Weight Loss Success: Make New Habits or Break the Old?

Which works better for weight loss: creating new healthy habits or getting rid of bad ones? 

A small but clinically significant study was recently published in the International Journal of Obesity that addressed this question. The good news is that BOTH interventions produced sustained weight loss at one year, with the 21 adults who created new habits having a 6.2% weight loss (roughly 12.5 lbs) and the 22 adults who worked on breaking unhealthy habits having a 4.8% (10.1 lbs) weight loss. 


The intervention group that tried new habits followed the researcher's "Top Ten Tips" which included fairly predictable weight loss strategies such as walking 10,000 steps/day; reading labels, watching portion size and reducing fat content; packing snacks and sticking to a meal routine; choose water over other drinks; slow down and be mindful while eating; and of course, my standard preach of at LEAST 5 servings of fruits and veggies per day.

Interestingly, the bad habit breaking group was called "Do Something Different" (DSD). The concept was to "increase behavioral flexibility" by being assigned a different task to perform each day during the 9 week initial intervention. Tasks could include choosing a different route to work or wearing a new outfit, or even writing a short story.

I love the focus on all-around behavioral flexibility that includes new healthy habits. Consider challenging yourself (or better yet, share a challenge with a friend or family member to increase your accountability) to "Do Something Different" each day on your path to a healthier you. My challenge today? Substitute water for my recently "snuck back in" habit of having a soda with my lunch. 

Should You Be Gluten-Free?

I LOVE when patients ask me if they should be GLUTEN-FREE. Why? Because the gluten-free diet is inherently healthy (if you do it without searching out the elusive gluten-free twinkies) and because I have been following a GF diet for about seven years, so I have far more personal opinions and advice about this diet than your average non-GF doc.

Who NEEDS to be Gluten-Free? People with Celiac Disease. Anyone with this autoimmune disorder needs to COMPLETELY avoid gluten, which is a protein found in wheat, barley and rye. If they do eat gluten, their body basically overreacts and the inflammatory response in their gut damages the gut lining, which blocks absorption of important minerals and vitamins. Untreated celiac disease can lead to multiple complications, including anemia, a skin disorder called dermatitis herpetiformis, autoimmune disorders, neurological problems and some cancers.

Who MIGHT be helped from a gluten-free diet? People with autoimmune disorders. Gluten is pro-inflammatory, which means that it can stir up an overactive immune system by irritating the gut lining and triggering a whole body response, sort of poking the giant. With autoimmune diseases, the problem comes from too much immune response (too much inflammation) creating swollen joints, rashes, etc. The general concept is that if you remove gluten, that is one less thing to provoke your overactive system.

My most important advice about the GF diet: emphasize the natural foods that are gluten free- fruits, vegetables and protein sources (nuts, meats, fish, eggs, etc). If all you do is substitute the GF version of every bread, pasta, pizza, cookie, cake and twinkie for those things in your diet now, then yes, you will be GF but not necessarily healthy. And from the mental/emotional aspect, sometimes that's the easiest way to start GF without feeling deprived. But why not have those GF alternatives in moderation, while emphasizing the healthy wonder that is the colorful world of veggies and fruits? Your body will thank you for it.

Do I still seek out the best GF treats like pizza, calamari and brownies? You bet! Am I excited to find Udi's newest delicious GF multigrain bread? Of course! But my dietary GOAL remains focusing on more vegetables and fruits, always paired with a protein source.

BOTTOM LINE: Gluten-free diets are necessary for people with celiac disease, probably good for those with autoimmune disorders, and healthy for all of us as long as we "go natural". 

Sunscreen 101

See that shot glass? BURN that image into your memory, because believe it or not, that's how much you should use every time you apply sunscreen! What else do you need to know? Here's my Sunscreen 101.

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? See above- an OUNCE of prevention here for sure, 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 and 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 scan the ingredients to be sure it also contains zinc oxide or titanium dioxide. 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.) Ask your doctor for more specifics if you are concerned about allergens.

Easy Sprays...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's current favorites are Banana Boat's Sport or "Baby" lotions. To sunscreen'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.

Yesterday's tragic accident has no doubt magnified the fear of flying for many people (and let me add prayers of sympathy for those directly affected, as well as kudos to the brave pilot, Tammie Jo Shults, and flight attendants who helped save the rest of the passengers.) Despite the fact that this type of accident has not happened before, and is very unlikely to happen again, hearing and reading the horrific details add fuel to any anxiety surrounding flying. If you suffer from this fear, know that you are not alone- and that your family physician can offer you a few different medications that may reduce your stress. Many patients have told me they were afraid to ask for any medication, because they did not realize these drugs could be used situationally for a single event such as a flight. Of course our wonderful colleagues in psychiatry can also offer Cognitive Behavioral Therapy (CBT)- talk therapy that has excellent success for social phobias such as aviophobia, but if you have an upcoming flight next week, the medications might be more accessible before this trip.

Medication options include:

• Beta-blockers- this class of medication simply keeps your heart from racing, and lowers your blood pressure. When the physical symptoms of anxiety are reduced, the brain feels calmer too. (We also prescribe this drug for public speaking.)
• Sedatives- although when used frequently these medications are definitely addictive, taking a short-acting sedative for a flight is a very reasonable option. Alprazolam (trade name xanax) is commonly prescribed in small doses (and very small quantities). Note that these pills should never be combined with alcohol. 
• Sleep aids-these are longer acting sedatives indicated for treatment of insomnia; physicians consider prescribing these for flights longer than 6 hours, such as fully across the country or overseas.

Behavioral modifications are also key to help the time "fly" by; consider:

• Noise-cancelling headphones make a world of difference, especially if you can use them to engross yourself in a visual media as well, such as your favorite television series or movie. 
• Music by itself, particularly a very familiar whole album or musical 
• Crazily addictive games on your phone or iPad 
• Puzzles or word searches

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 CBT with a trained clinician, biofeedback, hypnosis, or meditation training.

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.

Getting ANXIOUS for FINALS? Try This!

INTENSE TEST ANXIETY affects up to 20% of college students, and this time of year is the worst. Finals are approaching, projects and papers are due, and added pressure from mistakes earlier in the semester can push students over the edge. What's the difference between appropriate "nerves" and serious test anxiety?

With a typical student, test day adrenaline might cause extra bathroom trips up until the test starts, a racing heart and anxious anticipation, but once she starts answering questions, the physical symptoms subside enough for the student to focus effectively.

The student with intense test anxiety, however, accelerates symptoms rather than settling down as the exam begins. Sweat pours down his neck and slicks his palms, his racing heart tries to leap out of his chest, meanwhile his lips and fingertips tingle and he feels short of breath (from hyperventilation) and his brain sputters or completely blanks out.

Is there anything that can be done at this point in the semester? YES! Both behavioral and medicinal options are available to reduce or eliminate test anxiety.

·     Breathing exercises- Stop rolling your eyes...breathing exercises really do work, and since this is free and simple, start here. Take one full minute to focus on your breathing before you enter the testing room, and again just before you start the exam. Breathe in for a slow count of four and then breathe out for a slow count of ten. Repeat this sequence three or four times till you feel your body relaxing.  

·     Cognitive behavioral therapy (CBT)-either individual or group –is highly effective in treating social phobias such as test anxiety. This “talk therapy” helps people recognize how they are unconsciously MAGNIFYING and catastrophizing potential negative outcomes, which triggers the physical anxiety responses. "I'm going to fail and flunk out of school" becomes "I may not do great on this test, but  I've done well on other assignments."

•       Will one CBT session be enough? Even one session helps people recognize harmful thought patterns and begin to reverse negative thinking. 
•       Can ALL students get appointments the last few weeks of the semester? Resources vary, so if you cannot get in this semester, start with online resources like AnxietyBC.

·     Medications-

o  The most common prescription medication used is actually a blood pressure medication (a beta-blocker called metoprolol) that is used in low doses primarily for the side effect of slowing the heart rate and reducing tremors. 

o  Interestingly, when the physical sensations of racing heart and tremor are stopped, the brain “hears” that the body is not stressed, and frequently this is enough to lower the test anxiety down to an expected, manageable level. This type of medication is not addictive, and in my clinical experience, there are very few side effects. In fact, students often end up only using these pills for a handful of tests, at which point they have broken the negative test anxiety cycle and no longer need the medication. 

o  Other social phobias such as fear of flying may be medically managed with sedatives called benzodiazepines, such as alprazolam (brand name Xanax). Note that these medications are very addictive, often misused, and sedating, so they are NOT a good option for test anxiety. 

Untreated test anxiety leads students to a swirling vortex of stomach pains, headaches, insomnia, fatigue, anxiety and depression. Then self-medication with too much caffeine leads to less sleep, more fatigue, more caffeine, more headaches, irritated stomach lining...and worsening test anxiety. BREAK THE CYCLE before you hit your final round of exams this semester!

BOTTOM LINE: Intense test anxiety is a common, real problem that can be dramatically improved with a few interventions. Schedule an appointment today and get help.

What's the BUZZ? Caffeine vs. Alcohol

We all know that caffeine is a stimulant, and most of us have a daily dose to fight fatigue and pep us up. So why create caffeinated ALCOHOLIC drinks? Doesn't that seem counter intuitive to put a stimulant (caffeine) with a sedative (alcohol)? A recent interesting high quality study, Acute impact of caffeinated alcoholic beverages on cognition: A systematic review points out a few facts you might want to share with your favorite college student...

• Energy drinks combined with alcohol DO decrease fatigue and "PERCEPTION of intoxication"
• However, despite FEELING unimpaired, complex tasks such as driving definitely ARE impaired.
• Additionally, caffeinated alcoholic beverages INCREASE impulsivity- which can obviously lead to drinking too much (further decreasing judgment and increasing impulsive choices).
• Finally, with this cycle of feeling less buzz and drinking more, ALCOHOL ADDICTION may increase.

I find this study particularly interesting in light of the "pre-gaming" with Attention Deficit Disorder (ADD) meds and alcohol that has become increasingly common on college campuses. Same concept- the ADD med stimulant taken before drinking alcohol blunts the "buzz" response from alcohol...at least for the first few drinks. Unfortunately, these stimulants do not blunt the other effects of alcohol toxicity such as decreased gag reflex, poor muscle coordination, feeling off-balance, nausea, vomiting, and ultimately impaired breathing. So what happens is you feel "fine" till suddenly you are unpleasantly drunk, then you risk vomiting with impaired consciousness and/or gag reflex...allowing you to choke and aspirate your own vomit-which, by the way, can be lethal. Or worse, you feel "fine" and choose to drive because you have no idea that your judgment and motor skills are significantly decreased, leading to a wreck that hurts not only you but potentially others...because you are driving a one ton weapon. 

BOTTOM LINE: Combining caffeinated energy drinks (or ADD meds) with alcohol is a potentially very dangerous choice because you blunt the "buzz" of alcohol without decreasing the other negative effects of rising blood alcohol levels. Just say NO.

Can't (cough) Stop (cough) COUGHING?

COUGHS often seem to hang around FOREVER, and this year's flu season has been a prime culprit.
Allergies certainly can cause coughs as well, but typically allergy coughs are more the dry, annoying, clear-your-throat variety, rather than the wet sounding coughing fits (that worsen every evening and prevent sleep) which come from viral respiratory infections. Typically there are a few days of headaches, fever, body aches, sore throats and stuffy nose,  but then the cough itself may persist for up to SIX WEEKS after the initial illness.

Is there anything that can be done for a cough that wont go away? Yes, absolutely.

Will an antibiotic fix a cough? Especially is there is green mucus? Probably NOT, because the vast majority of respiratory infections are viral. Green mucus does not equal bacterial infection.

So you NEVER need an antibiotic for a cough? No, that is not true- sometimes a cough IS being caused by a bacterial infection (possibly a pneumonia), but this is the exception, not the rule.  If you are a week into your symptoms, slowly getting better, and then 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.

If antibiotics don't help, why see your doctor for a cough? 
Certainly not every cough NEEDS to be evaluated by a physician. Over-the-counter cough products include DM (dextromethorphan) (which works at the brain level, decreasing the drive to cough) plus expectorants like guaifenisen (ex. trade name Mucinex) to thin up the mucus. Combinations of these ingredients (along with decongestants to help stuffy noses) make up the cough/cold/flu products like Dayquil/Nyquil/Robitussin/etc. and may be helpful in alleviating cough and cold symptoms in adults.

Cool mist humidifiers next to the bed often bring relief, and honey (either taken as a straight teaspoon or in a hot tea) has been objectively shown to help improve coughs (though never for children younger than one year).

However, often after a viral respiratory infection, the lungs' defenses become overly reactive, creating too much mucus and then subsequent spasm of the airways- we call this "reactive airway disease" and this is the same process we see with asthma. Subsequently, persistent coughs often resolve more quickly when treated with prescription asthma inhalers or other oral medications (possibly anti-inflammatory steroids).

Additionally, there are other prescription cough medications that might help.
Benzonatate (trade name Tessalon) is a non-addictive, non-sedating medication that works in the lungs to decrease the cough reflex by numbing the stretch receptors in the respiratory tract. (In my clinical experience, this drug either works like a dream or has little impact, but its low side effect profile makes it an attractive choice.)

Finally, a cough that is keeping you (and/or your bed partner) up all night despite OTC medications may require a sedating prescription cough syrup. With our current opioid crisis, know that conscientious physicians are appropriately limiting the quantities of these potentially addictive medications, and this is not a long term solution.

Finally,  a cough may come from other sources, such as acid reflux or sinus drainage or a medication side effect (such as from one class of blood pressure medications), which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- please don't expect antibiotics, but know there are other treatment options.

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was the entire nail black or only the base?  "Skier's toe" is a common and often very frustrating injury from skiing.

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big ski boot (which allows your foot to slip back and forth, slamming your toes repeatedly).

If YOUR toenail is black and painful at the end of your ski day- do NOT wait to go in to a clinic, because the sooner you get treatment, the higher the success rate. The treatment procedure involves burning a tiny hole through the nail, which allows the trapped blood to drain. There is typically only a few drops of blood, but the pain that small amount of blood causes underneath the nail (if NOT removed) is fairly intense.

As with so many medical problems, PREVENTION is key! Make sure your ski boots fit properly- do NOT cram your foot into a friend's boots- and be sure your socks are not bunched up. Using the newer thin ski socks, rather than old school super thick ones, also helps. (Don't worry, the new fabrics keep your toes warmer, despite what it might appear.) This painful injury should NOT occur if your shoes/boots fit correctly.

BOTTOM LINE: Make sure your ski boots and socks fit properly to avoid getting skier's toe!

PS. While in experienced hands, the red-hot tip of a flame-sterilized paperclip may be used to swiftly burn a tiny hole through the nail, I would definitely NOT recommend trying this on your own after watching a youtube video for training. Among other challenges, people have been known to pass out from simply watching this procedure done...and dealing with the head injury (or other trauma) that results from someone passing out (often in a bathroom with sharp or hard counter edges) is worse than the original problem.

Spring Break 2018: Know Your Limit

Spring Break is here, and students everywhere are gearing up for a week-long party. ALCOHOL is typically a focus of these festivities, so let's review some facts about alcohol dangers. In recent years, studies show that about a third of college students admit to binge drinking (consuming 5 or more drinks in a row.) The good news is that this number is down over 15% from over the last two decades, and actually, drinking trends in ALL categories are decreasing- whether the measurement is annual consumption, monthly, weekly or number of binging episodes. A great tool to educate yourself (or your favorite college student) is this VIRTUAL BAR  where you can enter in your gender, age and weight, and then "pour" yourself drinks and watch your blood alcohol levels rise...

Another wonderfully informative program/website is Aware Awake Alive. Check out their table with drinks/blood alcohol concentrations, and SHARE THIS WITH YOUR FRIENDS. Ultimately, know that if you have a THIRD drink, you are most likely legally drunk. AND, please note, this is a third drink measured by the book (not a "college pour" of alcohol into a plastic red cup- those cups hold several servings in just one glass). The biggest mistake friends make is leaving their intoxicated friends alone to "sleep it off".  If someone has "passed out," they NEED supervision. The alcohol level in their bloodstream will continue to rise, which can cause them to either vomit (and potentially choke, because their gag reflex is dulled by the alcohol) or to stop breathing. If their breathing is less than 8 breaths/minute, CALL 911 immediately.

Pain killers often find their way to spring break as well, whether that is courtesy of a knee injury skiing, or simply part of someone's personal medicine cabinet. Please take note:

Pain Killers (narcotics- think codeine or vicodin) + ALCOHOL= DEATH.

This combination accounts for far too many accidental suicides per year- NEVER MIX THESE.

BOTTOM LINE: Enjoy spring break, but if your festivities include alcohol, make sure you know your limit AND know exactly what to do if one of your friends drinks too much. 

Altitude Matters!

Skiing for spring break? Whether you prefer downhill or cross country skiing, remember that the high altitude might add in a few medical challenges. Be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness) and if you are susceptible to this issue, look closely at ski resort ALTITUDES. Full disclosure, my destination of choice is Crested Butte, CO, which is one of the higher resorts...no pun intended.

HOW HIGH do you have to be for altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby. This is very common- an estimated 75% of people visiting mountains with altitudes higher than 10,000 feet will get some degree of altitude sickness. Note that many people have a significant difference in degree of symptoms between altitudes of 9000-13,000 feet- which may explain why they "felt fine" skiing last year at a different resort.

For Colorado skiers: 
The highest ski mountains are in Arapahoe Basin and Loveland (13K), with Breckenridge barely under at 12,993'. Snowmass/Aspen, Keystone and Copper Mtns peak at roughly 12,300-12,500', with Crested Butte and Winter Park closer to 12K. Vail is 11,500 while Durango and Steamboat are around 10, 500. To get below 10K, consider Buttermilk at Aspen (max 9900) or Steamboat Springs Howelsen Ski Area at only 7,136. Obviously the ski towns themselves are not at these peak mountain summit heights, and many resorts offer lodging at a variety of elevations- consider this factor when deciding about the convenience of ski in, ski out, as sometimes you are better off further down the mountain.

When does altitude sickness begin?

Symptoms usually start within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath
• Note that in severe forms, there can be brain swelling (High Altitude Cerebral Edema) and/or fluid collecting in the lungs (High Altitude Pulmonary Edema)- these are medical emergencies.

Treatment?

Ultimately, GOING TO A LOWER ELEVATION will relieve symptoms, but rest and hydration usually alleviate most mild symptoms at your current elevation. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications. In Colorado, there are oxygen bars and even over-the-counter oxygen cans that can help relieve mild symptoms. For insomnia, try over the counter melatonin.

PREVENTION:

• Increased hydration with water or sports drinks, and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

Flu Tests 101

Positive Rapid Flu Test for Type A Influenza    (C is Control)

Flu season is in full force. If you have high fevers, intense headaches, screaming muscles, razor blade throat pain and/or a wicked cough, should you go get a flu test? How reliable are these rapid tests anyway?

Let's cut to the chase: if you have flu symptoms and a POSITIVE rapid flu test (from a swab lovingly probed up inside your nose), YOU HAVE INFLUENZA. These positive tests are extremely accurate- typically 98-99%.  This means they are very SPECIFIC tests- if the test says you have flu, there is a 98% chance that you really do have the flu, so the likelihood of a false positive is very low.

HOWEVER, if you have flu symptoms and your rapid flu test result is NEGATIVE, you might still have the flu...and your doctor should rely on her clinical judgement. Why? Because these rapid flu tests are very SPECIFIC, but much less SENSITIVE. Sensitivity reflects the percentage of the time that the test is positive when the disease is actually there. Rapid Influenza Diagnostic Tests (RIDTs) average a sensitivity of about 62%, meaning the test turns positive 62% of the time in someone who is truly infected. Rephrased, up to one third of the time when a person has the flu, the test could miss it. Newer digital immunoassays (DIAs), and rapid nucleic acid amplification tests (NAATs) may have significantly higher sensitivities (as noted in this 2017 Systematic Review) but for now these tests have a lower share of the market, and many current studies are industry backed. Meanwhile, most of us in primary care have the less sensitive RIDTs in our practice, which are still quite clinically useful.

Why do doctors even use these tests if they are not super sensitive? Because it affects our treatment plan. If we have confirmation that someone has the flu (with a positive test), then we can feel more confident in NOT prescribing an antibiotic, and limit our conversation to pros/cons of taking an antiviral medication as well as medications for symptomatic relief. This step greatly reduces unnecessary antibiotics, which is critical in an era of increasing antibiotic resistance.
Additionally, knowing a patient definitely has the flu helps us advise them about returning to work/school/activities, since we know flu stays infectious for up to a WEEK. (So STAY HOME at least several days, AND if you have fever, wait until you are fever-free for at least 24 hours without taking tylenol or advil!)

If you had the flu vaccine, will that affect your rapid flu test?  No*. 

(*In prior years when the nasal spray flu vaccine was recommended, there was a chance that you could have a false positive test. Studies have shown that in the first several days after receiving the nose spray vaccine, people may test positive for the flu (even though they are not infected.)

Who should be treated with SUSPECTED illness?The CDC encourages doctors to treat all high risk individuals with suspected flu with antiviral medications. Who is "high risk": anyone hospitalized, patients in nursing homes, and people with immune problems, significant chronic problems (lung or heart disease, for example) or with severe illness such as pneumonia. However, HIGH RISK also includes all otherwise healthy children under the age of two years,  adults over the age of 65, and women who are pregnant or have just delivered their baby within the past two weeks. There are also other less common subgroups that are high risk such as people who are very obese (BMI >40), American Indians or Alaska natives, and youth under 19 who are on chronic aspirin therapy.

Who should be treated with CONFIRMED illness? 
Anyone in the high risk categories above should be treated with antiviral medications if they have a positive test, because treatment definitely decreases severe complications, hospitalization and even death.

Otherwise healthy, active adults who test positive for the flu should have a discussion with their physician about taking the antiviral medications. When taken within 48 hours of the onset of flu symptoms, these drugs have been shown to decrease the duration of the flu by one or two days...which may make a big difference to a student, parent or employee. However, these medications are not without side effects, and for some people, they may aggravate flu symptoms- particularly nausea. In controlled studies, the antiviral medications only cause about 10% more nausea/headaches/fatigue than placebo, but there is no doubt that in a minority of patients, the medicine causes more side effects than they are worth. However, since you have the FLU when you are taking the medications- you already likely HAVE nausea, headache, fatigue, etc- so it is often difficult to sort out. In my family, half of us can tolerate the antiviral medications with zero problems, and half...barely keep the pills down long enough to know.

BOTTOM LINE: If you have flu symptoms, get to the doctor as soon as possible (especially if you would consider taking antiviral medications), and understand that a positive test is REALLY positive, but a negative test does not definitely rule out the possibility of the flu. 

AND...that ounce of prevention...remember to GET YOUR FLU SHOT NOW to reduce your chance of getting the flu (or to at least minimize your symptoms if you do catch it.)

Starting to Exercise? Time for SOLE Searching!

If your New Year's Resolutions include an exercise program, START by taking a close look at the BOTTOM of your shoes. If they look like mine in the picture above, get thee to a shoe store before you get moving with your walking/jogging/running plan. Note the smooth areas (not to mention the circular area trying to be an actual hole)- that means I have completely lost the tread and traction in that area. 

Are new, good quality running shoes necessary? YES. After two decades of private practice (and seeing hurt knees, hips and ankles that might have been prevented with proper fitting footwear), my mantra is "yes, new shoes may be expensive, but NEW SHOES are cheaper than NEW KNEES."

If you are walking or jogging regularly for exercise, odds are good that you should be replacing your shoes every six months...even though the "shoe still fits"- meaning you have no foot pain, and the tops may even look "practically brand new". 

BOTTOM LINE: Look deep into your "soles" to see if it is time for new shoes! 

PS. I strongly encourage you to head to a local running shoe store with experienced and knowledgable sales people to be properly fitted for shoes. They should not only measure your foot, but watch you walk/run/jog to help advise you on your shoes. Locally here in Austin, I recommend Ready to Run.

2018 SIMPLE Doctor Approved Master Cleanse

Happy New Year and Welcome to 2018! 

This year, my theme is SIMPLE. Attention spans are decreasing as fast as our waistlines are increasing (coincidence? Hmm). With tongue firmly planted in cheek, I'm putting everything in my life on a "diet"- or at least a simplification plan, from our overflowing garage and closets, to medicine cabinets, to e-mail in-boxes, to my blog word count, and yes, my own body. Like many, I happily over-indulged in treats, sweets and celebratory liquid calories during the holidays, but now it's time to face the scale, own the numbers and get to work.

How do I kick start my own weight loss program? 

Dr. Grimes' Master Supreme Cleansing 3-Day Detox Diet*:

SIMPLY PUT: Drink water, and eat fruits, vegetables, and a protein source at every meal.

Yep, that's it. Processed foods are eliminated. This "cleanse" is automatically gluten-free and dairy-free (which helps those with undiagnosed celiac disease or lactose intolerance).  Skip everything with high fructose corn syrup and additives or chemicals you can't pronounce. Skip carbonation, caffeine and alcohol. Yes. Those are extras our body does not need. If you are going to get a caffeine-withdrawal headache, keep one cup of coffee but drink it plain- no sugar, cream, etc. Feel free to add a lemon, lime or orange wedge to your water if you want flavor. Please skip sugar substitutes (aspartame, etc.) We are going for a "cleanse" here!

What counts as a protein source?

•  Eggs, fish, nuts, beans or lean meat

Can you cook them?

• Absolutely! This is not a "raw food" diet, but a simplified diet. Feel free to use olive oil (one to two tablespoons should be enough per meal), salt, pepper, or herbs to season and cook the protein or veggies. 

How much should you eat?

• Limit your protein to a serving roughly the size of your expanded, cupped hand (at each meal)
• Fruits and vegetables? No maximum, but a minimum of two servings per meal (a handful is one serving.)

How often?

•  Eat four meals: (essentially breakfast, lunch, afternoon snack and dinner.)
•  Make sure your first meal is within an hour of waking up.

How much water?

• One large glass with each meal, and any time you are thirsty (no maximum)

*Despite the tongue-in-cheek Master cleanse name, there is nothing special or magical about this recipe. Does it work? Well, yes- it does. It "works" to help you realize what your body needs, versus what your mouth, eyes or mind want. For those with lactose intolerance or celiac disease, this often "works" to improve bowel/abdominal bloating and discomfort. For those trying to focus on better nutrition and weight loss, this frequently "works" as a great jump start. Can you modify this and use yogurt as a protein source? Certainly! The point here is to spend a few days with simple eating and no extra..."extras". Wishing you good luck and great health in 2018!

Bottom Line: If you're looking to "cleanse" your body for a few days, keep it SIMPLE and stick to water, fruits, veggies, and simple proteins (eggs, beans or meat) for a healthy jump start!