Say NO to Delivery Food!

Have your kids reached the "I'm bored" stage of summer yet? If so, why not spend some quality time together in the kitchen? Our family is challenged with one vegetarian and one GF (gluten-free) dieters, but we have found multiple menus that still please everyone. Today's meal (pictured above) was made by our younger teenage daughter, proving that 14 year-olds can definitely do more than order pizza!

Nutrition studies have found that kids are far more willing to expand their palate when they are involved in preparing the food. Fruit smoothies are probably the easiest and most delicious way to engage your child in the kitchen. Grab some frozen fruit, a banana, and some plain or vanilla yogurt. Toss the ingredients together in a blender and voila- healthy breakfast you can drink on the run as you dash off to dance camp!

My next favorite is today's dish-stir fry. This meal is simple to make vegetarian by adding your beans of choice, but can also be protein-enhanced with chicken, fish or other meats. Supervise your kids as they learn to chop up squash, zucchini, mushrooms, onions and carrots, then toss them in a large wok or pan and stir fry with olive oil. You can also add some garlic and other seasonings as they expand their palate. We serve this over rice (using the" toss in the microwave for one minute" super-fast option) or pasta or even simply over lettuce for an extra veggie load.

BOTTOM LINE: Break the pizza/burger/nachos summer habit, and substitute some healthy dishes and family fun in the kitchen!

Is this Carpal Tunnel Syndrome?

With all the time we spend at computers, I'm amazed we don't actually see more complaints of carpal tunnel syndrome (CTS), the single most common cause of peripheral nerve compression. Carpal tunnel symptoms include pain, numbness or tingling of your THUMB, INDEX, and MIDDLE fingers, and may extend to include your wrist, palms and forearms. Typically, the pain is worse at night, although that is not true for every person. Extended use of your wrists or hands- such as typing at a computer- also tends to increase discomfort.

The actual problem in CTS is pressure on the median nerve at the wrist. The median nerve only supplies the thumb "side" of the hand and fingers, which is why the symptoms do not show up in the pinky finger. (If the pinky is numb or tingling, you may be pressing on the ulnar nerve at the elbow).
The space in the wrist is limited- restricted by a ligament on the bottom and bones up above, so even general fluid retention and swelling can cause compression and lead to carpal tunnel symptoms. Pregnancy, for example, often results in enough fluid retention to cause CTS. Other risk factors include diabetes, kidney failure, low thyroid and birth control pill usage, as well as jobs or activities that result in prolonged flexion or vibration of the wrist, such as golfers, carpenters, musicians, jack-hammer operators and assembly line workers or grocery clerks.

There are a couple simple tests that doctors use to help diagnose CTS. Tapping on the underside of your wrist may cause a shooting electric pain to jump up into your wrist or palm- that is called the Tinel sign. Holding your hands together, bent downward (like reverse prayer hands) can worsen the numbness, pain or tingling in your thumb and first two fingers- this is the Phalen's sign.

Treatment obviously varies depending on the cause of the CTS. If the primary cause is fluid retention from another medical problem or medication, then treatment will target those issues. Prescription strength ibuprofen or similar anti-inflammatory medications have traditionally been used to provide relief of symptoms, although the scientific evidence is lacking to support this approach. Various splints are available and have been proven to provide some relief when worn consistently at night. Local steroid injections into the wrist have definitely been shown to be effective for at least short-term relief of symptoms (compared with placebo). Physical therapy and avoidance of behavioral triggers play a significant role in treatment. Finally, a minority of CTS cases may require actual surgical decompression to improve symptoms.

BOTTOM LINE: If you are having persistent or recurrent numbness, pain, or tingling in your thumb or first few fingers, head to your family doctor for a definitive diagnosis- don't wait until the symptoms have been stuck there for months, because the longer you've had symptoms, the more difficult it is to cure.

Is Your Pinky Tingling?

Have you ever had your pinky go numb or start tingling, especially at night? If so, did your co-worker tell you it might be carpal tunnel syndrome? Hmm...probably not the right diagnosis. Although carpal tunnel syndrome also involves fingers starting to tingle or go numb, that problem is associated with the median nerve, which supplies your thumb and first three fingers (and half of your ring finger.) If your PINKY gets involved with the tingling, that is due to the nerve on the other side of your arm- the ulnar nerve.

Cubital Tunnel Syndrome, also known as Ulnar Neuropathy, results from pressure or compression of the ulnar nerve at the elbow. Men suffer from this problem much more than women, anywhere from 3-8 times more often. What causes this? Sleeping with your elbows bent and arms overhead (scrunched up under your pillow as a side-sleeper) is a common cause. Athletes who have repetitive upper arm motions such as throwing, hitting with a raquet or skiing can also suffer from this problem.

The primary prevention is to avoid prolonged periods with pressure on your elbow. For example, if you are driving a long distance, be careful not to prop your left elbow on the arm rest (putting pressure directly on the side of your elbow) for extended amounts of time. If you are a side sleeper, try not to extend your arms over your head.

Treatment depends on the severity and duration of symptoms. Many cases can be treated with NSAIDs (like ibuprofen) or a simple steroid injection into the elbow, coupled with the avoidance behaviors noted above. Bracing at night, physical therapy and ergonomic corrections to computer desks go a long way towards correcting and preventing future injuries. A minority of cases are so severe that they do indeed require surgery, but 85-90% of all cases of cubital tunnel syndrome will resolve with good to excellent results.

BOTTOM LINE: All that tingles (in fingers) is NOT carpal tunnel- if you have persistent pain, numbness or tingling in your ring finger, pinky , or forearm, you may be suffering from another compression syndrome such as Cubital Tunnel Syndrome.

Ugh- Athlete's Foot!

Athlete's foot, known medically as "tinea pedis", is one of the most common skin infections encountered in primary care practices. With bare feet and wet public areas for summer fun, athlete's foot shows up more this time of year. This infection is caused by a fungus that can grow on skin, nails or even hair. As the fungus grows and spreads, there is typically a red edged border, with the central area clearing and looking like normal skin. On the feet, however, the fungus causes an itchy red rash with thick scaling, cracking, and redness between the toes and on the heels, sometimes accompanied by a strong, unpleasant odor. (If you have a sweaty teenage athlete who props their feet up on the couch to share their stinky feet with the rest of the family, you know the smell...) We see athlete's foot most often in young adults, aged 20-50 years old, although it can certainly occur at any age. Men seem to contract it more than women, although the reason for that is unclear.

How can you prevent it?
Getting athletes foot does not imply you have poor hygiene, but it likely does mean your feet are staying damp for prolonged periods. Wearing rubber sandals or other foot protection in community showers and locker rooms can help, as well as doing whatever it takes to keep your feet dry- from careful towel drying after getting wet, to changing socks half-way through the day if you tend to have sweaty feet.
The key is DRY.
Bonus tip of the day: to avoid spreading the fungus to other parts of your body, put on your socks before your underwear (if you have a case of athlete's foot).

How is it treated? 
There are multiple OTC sprays and creams that might help, but severe or chronic cases may require prescription anti-fungal medications that are taken by mouth. If you have already tried a full week of treatment with OTC products and are not getting significant relief (or if you keep treating it but getting it back), schedule an appointment with your family doctor to fully address this problem.

BOTTOM LINE: In moist or damp public areas such as showers, pools, and locker rooms, wear foot protection to avoid prolonged contact with the fungus that causes athlete's foot. 

Don't Forget to Book Your Back-to-School Physical!

July is here already, so before you know it, our kids will be headed back to school. Why am I bringing this somber fact up on July 1st, in the very heart of summer? Because part of back-to-school preparation is that doctor check up, complete with the mountain of forms your child's school has sent you. Whether your baby is starting pre-K or headed off to graduate school, our educational institutions rightly want to protect their students' health, including reducing the spread of preventable, communicable diseases with vaccinations. Prioritize calling your family doctor RIGHT NOW and get your kids appointments on your calendar (and your doctor's) before camps, family vacations and other summer fun fills every day.

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

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

Finally, be aware that our immunization schedules are always changing. For example, HPV vaccinations are now recommended for all boys and girls at age 11-12. "7th grade" vaccinations have included the meningitis vaccine, and the booster shots for chicken pox and tetanus for several years now, but current recommendations today also include a BOOSTER Meningitis vaccine for all college students up through age 21, that must be given on or after the child's 16th birthday. 

BOTTOM LINE: Back to school preparation INCLUDES a doctor's visit for your child (unless she's recently had a checkup). Sign up now and don't forget to bring those school & sport forms to the appointment! 

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