Wednesday, December 12, 2012

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!!

Tuesday, December 11, 2012

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!

Wednesday, December 5, 2012

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!

Tuesday, December 4, 2012

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!

Saturday, December 1, 2012


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.