, Washington D.C., has the highest prevalence of HIV disease within our country.  There are now over 1.1 million Americans living with HIV disease. The good news is that with the tremendous advances with antiviral therapy in the last decade, most people with HIV infection are able to continue to lead productive lives, although they must be extremely vigilant about their health maintenance. The Center for Disease Control (CDC) estimates that one in four new HIV infections occur in young people ages 13-24, with over 12,000 new infections in this age group each year.

Perhaps the most frightening issue with HIV disease today is that a significant portion of these infected individuals- up to an estimated 60% of infected youth- have no idea they are infected, and therefore can be unknowingly spreading this disease. The current recommendations are for EVERYONE aged 13-65 and living in the United States to be tested, regardless of perceived risk. With this universal directive, we will be able to identify all those with silent disease, and initiate early treatment that will improve and prolong their health.

BOTTOM LINE: Current guidelines encourage all Americans aged 13-65 to have at least one HIV test. Talk with your doctor today and GET TESTED. 

Birth Control Pills Going Over the Counter?

The American College of Obstetrics and Gynecologists (ACOG) have released a committee opinion statement that they recommend over-the-counter access to oral contraceptive pills (OCs). ACOG believes that access and cost are the major barriers to women using contraception, and that OTC birth control pills will greatly reduce those barriers, thus lowering the unintended pregnancy rate. ACOG feels that there is no significant safety risk when OCs are compared with medications such as aspirin, which has been OTC for decades. (Note, however, aspirin would unlikely be approved if it were starting the whole FDA approval process in 2012! Great drug, very useful, but the side effect profile is much higher than tolerated in drug trials today.)

This issue will surely be open to widespread debate, pulling in religious and political arguments as well as medical. I'd like to share my thoughts on purely the medical front. As a family physician, I appreciate the value of an "annual" physical exam and know that OC prescriptions are usually a tiny portion of that visit. As a busy mom, however, I know that many women are only motivated to make time for that exam when that visit is a requirement to continue taking a prescription medication- which for many healthy women, is only an oral contraceptive. I worry that women will push aside their other often silent health issues such as weight, blood pressure, blood sugar, cholesterol if there is not another reason "forcing" them back in to see their physician. Additionally, there is significant counseling that we pair with birth control prescriptions- from logistics about the medication itself (taking it the same time every day; what to do if spotting or missed pills, etc.), discussions about the impact of OC's on other conditions such as depression or migraines,  and of course, education about sexually transmitted diseases. Additionally, I believe most clinicians and many OC users would agree that there is an art to choosing the correct OC that goes well beyond a basic flow chart. I shudder to think of the media war that will ensue as the drug companies ramp up their ads to try and capture their piece of the OC market. The pharmacists, though well-versed in OC pharmacology, simply will not have time to individually counsel women about these issues.

BOTTOM LINE: OTC OC's? Buyer beware. 

Texting Can Save Lives?

http://t.cdc.gov/ecards/message.aspx?cardid=573&category=157

Following up on yesterday's Great American Smokeout..., an interesting study was published this year looking at the effectiveness of TEXTING support to help people quit smoking. This was an analysis of several other studies, including over 9000 total participants. Text messages were used either exclusively or as a supplemental part of smoking cessation programs. Although the results were not fully consistent between the individual studies, ultimately the data is encouraging to support use of this ever-present appendage to aid people in quitting smoking.

In fact, the National Cancer Institute has a texting support program for smokers wanting to quit. Smokefree TXT is designed to be a 24/7 support system offering advice, encouragement and tips for tobacco users trying to kick their habit.

More and more, we are finding ways to use technology to help our health. This picture above is from the free e-card collection at the Center for Disease Control (CDC). Use the link above to check out the wide range of health reminders that you can share with your friends and family! Everything from flu shot reminders, to cancer screenings (think mammograms, pap tests and colonoscopies) to yes, quitting smoking.

BOTTOM LINE: Every bit of contact and support that we can give our friends to help them quit smoking is worthwhile- even texting!

Great American Smokeout!

TODAY, the third Thursday in November, is the annual GREAT AMERICAN SMOKEOUT sponsored by the American Cancer Society. Each year, smokers are encouraged to use this day as a QUIT date, or at least as a day to make a plan to quit. If you have a friend who still smokes, please reach out to them today and kindly encourage them with a reminder that today is a special day earmarked for their health. With this vice, there is NO amount that can be justified as being "good" for you.  Tobacco harms virtually every organ in the body. Everyone knows about the cause and effect of smoking and lung cancer, but cigarettes also greatly increase the risk of developing cancers of the bladder, kidney, pancreas, esophagus, throat, mouth, pancreas, stomach, ovaries, cervix and colon. Smoking directly increases your risk of heart disease- both heart attacks and strokes. Obviously it damages the lungs, causing chronic conditions with increasing shortness of breath and lack of energy.
Finally, appealing to your vanity (hey, whatever it takes!)- tobacco stains your teeth and gives you bad breath. And guys, smoking can lead to erectile dysfunction that evenViagra cannot "cure"...enough said.

Tobacco is one of the strongest addictions, and therefore often the most difficult to quit- if you are a smoker, I don't have to tell you that! The good news is that we have more ways to support you as you quit, and even if you have smoked for many years, quitting now still yields many benefits for your health! Blood pressure and carbon monoxide levels improve the first DAY you quit. In a couple months, both your circulation and lung function start to improve. In just one year after quitting, you will have cut in half your excess risk of heart disease compared to people still smoking. In a decade, your risk from dying of lung cancer falls to half that of a current smoker.

BOTTOM LINE: If you smoke- even "socially"- the SINGLE MOST IMPORTANT THING YOU CAN DO FOR YOUR HEALTH IS TO QUIT SMOKING!!! Talk to your doctor and make a plan TODAY.

Elect NOT To Gain Weight This Holiday Season

Happy November! In honor of election day tomorrow, let's ELECT NOT to gain the standard 7-10 pounds during the holidays this year. We have begun the eating trifecta...Halloween, Thanksgiving & Christmas/Hannukah. Americans love to celebrate these holidays with excessive amounts of high calorie foods- in large quantities. Can you enjoy the season and NOT gain weight? Of course! But yes, some discipline and primarily large doses of awareness are necessary.

Let's start with the Halloween candy. Most people have "leftovers" of snack-sized chocolates. We finish up our favorites (always the Reeses cups in our home) and then mindlessly polish off the less desired ones simply because they are THERE. Take a look right now at your candy bowl (if it is still sitting out). Grab a bag & toss the candy into it, and drop it off at your neighborhood food pantry if you don't want to "waste" it by throwing it away.

As we move into party season, be very mindful as you walk into each gathering. Often hosts are handing out a delicious alcoholic beverage as guests enter...which is a double whammy. Number one- high calories in sipping form. Number two- alcohol goes hand in hand with mindless munching, especially high fat or high calorie treats. SO- politely declare your thirst and ask if you can start with a glass of WATER, which will actually help fill you up and keep your head clear for healthier choices. Many studies have shown that simply drinking a full glass of water before meals cuts calories and promotes weight loss, so this is a win-win!

BOTTOM LINE: Be conscious of mindful eating (and drinking) as we begin holiday celebrations, and there will be one less New Year's Resolution on your list!

PS. Did you remember to change your air filter on November 1st?

Can't Swallow That?

Difficulty swallowing, known medically as "dysphagia", is a very common complaint. In fact, up to nearly a quarter of patients seen in primary care settings will suffer from this problem. Dysphagia is definitely more common in the older population, whether they are in nursing homes or living independently.

What causes dysphagia? The most common cause depends on the age. In small kids, there may be structural problems present from birth that may need surgical correction. In adults, however, the cause is often something that can be fixed more simply, with medications and/or behavior changes.

Smoking, excess alcohol, and obesity all tend to increase stomach acid refluxing back up into the esophagus, which can cause pain or difficulty in swallowing. Reflux, also known as GERD (Gastro Esophageal Reflux Disease) is a very common cause of dysphagia that is seen in otherwise healthy people. Quitting smoking, stopping excess alcohol and weight loss can all improve symptoms, as well as taking medications that reduce acid production.

Medications such as NSAIDS (like ibuprofen), potassium supplements, antibiotics and osteoporosis medications can all cause problems with swallowing, so both diagnosis and treatment of dysphagia in this case may involve stopping prescription medications.

• Let me take this opportunity to caution against "DRY SWALLOWING" pills. I cringe when I see people grab an ibuprofen and swallow it without a drink. Every time you take a pill or capsule, swallow it along with at least a half glass of liquid. Dry swallowing can essentially "scrape" or chemically irritate the lining of your esophagus. And please, let gravity help you get that pill all the way to your stomach- don't lie down for at least five or ten minutes after you take medications.

Less commonly, the more serious causes of dysphagia are to blame, including cancers, strokes, neurologic disorders such as Parkinson's Disease, advanced infections, or scarring from prior trauma or radiation.

BOTTOM LINE: Don't ignore trouble swallowing, especially if it persists or is getting worse. Schedule an appointment with your family doctor!

Hormones- Should We Take Them or Not?

Hormone replacement therapy (HRT) for menopausal women has been back in the news. In medicine, we've swung from placing virtually every post-menopausal woman on estrogen to barely allowing even the most miserable, hot-flashing, night-sweating woman to have any (after the Women's Health Initiative- WHI). What's the answer? Is estrogen safe or not?

As always, the devil is in the details. The WHI never said that we shouldn't be using estrogen (and progesterone) for women who had menopausal symptoms (such as hot flashes and night sweats). In fact, this is an excellent use of estrogen, and physicians and patients need not fear the short term (around five years) use of hormones to reduce symptoms as a woman's body adjusts to menopause.

The larger questions are those involving taking hormones as prevention for other issues, such as thinning bones (osteoporosis), heart disease, or dementia. Although earlier studies suggested estrogen helped protect against Alzheimers, there is not enough evidence to support taking HRT for this reason. Estrogen is one of the strongest protective factors for thinning bones, however, so for women at high risk for osteoporosis and bone fracture, there is data to support starting hormones around menopause in this group. Heart disease, however, is another story. The old thinking was that it was estrogen in women that allowed women to have lower rates of heart attacks than men, and therefore HRT might continue that benefit for menopausal women. The WHI study raised the alarm that women on HRT had a higher incidence of cardiovascular events (heart attack and stroke), and therefore confirmed other studies that suggested HRT is not appropriate if given only for prevention of heart disease. This was not new information, but it was magnified in the media and popular interpretation was that HRT is BAD and causes heart disease.

What do we know today? We shouldn't be starting hormone therapy on women who have gone through menopause many years ago. Hormone therapy is best used at the beginning of menopause, and is fully indicated for those women who are complaining of hot flashes, insomnia, night sweats, etc., during this transition time. How long should we use it? About five years. If symptoms flare as the woman tries to go off HRT, go back on for awhile longer and try to taper next year. There are many subtleties that need to be addressed (such as adding progesterone if the woman still has a uterus) but the take home message should be that women need not suffer through menopausal symptoms.

BOTTOM LINE: Estrogen is still the best medication to address menopausal symptoms such as hot flashes, insomnia, and night sweats- talk to your doctor about HRT if you are suffering!

Gardasil- Not for the FAINT,,,

Continuing my discussion this week about the HPV vaccine, Gardasil, I'd like to address side effects. At this point in the United States, there have been over 46 million doses of HPV vaccine administered (the vast majority Gardasil), which implies over 15 million people (since a series includes three shots.)
Unfortunately, when you start involving a population this large, within that group there will be uncommon diseases that occur in the general population. For example, a disease that occurs in only one out of 500,000 will have 30 cases in this group. Sorting out which of these rare occurrences are random and which are linked to a cause such as a vaccine can be challenging.

We have multiple organizations that closely follow adverse reactions to vaccines. The VAERS (Vaccine Adverse Event Reporting System) accepts reports from anyone- patients, family members, clinicians, etc. The Vaccine Safety Datalink coordinates the CDC- Center for Disease Control and Prevention- with managed care systems through electronic medical records. The Clinical Immunization Safety Assessment (CISA) network hooks up the CDC with our academic medical centers. All of these organizations collect and analyze adverse reactions to vaccines, from minor issues like transient pain, redness, swelling or headache, to fainting, blood clots and even death. What have they discovered from Gardasil?

Let's address what was not found first. Although there have been over forty deaths reported, there is no common pattern in these tragic events to link the cause to this vaccine. Some causes of death included diabetes, illicit drug use, heart failure and viral infections (not HPV).

There is an increased incidence of serious blood clots in this group, but only 10% did not have other obvious identifiable risk factors for clotting (such as obesity, smoking, or oral contraceptive use.)

FAINTING (medical term, syncope) IS a real possible side effect of this drug. The numbers are not staggering, but they are significant. Although fainting after vaccination is reported in significantly less than 1% of Gardasil recipients, Gardasil is the most frequently reported vaccine to cause fainting (as a single vaccine), accounting for over half of vaccine-related fainting episodes reported. The good news is that half of the fainting episodes occur within 5 minutes of receiving the shot, and 80% occur within 15 minutes.

BOTTOM LINE: Make sure to wait the full recommended 15 minutes after injection to minimize the risk of fainting, but be assured that Gardasil is a safe vaccine.

Gardasil- What's IN it?

Continuing the discussion about the HPV (Human Papillomavirus) Vaccine Gardasil...I'd like to step back and talk about exactly what is IN this vaccine. Much of the fear about immunizations surrounds concerns about the makeup of the vaccine, and what peripheral damage could potentially be caused from the content.

First of all, can you "catch" HPV from the vaccine? NO. Absolutely NOT. There are vaccines (like chicken pox or measles) that contain essentially watered-down versions of live virus, and as such, can in the course of an appropriate response cause a mild version of the disease as the body reacts to the vaccine, causing long-term immunity. However, the HPV vaccine does not work this way. There is only a tiny portion of the virus  (a surface protein called L1), that scientists extract, multiply and wad up into a ball. Our immune systems "see" this balled-up material as the whole HPV, and make very effective antibodies to fight it off.

What else is in the vaccine as a by-product? Is there thimerosol? NO. Is there Mercury? NO. Is there a tiny bit of aluminum? Yes. 225 micrograms of alum, to be exact, which is the same tiny amount that is allowed in infant formula (and yes, there is even aluminum in breast milk, though less than formula.) Why is there any aluminum in there at all? Well, aluminum is the most common metal found in nature- present in our water and much of our food. In vaccines, aluminum is an "adjuvant"- something added to improve the immune response.

BOTTOM LINE: The HPV vaccine Gardasil creates very effective immunity against the strains of HPV that cause 90% of genital warts and 70% of cervical cancers, and does NOT contain other byproducts that have raised concern in other immunizations.

PS Full disclosure: I am not on Merck's payroll in any fashion. I am a family physician with a special interest in STDs & I believe this vaccine will help prevent much disease & heartache.

Gardasil & Increased Promiscuity? NOT an Issue

The Gardasil vaccine is back in the news. Gardasil is the vaccine recommended for both boys and girls to protect them against the Human Papillomavirus (HPV), which causes genital warts and cervical cancer) Yesterday, an article published in Pediatrics confirmed that girls who had received this vaccine did not, in fact, have any increased sexual promiscuity compared with their peers who did not receive the vaccine. Why was this study done? One reason for lower vaccination rates with this recommended vaccine (compared to other vaccines recommended in this age group) was parental concern that giving their preteen and teenage daughters this shot would appear to be giving "permission" to be more sexually active since they would be protected.

This study looked back at roughly 1400 girls over three and a half years. Almost one third of these girls received the Gardasil vaccine, while the other 2/3 did not. After the immunization, medical issues that can result from increased sexual activity- pregnancy and sexually transmitted diseases- were measured and compared between groups. Results? No significant difference in the two groups.

The results are not surprising, but I am happy to have this data to help reassure any parents who may have this concern. I have not yet found a teen who believes that the Gardasil vaccine somehow makes them bullet-proof in the sexual arena, although I have seen many who falsely believe condoms will do so- but that is a different discussion. If teens are aware of Gardasil, they know it is "for cancer". Only the rare teen (and parent, frankly) seems to realize that this vaccine also protects against genital warts- a disease that affects over a MILLION sexually active people each year in the United States; a disease that often destroys the self-image of young people just as they are trying to make critical life decisions. Genital warts make people feel "dirty" and "gross", and although we can treat warts to make new outbreaks resolve more quickly, we do not have a cure. And if you've ever had a wart frozen off your knee or finger, you know it hurts, so add painful plus embarrassing when that wart is in the genital area.

BOTTOM LINE: Gardasil is recommended as part of our routine vaccinations for both girls and boys to protect them from HPV-related cancers and genital warts. If your child is not yet vaccinated, talk with his or her doctor at the next visit.

Teen Sexting & Risky Behavior

In 2009, headlines already noted that one in five teens "sext" despite knowing the risks. Teens sexting may be old news, but as the percentage of teens involved in cell phone based sending and receiving of sexually explicit pictures and texts increase, the links from this behavior to end points such as sexually transmitted infections and/or pregnancy need to be assessed. Last month in Pediatrics, a new study focused on teens & sexting: "Sexually Explicit Cell Phone Messaging Associated with Sexual Risk Among Adolescents". Nearly 2000 students from Los Angeles high schools were surveyed to try and determine if sexting was merely a safe alternative to the real thing or part of a pattern of risky behaviors.
Not surprisingly, sexting does indeed seem to be "part of a cluster of risky sexual behaviors" including not only sexual activity but specifically unprotected sex at last sexual encounter.

Who is doing all this sexting? Another large study from this year took place here in Texas, including 964 public high school students in Houston. (Teen Sexting and Its Association with Sexual Behaviors, from Archives of Pediatrics & Adolescent Medicine, Sept 2012).  Interestingly, although the make up of the study participants was racially split fairly evenly, "whites/non-Hispanic" had by far the highest percentage sending and requesting texts, with ~34%.  Over a quarter of these teens (28%)  reported having sent a naked picture of themselves, with equal numbers of males and females, although the girls were more likely to have been asked to send a sext. (68% girls vs. 42% of boys were asked to send one.) Of note, this request (to send a naked picture) bothered  27% of the girls "a great deal" versus only 3% of the boys.

Sexting is bringing with it a whole new set of challenges for our teens. What starts off as a joke or simple flirting can rapidly progress to pictures that would not only give their parents a heart attack, but can label the sender or recipient as a sex offender or pornographer. Behind closed doors  in the comfort of their own bedroom, teens feel safe and private flirtatiously sexting, but these exchanges rarely remain private. Additionally, these couples are at a whole new level of intimacy the next time they are together in "real life", which leads to more advanced physical intimacy at a quicker pace.

Personally, I think the vast number of non-sexting photos that young people are posting is escalating the sexting. When a guy can look and see a hundred pics of his girlfriend (& all her friends) in bikinis at the lake,  there isn't much left that wont cross the line if she wants to send something more intimate. Just my  "insta-opinion".

BOTTOM LINE: Parents, if your kids have a cell phone, please open the discussion about sexting- perhaps leading with asking if they are being sent (or asked to send) any "inappropriate" photos. 

What's This Little White Pill?

I'm guessing that I am not the first person to stumble across a stray pill- whether it's in the bottom of the purse, on the bathroom floor, or maybe in a pill bottle where you tossed together all your meds for a trip.  Certainly it can be alarming if you find a stray pill in your house- whether you are worried about your pet accidentally eating it or wondering if your teen/spouse/roommate is using a new medication. Today I simply want to share that if YOU find one of these strays somewhere and want to know what it is, thanks to technology there is a much easier answer than flipping through the picture pages of a PDR (the Physicians Desk Reference for drugs).

Online pill identifiers have you enter the pill color and shape, and then any imprint on the pill. Most pills have numbers and letters imprinted on the surface of one or both sides if you look closely. If you are still in doubt, head to your favorite pharmacy and the professionals there can use their additional resources to help identify the pill.

BOTTOM LINE: If you find a "stray" pill, start with an online pill identifier to determine what you've got. I've linked to the WebMD identifier, but there are many available. 

PS. Happy new month! You know what to do- change those air filters!

Go Purple- Help End Alzheimer's Disease!

The heart remembers...Today, September 21, 2012, is Alzheimer's Action Day- so put on your PURPLE and help to raise awareness for this devastating disease. Over 35 MILLION people worldwide and 5.4 MILLION Americans are living with Alzheimer's disease (AD). $200 BILLION will be spent in the US alone this year caring for people suffering with AD. This disease slowly invaded my amazing mother's brain, creeping along for over a decade, steadily pulling her away from our family. As we don our purple today, we stand together with every other family who has helplessly witnessed this "long goodbye". I hope and pray we are in the last decade without a cure or full prevention for Alzheimer's.

Significant memory loss is NOT a normal part of aging. Misplacing your keys, forgetting a friend's name at a chance meeting or not being sure why you walked in to a room are frustrating events- but usually a sign of a busy mind focusing on other things. Missing multiple appointments or bills, not knowing how to drive home from your neighborhood store or losing the ability to balance a checkbook (when that used to be a straightforward process) ARE worrisome signs.

Major advances are being made in understanding how Alzheimer disease affects the brain, and the sequence in which it progresses. The hope is to find a way to block that progression, and research dollars donated today will help scientists find that barrier.

BOTTOM LINE: If Alzheimer's disease has touched YOUR life, join in the fight to find a cure and start with wearing PURPLE today!

New Study Offers Hope for Alzheimer Prevention

A glimmer of hope shines in the devastating world of Alzheimer's Disease (AD), as this week a study published in the Archives of Neurology journal reveals that a class of blood pressure medications (Angiotensin Receptor Blockers, known as ARBs) may reduce the risk of developing Alzheimer's.
Although the mechanism of Alzheimer's is not fully understood, we do know that abnormal deposits of amyloid (a protein) occur early in brain as an early stage in the disease process. This new study, the Impact of Angiotensin Receptor Blockers on Alzheimer Disease Neuropathology in a Large Brain Autopsy Series, looked post-humously at the brains of 890 people who had suffered from AD and high blood pressure, and found that those patients who took ARBs (for their blood pressure) had significantly LESS of these amyloid deposits built up.

The hope is that if we can find ways to prevent the build up of these amyloid deposits, then this will halt the progression of Alzheimer's both pathologically and clinically. Prior studies have shown    some clinical evidence that patients on ARB's for their blood pressure have a lower risk of developing AD, but this is the first study to show us the actual physical changes in the brain- very exciting news!

So, if you have a strong family history of Alzheimer's disease and/or are experiencing progressive memory loss, should you ask your doctor to prescribe you an ARB today? Well... yes and no. I would NOT prescribe an ARB for a patient in this situation who had normal blood pressure. However, if she had newly diagnosed high blood pressure, I would certainly consider starting her on an ARB (rather than a diuretic or beta-blocker, our other first-line medications), and I would be open to a discussion about changing her to an ARB if she had hypertension and was already being treated with another class of medications. Of course, when choosing a medication, there is a range of different issues- from side effects and drug interactions to cost (and health insurance preferences), but potential "side"benefits such as this are absolutely part of the decision process.

BOTTOM LINE: Alzheimer's research is critical to help us find a cure for this debilitating disease, and this new study offers encouragement that ARB's may play a role in slowing the development of AD.

It's BACK- the Cursed Halloween Candy

Yes, we've just got our kids starting to settle into their school routine, and yet what has already appeared in the grocery stores? That's right- Halloween Candy. I swear this is the start of the fall fattening project...

Don't get me wrong, I love Halloween! I adore seeing all the kids in costumes and frankly, I pull out a witch or Mrs. Incredible costume for myself each year. But here is the catch- candy to the max on one night per year is no big deal (brush & floss those teeth afterwards, of course.) Unfortunately, what happens in many households and work sites is that those "sample size" candies start showing up in a convenient drawer near you, handy for daily snacks and pick-me-ups. Before you know it, you've got a candy habit that is truly tough to break, not to mention that the extra 500 calories per day that you are innocently consuming is adding on a full extra POUND per week!!

If you think I am exaggerating about this, check the calorie count and serving size on your favorite candy. Hershey's miniatures, for example, are only 42 calories per mini, but most of us don't stop at one- even the "serving size" is 5 minis at 210 calories.




BOTTOM LINE: If you don't want to literally increase YOUR "bottom line", save the Halloween candy for HALLOWEEN and don't buy it till October 30th. Trust me, the stores will still have it in stock.

Breaking News: Fish Oil Supplements "Out"?

Today the Journal of the American Medical Association (JAMA) published a study about the Association Between Omega-3 Fatty Acid Supplementation and the Risk of Major Cardiovascular Disease Events. The popular media has picked this up and many headlines are focusing on removing these fish oil supplements from your medicine cabinet- is that the take-home message? Maybe not...

There are a few separate issues to discuss. First of all, note that the reason there was a study to begin with is that it has long been established that populations with primarily fatty fish-based diets have lower rates of heart disease. Being Americans looking for a quick fix, we'd rather pop a pill than change our behavior, so rather than add fish to our diets, we look to taking a capsule filled with fish oil. Supplement studies, however, have not been as robust in demonstrating the same heart benefits as simply changing your diet. This study was a meta-analysis that examined over 3600 previous studies, ultimately including 20 of them that met criteria to eliminate bias and make them truly "evidence based". This included nearly 70,000 patients and their rates of heart attack, stroke, and death. Ultimately, fish oil supplements by themselves were NOT shown to lower the risk of death, heart attack or stroke. Do omega-3 supplements lower triglycerides? Yes- but if you are focusing on patient outcomes and not simply lab numbers, the benefits are not there.

Are there other reasons to consider taking fish oil supplements? Probably so, although I will continue to argue that you are better off adding salmon, tuna, trout or sardines to your diet several times per week. Beyond lowering triglycerides, Omega 3 Fatty Acids have been been recommended for potential benefit against numerous cancers, inflammatory bowel disease, dry eyes, rheumatoid arthritis and even dementia. If you are NOT willing to add fish to your routine diet, then taking fish oil supplements for any of these reasons may be beneficial, and there appear to be no serious negative effects (except for a shrinking wallet.)

BOTTOM LINE: If you are taking fish oil supplements to improve your cardiovascular health, you may be improving your lab values but not decreasing your risk of heart attack or stroke- go for a jog or go fishing (and eat your catch) instead. 

Was it Food Poisoning or a "Stomach Flu"?

All this talk about fruits and vegetables reminds me of...food poisoning. In the recent past, we've had several outbreaks of food borne illnesses that have caught our attention- first the E-Coli in hamburgers, then the Salmonella outbreaks from eating tuna (or perhaps from handling small turtles), and let's not forget the Listeria-infected cantaloupes!  As such, I thought it would be helpful to go over some facts about food poisoning.

First of all, you are unlikely to know if your last bout of intense stomach upset was the result of food poisoning rather than a "stomach virus", unless there was a specific, easily identifiable source and obvious consequences (four coworkers had egg salad, the other ten had ham sandwiches, and only the four egg-eaters were sick that night). For every one case of food poisoning that is reported, the CDC estimates there are at least another 30 cases that went unreported for this very reason.

The good news here is that the treatment really is the same, regardless of the source of the stomach upset (nausea, vomiting and/or diarrhea). The vast majority of food poisoning does NOT require specific treatment such as an antibiotic. In general, the best treatment is to gently stay hydrated (watered down sports drinks seem to work the best), rest, and avoid irritating your stomach for a few days by sticking to a relatively bland diet free of caffeine, alcohol, dairy or spicy foods.

Food-borne illnesses are very common, with over 38 million cases of gastroenteritis , over 70,000 hospitalizations and over 1600 deaths per year in the United States alone. The agents that are the most lethal (cause the greatest number of deaths) are Salmonella, Listeria, Toxoplasma and norovirus, although in healthy adults, these diseases are only occasionally severe. Additional food poisoning culprits include the bacteria Campylobacter, Shigella, Yersinia, Clostridium botulinum (causes botulism) and Staph. Stay tuned this month for more details on these illnesses.

BOTTOM LINE: Food poisoning is common, but identification of the source or causative agent is much less common and not usually medically significant. Prevention is definitely worth a pound of cure for these illnesses!

Doctor, How Do YOU Stay Thin? My Not-So-Secret Revealed...

"But Dr. Grimes, YOU don't have to worry about YOUR weight- you're tiny! You don't know what it is like to struggle with your weight." 

Every time I hear this from a patient, I am not sure if I should laugh or cry. While yes, there are some people out there who seem to be able to eat whatever they want and never exercise, and yet stay thin, healthy, gorgeous, rich and let's throw in perfect in every way (ha!), MOST people who appear healthy make very conscious choices to keep themselves there. As my close friends can attest, I love to eat delicious foods of all categories- nutritious or not.

Unfortunately, after having an exceptionally active metabolism up until age 25, I am now (& have been for over two decades) fully capable of packing on the pounds with the best of them. In my first pregnancy, despite delivering a month early and enduring over seven months of morning sickness that lasted day and night, I was mortified to gain forty pounds. I'm sure eating nonstop pizza & burgers (because nothing else appealed to me) might have had something to do with that...but I digress. The point is that if I do not keep a close eye on my weight, I gain more than I would like. I can lay the blame wherever I would like- blame medications, injuries, stress, or whatever- but that doesn't change the end result. If I gain weight, I have to lose it the same way everyone else does, by burning more calories than I consume. So what exactly do I do?

1. RECOGNIZE THE PROBLEM- I try to weigh every morning, aware that everyone has a natural up and down flux of a couple pounds. When I hit 3 pounds higher than my average, that's my ceiling and it's time to get serious before it gets out of hand. (This may be the most important step. When I skip this step, it's 5-10 pounds up, which is much tougher!)

2. START WITH A SEVERAL DAY "CLEANSE"- I'm not talking about an enema here! I simply go back to basics and eat ONLY fruits, veggies, and a simple protein (nuts, beans, fish, chicken or lean meat.) I also drink as much water as I can stand (about 6 glasses in a day), and no other beverages. The picture above is my lunch- large portioned, delicious and 90% veggies.

3. RAMP UP MY EXERCISE- for the record, I walk our dogs around two miles per day every day. This is both for the dogs & for me to MAINTAIN my weight. If I need to lose, this is not enough, because this is my baseline- I need "MORE". I typically add in a second walk or get on the exercise bike for 30 minutes in addition to the daily walk.

4. TRY TO HAVE REALISTIC EXPECTATIONS- good weight loss is 1/2-1 pound per week. I am as guilty as the next person that after two days of being "perfect", I am disappointed when my weight has not miraculously jumped back two or three pounds to baseline. By the end of a week (Mon-Friday) I have typically seen the scale budge at least a half pound, and once I know I am headed back in the right direction, I start to loosen up the diet by allowing some processed foods back in, but at restricted portions. Truth be told, I let in dessert first- but make healthy choices such as some whip cream on strawberries or chocolate syrup on a banana. Next I might bring back corn chips (I'm gluten-free, so less likely to choose cereal, breads, or crackers). I very slowly add in other foods until I am back to my healthy baseline, which includes some high calorie treats ONCE I am back where I want to be.

BOTTOM LINE: Virtually EVERYONE needs to be conscious about their weight and health choices for nutrition and exercise- don't assume thin people are just "lucky".

What's YOUR Blood Pressure?

Today the Center for Disease Control and Protection (CDC) released their report "Vital Signs: Awareness and Treatment of Uncontrolled Hypertension Among Adults- United States, 2003-2010), and what did they find?

• 30.4% of American Adults have high blood pressure - over 66.9 MILLION of us!!!
• 14.1 million people HAVE high blood pressure, but do not KNOW it
• 
  Of those that have high blood pressure, over HALF are NOT CONTROLLED.
• 5.7 million people KNOW they have HBP but don't take medicine
• Of the 35.8 million people who have UNCONTROLLED high blood pressure, the VAST MAJORITY (89.4%) have a usual source of health care & (85.2%) have health insurance

The media is all abuzz with this information, and with good reason. Hypertension (high blood pressure) is a disease that is easily diagnosed- just a blood pressure cuff is needed. We have a plethora of medications that treat hypertension, the mainstay of which are older, effective drugs that should not be expensive. High blood pressure, however, is a silent disease- potentially no symptoms until that big heart attack, stroke, kidney or heart failure. It is challenging to convince patients to take a medication when they have no obvious symptoms that will improve by taking the medications. 

With one in three Americans being obese, it should come as no surprise that roughly that same number of Americans have high blood pressure. As a nation, we have got to start reversing these trends, and MEDICATIONS ARE NOT THE ANSWER. Yes, we need them to control pressures (and some hypertension exists in skinny, fit bodies, independent of weight), but the real focus should be on improving our exercise and food choices. The good news is that with even very modest weight loss (of as little as 5-10 pounds), much of high blood pressure resolves! So, back to M.O.R.E. on nutrition!

BOTTOM LINE: High blood pressure is a SILENT disease that will cause serious damage if not discovered and treated, so CHECK YOUR BLOOD PRESSURE today!

What About the HCG Diet?

If I had a penny- okay, maybe a dollar- for everyone who asked me about the HCG diet, I'd be ready for retirement! Locally here in Austin, we had a couple people within our medical community do the HCG diet and lose a dramatic amount of weight, which fueled the fire. In my practice, I have had multiple patients try (outside my advice) different versions of the diet- some shots, some sublingual, some pills- and though all lost weight quickly, virtually all regained it in the same time span. Reading the medical literature to find some evidence-basis for the diet, here is what I found:

1. First of all,  HCG is NOT FDA APPROVED for  weight loss, and in fact, the FDA ordered the removal of all homeopathic OTC HCG products from the market back in December 2011 (because not only do they not work, but they promote a dangerous diet.)

2. HCG diets "work" because along with the supplement, patients are restricted to a dangerously low 500 kcal/day diet. Most people consume around 2500 calories per day, so a deficit of 2000 calories per day would mean a 1/2 pound or more of weight loss per day. So YES, anyone who managed to limit themselves to 500 calories a day will lose weight, but at what risk? This amount of caloric restriction can lead to heart arrhythmias, gall stone formation and electrolyte imbalance.

3. The idea behind the HCG is that it will suppress your appetite so that you can stand the severely restricted diet. HCG is the "pregnancy hormone"- if you had morning sickness (which I can first-hand attest does not simply last in the morning) you can certainly believe HCG would make you not hungry. Interestingly enough, however, in the majority of controlled studies, HCG injections showed no benefit over placebo injections- the test subjects lost no more weight on HCG than placebo, and there was no magical "redistribution of fat" (that is often touted as a potential result.)

BOTTOM LINE: HCG diets "work" because of the severely restricted calories in the diet, not from HCG "magic". Talk with your doctor or  registered dietician to find the optimal weight loss plan for you. 

PS. Happy new month- change those AIR FILTERS!

Scary Mosquitoes & West Nile Virus

Bzzz....swat! The mosquitoes are particularly annoying this time of year, and now we have more to worry about than an itchy red arm- the West Nile Virus (WNV) is spiking again. In fact, the 1118 cases of human West Nile viral infection that have been reported to the CDC in 2012 mark the highest number of cases since the recognition of this disease back in 1999. Unfortunately for my neck of the woods, over 75% of the cases have occurred in Texas, Mississippi, Louisiana, Oklahoma and South Dakota, including 41 deaths. That's the bad news. The good news is that very few people who are infected ever develop serious illness- only around one in 150. In fact, about 80% of people infected will never know it, because they don't have any symptoms at all! AND, the vast majority of mosquitos are NOT infected to begin with, so most mosquito bites are not potentially serious.

What are symptoms if you get them? Picture the flu- in the wrong season. WNV occurs most often in summer and early fall. Fever, headache, body aches, nausea, vomiting, and possibly a rash make up the usual presentation. These symptoms a few days to a couple of weeks. The severe disease (remember, just one in 150 infected) starts the same way but progresses to seizures, disorientation, tremors, numbness, paralysis and potentially death.

Mosquitoes spread the West Nile Virus by feeding on infected birds and then biting humans. Symptoms show up within days to possibly two weeks of the bite. The bite itself does not look different than other mosquito bites.

Prevention is all about clothing and mosquito repellent. You already know if YOU are the "mosquito magnet" in your family or friends. I know I am! The only time my husband has been bitten by mosquitoes when I am nearby was when I was pregnant (guess the hormones that made me nauseated did the same for the mosquitoes...) I have bathed in Skin So Soft & every other "natural" repellent, but the only thing that works for me is a physical barrier (light weight hiking shirts) PLUS sprays with DEET. What else can you do? Make sure you eliminate any standing water (such as in buckets or children's wagons or other toys) in your backyard, to get rid of mosquito breeding grounds. Use mosquito repellant that contain DEET or Picardin, or oil of eucalyptus. Finally, if you find a dead bird, do NOT touch it without gloves, and call your local health department to report it.

BOTTOM LINE: If you are a mosquito magnet, take some extra precautions this time of year if you are going to be outside from dusk to dawn, so you can avoid becoming infected with West Nile virus.

Is it a New or Old Weight Loss Drug?

This month I am talking about obesity & weight loss. By our human (and American) nature, we would all like a quick fix to solve our weight issues. This summer, the FDA approved not one, but TWO new weight loss drugs.  My last blog addressed lorcaserin (Belviq), and today's focus is really something old in a new package.

Qsymia was FDA approved in July 2012, and it is a combination of two older drugs that have been used independently to help with weight loss: phentermine and topiramate. Phentermine is an appetite suppressant, and was half of the infamous fen-fen (a diet pill combo that was removed from the market once its use was associated with the development of pulmonary hypertension (a damaging condition in the lungs) and heart valve issues. Phentermine by itself is still approved for "short term" use- a few weeks- as an appetite suppressant, but there is limited efficacy and safety data available. Topiramate was originally classified as an anti-seizure medication, but indications now also include migraine prevention. Physicians and patients were generally pleased to see that a side effect of topiramate is weight loss (to the point where I have had patients without frequent migraines ask if I will prescribe this drug "just in case"!)

Qsymia combines these two drugs, and showed significant weight loss at one year- an average of 8.9%.
Both drug components are  at much lower doses than the individual drugs are typically prescribed, which hopefully will limit side effects. Indications for this new drug are for patients who have a BMI>30 (defined as obese) OR if they are overweight (BMI>27) AND have high blood pressure, diabetes, or high cholesterol.

If you meet those qualifications and are interested in trying this new drug, don't rush to your doctor quite yet! Qsymia is not yet in pharmacies, though it is anticipated to be in "certified pharmacies" next month (September 2012).

BOTTOM LINE: The newly approved weight loss medication, Qsymia, combines two older medications and may prove to be significantly effective in helping treat obesity, but it is not available quite yet. 

A New Weight Loss Drug!

Have you heard that the FDA approved not one, but TWO new weight loss drugs this summer? Hooray! Our problems are solved, right? Are there still overweight doctors out there? Well...yes, there are, so that should give you a clue that these new drugs are not miracle workers.

Today I will focus on the first drug approved. Locaserin, brand name Belviq, came out in June 2012. This drug will decrease your hunger and increase your feelings of satiety (feeling full after a meal). Locaserin works within the serotonin system (like the antidepressants such as Prozac) but targets a specific receptor that is key in the appetite game, rather than mood. Fenfluramine, an older drug with a similar mode of action, was removed from the market in 1997 due to concerns of its detrimental affect on heart valves. The selling point of locaserin is that it targets a different, very specific receptor that is not linked to these deleterious valve changes.

In the studies necessary to get approved by the FDA, patients on this drug lost an average of 12 pounds in one year. Let me remind you that good steady weight loss is a pound or two per month (not the 30 pounds in 30 days we all would like), so this is reasonable weight loss. However, from my standpoint, I'd like to see a drug produce better results before risking the side effects. In this case,  side effects of lorcaserin include headache, dizziness & nausea. So at this point, I am not impressed enough to prescribe this drug.

BOTTOM LINE: Lorcaserin (Belviq) may provide obese patients help with decreasing their appetite & increasing satiety, but does not provide dramatic weight loss results.

Which Diet is Best for Weight Loss?

Now there is the million dollar question, right? Interestingly, despite billions of health care dollars being spent on "diets", there are not recent high level studies in the medical literature to support touting one weight loss diet highly above all the rest. In 2001, there was a scientific review of popular diets by Freedman, King, & Kennedy, that concluded "low fat, low calorie diets are the most successful in maintaining weight loss." Note- this is in MAINTAINING weight loss, not LOSING weight. Ultimately, as should come as little or no surprise, CALORIC BALANCE is the major determinant of weight loss, regardless of the composition.

So...which diet? HIGH protein, LOW carb diets have a very high satiety effect- you are simply not as HUNGRY when you restrict calories if there is a high protein content. Several studies have demonstrated that the less hungry (more satiated) people are, the higher their compliance rate with a calorie restricted diet. This sounds rather obvious- if you are not hungry, you won't "cheat"- BUT...remember most of us do not eat because we are hungry. We eat because we are happy, sad, mad, bored, distracted- you name it. (See related post "Break the Eat, Repent, Repeat Cycle").

Are high protein diets safe for the kidneys?  A 2012 study at the Indiana School of Medicine confirmed that low carb, high protein diets do NOT cause any harm to the kidney function in obese patients who had healthy kidneys at the start.

What about the heart? A very large study this year in Sweeden (>40,000 women) did show that women do develop an increased risk of cardiovascular disease (heart attacks & stroke) if they stay on a low carb/ high protein diet long-term.  However, in the short term (at one year), low carb/high protein diets are more effective in weight loss and reducing cardiovascular disease risk.

BOTTOM LINE: Low carb/ high protein diets may help you lose weight in the short term (~ a year), but for long-term weight maintenance or continued weight loss, go for what you know to be healthy- MORE fruits & vegetables & a lean protein source. 

You're "Obese"- Now What?

Yesterday's WAKE UP blog entry referred to the USPSTF recommendation that all patients who have a BMI >30 should be referred to an "intensive, multicomponent behavioral intervention" in order to lose weight and therefore decrease their health risk. These recommendations are evidence-based, focusing on patient outcomes (disease states, not purely lab numbers).

What is "intensive"? 

• 12-26 sessions per year (often weekly to begin, then monthly.)

What is "multicomponent"?

• Individual or group sessions with physicians, dietitians, and other trained providers
• Include physical activity
• Address issues that keep people from changing behaviors
• Encourage self-monitering of nutrition and exercise

What results can be expected? 

• Weight loss typically ranges from 8.8-15.4 pounds in the first year
• Glucose tolerance is greatly improved- in fact,  that there is a 50% decrease in new diabetes diagnoses in only 2-3 years 
• Cardiovascular risk factors are improved (lower cholesterol & lower blood pressures)

If your BMI is >30, you are more likely to develop heart disease, strokes, high blood pressure, diabetes, certain cancers (esophagus, breast, uterine, colon, kidney, thyroid,  and gall bladder). It doesn't matter if you LOOK "okay"- this is NOT a cosmetic issue! While 15 pounds may not be all you need to lose, often that is enough weight loss to make a very significant positive impact on your health

BOTTOM LINE: Talk with your doctor about your BMI at this year's annual physical, and prioritize a healthier lifestyle starting today.

WAKE UP America- Courtesy of Colorado!

This summer I had the pleasure of spending some time in the gorgeous mountains of Colorado, a state which has long been one of the "healthiest" state in the nation- especially as measured by weight. Colorado has "only" 20.7% of the population with a BMI (body mass index) that indicates obesity, compared with 35.7% of overall American adults who are obese. That's ONE in THREE American adults who are obese! But I digress...my point was going to be that as our family watched some of the Olympics on tv, we saw a Colorado health-awareness commercial that I thought was extremely well done. The commercial shows people waking up in bed, challenging the Colorado population to actually "WAKE UP" and look in the mirror and see their true reflection- not the image in their head. The point is that obesity is "not as extreme as you think", and certainly my clinical experience echoes that thought.

Most adults are so comfortable with the notion that they "will never look like/ weigh what they did in high school" to the point that as they carry around an extra 20-30 pounds, it doesn't occur to them that they are jeopardizing their health in any way. And their physicians (who are not immune to the same beliefs for both themselves AND their patients) are along for that joy ride.

In June of this year, the  United States Preventative Service Task Force issued an update to physicians regarding screening for obesity. We are called to screen EVERY adult (which means get a weight & height & determine a BMI) and then for every patient who is obese- meaning a BMI >30- we should direct them to an "intensive, multi-component behavioral intervention". What is that and why? More on this tomorrow...

BOTTOM LINE: "WAKE UP", step on a scale & check your BMI today- don't assume weight is not an issue if you don't "look" or "feel" obese. 

PS. It's the FIRST of the month- change those air filters!

UNPLUG Your Kids!

As summer goes on, kids get sucked deeper and deeper into their electronic abyss. Before you know it, they are sleeping past lunch, staying awake all night and receiving all their light rays from a computer screen or their phone. Today's blog is my public service announcement to parents to UNPLUG your kids!! Remember that all the medical academies recommend we limit screen time to LESS than TWO HOURS per day. Yeah, I know- your kid had that much screen time before she ever got out of bed this morning...

I love camps that prohibit all electronics and allow kids to go back to being kids- jumping in lakes, riding horses, crafting or just hanging out and actually talking out loud instead of texting. Kids (yes, teens, especially) seem to come back home recharged and more socially engaged. However, YOU can create (force, whatever!) your OWN electronic fast  for your kid right at home. Create at least a day (or start with a half-day) of UNPLUGGED time. What can they do? Read a book. Talk. Play cards, or maybe a board game. Better yet- make THEM come up with a list of 10 things they could do.

Of course, adults, we could all use this advice, too. So, stop reading this blog & UNPLUG yourself for a few hours!

BOTTOM LINE: Don't let your kids (or yourself) stay "plugged in" to electronics- limit that screen time!

Summer Swimmer's Ear PREVENTION

Swimming all summer is FUN...till someone gets "swimmer's ear". An ounce of prevention here is truly worth the proverbial pound of cure, and the best news is that you can MAKE that "ounce" right in your kitchen!

Swimmers ear is caused by bacteria and fungi, which get access to the ear via the pool or lake water during swimming. (By the way, using q-tips to "clean" the ear serves to cause minor trauma to the ear canal and tends to make it easier to get these outer ear infections, so skip the q-tips, please.) 90% of the time, swimmer's ear only affects one ear. If you wake up with both ears hurting, it is more likely your middle ear causing the problem, and all the topical treatments in the world won't help.

Back to your kitchen- grab a bottle of vinegar and then a bottle of rubbing alcohol, and mix them together half & half. This mixture can be spilled on to a cotton ball and squeezed into the ear canal OR my preference is to use the bottle from the over-the-counter swimmer's ear prevention product and fill it up with my "home brew". Place around six drops in each ear, and allow to drain back out- do this after every swim session, and three times/day if you develop a sore ear. Warming up the bottle in your hands will make it less irritating to your ears. The vinegar kills the bacteria & fungus and the alcohol dries up any remaining moisture. Voila! Prevention & cure- same solution. I would estimate this will treat the vast majority of infections, but if your sore ear isn't improving in a couple days, please call your doctor & let them take a look. We certainly see "swimmer's ear" infections that require topical antibiotics and or topical steroids (to decrease inflammation and swelling.)

BOTTOM LINE: If you (or your kids) are frequent swimmers, don't wait for a sore ear to start using swimmer's ear prevention this summer!

Why Visit Someone with Dementia?

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.

So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.

So, here are a few suggestions for an easier visit:

1. Bring pictures, especially of you and your friend together.

2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.

3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.

4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)

5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.

BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.