Wednesday, June 25, 2014

Worried about Dementia? Try Something New...

This week, JAMA Neurology offered an encouraging study for our aging population which demonstrated that continuing to stimulate your brain through intellectually challenging work or leisure activities (such as playing a musical instrument, using a computer or reading) can postpone the onset of dementia. The investigators utilized nearly 2000 participants in the Mayo Clinic Study of Aging, specifically enrolling people aged 70-89 years old, and identifying whether or not they had APOE (a genetic marker linked with increased risk of Alzheimer's disease) and assessing their baseline cognitive performance.

People who had less mentally challenging occupations, less late-life intellectual stimulation and/or weaker educational backgrounds scored lower on the baseline cognitive assessment. Those people with more advanced degrees or continued late-life education scored higher, creating the anticipated advantage of "cognitive reserve"- in other words, they start with more brain power, so they can afford to lose more brain function before dementia is diagnosed. (For the visually-minded, imagine that dementia is diagnosed when the elevator gets below the 10th floor. If you are starting at the 21st  floor, you get there much later than someone who's elevator started at the 11th floor.)

The surprising good news from this study is that regardless of your baseline brain power, life vocation or genetic predisposition for Alzheimer's disease, everyone's memory power benefits from intellectual stimulation after age 40. In fact, this study showed that the intellectually stimulated people postponed the onset of dementia beyond 7 years compared to their peers who did not mentally push themselves.

Of note, there were observed positive snowballs- the more education a person has on the front end, the more likely he or she is to continue a lifetime of intellectual stimulation.

Does it matter what type of intellectual stimulation? We don't know for certain, but psychologists will be the first to tell you to pick what you ENJOY, because you are far more likely to keep it up. Remember that what you enjoy may or may NOT be what your aging friend or parent enjoys…so whether it is learning to knit, playing the piano, learning a new language or even learning how to text on an iPad- push yourself to learn something that sounds interesting to YOU.

Special kudos to my amazing mother-in-law, Bene, for not only continuing to reading medical articles long beyond her nursing career, but for her constant willingness to learn anything! She texts faster than most adults (with far fewer spelling errors than the rest of us), and even learned to add emoji's last month. Pictured above is the two of us taking a "selfie" from her iPad.

BOTTOM LINE: Until we have a cure for Alzheimer's on the treatment end, the "ounce" of prevention  we all need is to STIMULATE our brains…and never stop!

Tuesday, June 24, 2014

The Gift of a Complete Smile

Mariza (needed lip revision)
Steven- showing off his cleft palate
Joseph- Dimples and all!

Mariza,  Joseph, and Steven are just three of many precious children that our Austin Smiles team enjoyed meeting and helping last week in El Salvador. Cleft lips and/or palates occur in the United States at a frequency of roughly 1 in 700-1000 births (roughly 7000 babies per year) making them one of the most common birth defects. However, these problems arise with more than twice that frequency in Central America and in some Asian countries. Why? We are not completely sure. Scientists continue to investigate the various contributing roles that genetics, nutrition, toxins, and environment play in creating these defects, hoping to find ways to prevent their occurrence. Meanwhile, plastic surgeons, dentists, orthodontists, cranio-facial surgeons, anesthesiologists, primary care physicians, speech pathologists and speech therapists are all working together to help re-align lip, nose, mouth, and palate muscles and other tissue that never came together, as well as using mouthpieces and tongue/muscle/speech exercises to improve tone and clarity of speech. The clefts can be on one side or both, and can involve the nose, the teeth, the jaw and the palate. The defects range in severity from a mild tenting of one side of the lip, to severe clefts extending through the nose and the entire roof of the mouth, leaving a gaping hole where there should be protective tissue. The costs of cleft lip and palate defects are measured not simply in dollars or time spent in medical care, but in emotional trauma as well. Many of these children and their families are shunned by their peers, and the mothers of these children may be inappropriately blamed for causing the disfiguring defects. You cannot imagine how much gratitude and tears of joy these families heaped upon us when we simply played with and LOVED their children. We praised the parents for their dedication, extra attention and efforts. One seven month old girl, Angelica, had a facial defect so incredibly severe that there was only a hole in the center of her face where the upper lip and entire nose should be. Her mother had to literally drip formula from a bottle one drop at a time on to her tongue to feed her, yet this child was well above average weight and height for her age. Think about the emotional and physical fortitude it must require to care for this baby. I could barely speak to this amazing young  twenty-two year old mom without tearing up, because I cannot imagine facing such an intense challenge. Our family is truly honored to be part of the Austin Smiles team, and to have met such inspiring individuals and families in El Salvador. Bottom line: Cleft lip and palate defects are common and CORRECTABLE, given adequate resources and funds. Please consider supporting Austin Smiles with a donation of your time, talents or treasure.

Baby Taylor- cleft lip & palate
Taylor after his lip repair
 (He should be big enough for a palate repair next year.)

Saturday, June 14, 2014

Planning International Travel? Check out the CDC!

I am  so excited to be heading to El Salvador today with Austin Smiles, a wonderful organization that gives the gift of a beautiful smile to people born with cleft lips or palates. Check out our blog and Facebook page!

If you are planning to international travel, start your medical planning for the trip well in advance- ideally six months ahead, and check out the CDC Traveler's Advice page.  Simply select your destination country, and you will see all the current medical recommendations for your travel. Please note that often vaccinations are recommended that may require more than one dose, so you may need to get started on your shots 4-6 months before you leave! For example, if you are headed to Central America and have not been immunized against Hepatitis A, this vaccine is given in two doses, six months apart.

In addition to vaccine recommendations, the CDC also gives you a handy medical check list that includes site specific prevention for issues such as travelers diarrhea, malaria, and altitude sickness. Advice for lodging and general safety issues (depending on the political climate, etc.) are also included.

Remember to see your family doctor well in advance of your trip, so you can have plenty of time to get any prescriptions you might need- whether it's medication for motion sickness, flight anxiety, or traveler's diarrhea. Think about the timing of your regular prescriptions, especially if you have medications that are filled monthly at your local pharmacy. Especially in summertime (on Fridays, at 4:59pm!) primary care doctors are swamped with panicked phone calls from patients requesting medications to be called in urgently to pharmacies, from birth control to blood pressure to actual travel destination-related antibiotics or other drugs...and that doesn't work well for anyone. Medical planning should happen at the same time you secure your passport, because neither of these processes can or should be rushed in the final hours.

BOTTOM LINE: For international travel, START EARLY with planning your medical prevention!

Monday, June 9, 2014

Nervous about Flying?

Do you have travel plans for the summer? Any fear of flying? If you do, you are not alone. Many people, especially since 9/11, are very nervous flyers. I know that I never had any issues about flying until I became a mother, at which point suddenly I was emotionally convinced I would die in a plane crash and orphan my child (despite the logical part of my brain telling me it's far more dangerous to drive on Saturday nights.)

So, what can you do? Well, there are many choices, but suffering in silence should not be one of them. First off, arm yourself with the facts that you are over thirty times more likely to have a fatal car accident than die in a plane crash. Most of the fear is not rational, however, so if the facts don't calm you, keep looking.

Plan ahead- create a diversion packet for yourself with an engaging book, music, or DVD. Get noise-canceling headphones (or at least good earplugs). It's amazing how when you can close your eyes and not hear the plane noises, you can relax much more easily.

Avoid stimulants like caffeine and decongestants
- no need to ramp up your heart rate before you even get on the plane!

If you have the luxury of time before you travel, consider biofeedback, hypnosis, or meditation training.

I mentioned yesterday that you might want to talk with your doctor. What can she offer? We have several choices, actually. For long flights, I will frequently prescribe a "sleeping pill" such as Ambien or Lunesta. Some patients do very well with medicines that simply control your heart rate, such as metoprolol (a beta-blocker). Others with more intense anxiety respond well to a rapid and short acting sedative such as Xanax.

Bottom Line: Fear of flying is common- plan ahead and talk to your doctor if you would like to consider a medication to lesson your stress.

Sunday, June 1, 2014

Summertime & SUNBURNS: Just Say NO

Happy June 1st! With summer here, it's time for my annual post on SUNSCREENS. Remember that "base tans" are a medical myth- no pre-tanning helps prevent sunburns. Period. As for sunscreens- which one is the best? Sprays are so fast and convenient- but do they work? Which ingredients matter? 

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? Surprise- would you believe it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors. (And no, I don't own stock or have financial interests in sunscreens.)

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...they are not my first choice. Why? Few have either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. In the medical literature, some debate exists as to whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use TINY portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF. Would I prefer that over skipping sunscreen all together? Yes...which means I do keep some on hand.

What do I usually buy? Our family likes Banana Boat's Sport or "Baby" lotions. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a compliment! Probably more importantly, for extended sun exposure we all use swim shirts, and try to consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.