Dr. Grimes' Bottom Line

HPV: Not Just for Genitals...

2012-01-30T08:25:00.001-08:00

A recent study published in JAMA has created a buzz about the Human Papilloma Virus- HPV- again, but this time, the focus is on the mouth. Researches have noted that despite a significant decrease in smoking, head and neck cancer rates are not falling in proportion. It turns out that not only does HPV cause cancers in the genital area (cervical, penile, anal, etc.), but HPV also plays a significant role in causing head and neck cancers.

The study is titled "Prevalence of Oral HPV Infection in the United States, 2009-2010." Over 5000 people (ages 14-69) participated in the study, and it turns out that roughly 7% of them had HPV detected in their mouths. (They swished mouthwash in their mouths for 30 seconds, then this liquid was DNA analyzed for the the presence of different HPV strains.) Men had a higher rate- 10% in men vs. 3.6% in women, and infection was much less common in those people with no history of any type of sexual contact (less than 1% in "virgins" vs. 7.5% in others.) The good news is that the primary cancer causing strain- type 16- was only present at a 1% prevalence rate across the board. (Let's step aside and note here that with HPV, certain strains cause warts, and others cause cancers, so not all strains are equally medically dangerous.) How does the HPV even reach the mouth? Mostly through oral sex. Use barriers (condoms) for ALL sexual intimacy, please. 'Nuff said.

So, will the HPV vaccines (Gardasil and Cevarix) protect against head and neck cancers, too? We certainly hope so! As we get more "herd immunity" (which means more people are vaccinated than not, and so live disease is passed less and less) we hope to see not only a decrease in genital cancers, but hopefully a parallel decline in oral cancers, too.

BOTTOM LINE: HPV is COMMON, both "top" and "bottoms"...let's use our knowledge to prevent the cancers HPV can cause! For me, this is yet another good reason to immunize against HPV.

It's NOT the Carrots!

2012-01-19T18:13:00.000-08:00

I've been practicing medicine for nearly two decades now, and I find it fascinating to see some of the persistent myths in medicine- most of which pertain to food/calories/weight loss. I find that people get very caught up in looking at specifics, and miss the big picture entirely. The classic example of this is CARROTS.

Many of my diabetic patients tell me that they are careful to avoid CARROTS, because they have such a high glycemic index. The same is true for fruits ("don't worry, Dr. Grimes, I KNOW not to eat bananas or apples!") Seriously? I believe with all my heart that everyone SHOULD know deep down that carrots and fruits are HEALTHY choices. Diabetic or not, these foods should be part of your healthy diet. Okay, yes, if eaten alone, carrots can transiently raise your blood sugar, but if you have adult onset diabetes, it is WEIGHT LOSS that will ultimately improve your blood sugars. I have yet to meet a SINGLE person who is overweight from eating too many fruits and vegetables. It simply does not happen.

If you are overweight, please take an honest look at what you are eating. In fact, write it down- all of it- for a few days. Perhaps the daily Starbucks muffin & latte have a little something to do with your extra calories...And while lettuce, carrots, tomatoes and cucumbers are all healthy, low calorie choices, adding tons of croutons, sunflower seeds, cheese and a generous amount of ranch dressing take a healthy salad and push the calories too high to help with a weight loss plan.

Carrots are a wonderful source of nutrition. They are packed with provitamin A, vitamin E and vitamin K. Carrots satisfy the need to crunch and work beautifully to scoop up hummus as an afternoon snack.

BOTTOM LINE: Recognize that no one is UNHEALTHY from eating too many fruits and vegetables. Ramp up these foods, limit processed "junk", and talk to a registered dietitian if you want to get serious about improving your diet!

Just One Meal...

2012-01-10T07:55:00.000-08:00

January is a great time to focus on your health, as we all feel that sense of renewal and a "clean slate" start-over. Rather than jumping into a strict diet that consists only of twigs & berries, why not start with JUST ONE MEAL? We eat (in theory) twenty one meals per week, right? (As an aside, if you are skipping breakfast, please start with adding IN that meal before anything else.)

I would like to suggest that you commit to having ONE vegetarian meal per week, and ONE meal that includes FISH as an entree. Vegetarian meals do not need to be bland, by the way. Picture a delicious taco salad, but with beans instead of beef or chicken. I often have the do-it-yourself version of this at home by making nachos loaded up with beans, onions, lettuce & tomatoes. Or you might try a colorful collection of veggies sautéed in olive oil and serve them over a bed of pasta or rice. I find that keeping bags of chopped onions, shredded carrots and bite-sized tomatoes minimizes my prep time and therefore makes it far more likely that I will include them in my lunch when I only have ten or fifteen minutes to prepare & eat it.

BOTTOM LINE: Make permanent changes in your diet by starting with ONE MEAL per week...and then feel free to increase that frequency as you enjoy these healthy, delicious meals!

2012 Health Action Plan (aka. New Year's Resolutions)

2012-01-06T04:03:00.000-08:00

Welcome to the first Friday in 2012! How are those New Year's Resolutions coming along? Already blown them? If so, no worries, because you are not alone. I'm hearing more people say they haven't even MADE their resolutions yet, so really, you could be ahead of the game if you even know WHAT you'd like to change. Though I am sitting here with my laptop in glow of our Christmas tree lights, many people have packed up their holiday decorations or plan to "clean up" this weekend. As we all make the mental shift from holiday time back to ordinary routines, I'd like to encourage you to make CONCRETE PLANS to improve your health- whether you call them New Year's resolutions or not. Here's a starter list:

1.If you have ANY health concerns that you have not fully addressed with your family doctor, call TODAY and schedule an appointment. And PLEASE let the office know what you are truly coming in for- even if you simply say "I have four or five separate minor concerns" if you don't want to list specifically what they are. If you are trying to squeeze in questions about your weight, insomnia, or indigestion during an office visit you've booked for your sore throat (or worse, during your spouse's or child's visit), you are obviously not going to get the full attention and evaluation those issues deserve. I find that patients don't want to "bother" their doctors with "minor stuff like that"- but we'd much rather you schedule a longer appointment to address multiple concerns than to either ignore them or to toss them in as a "by the way, while I'm here..."

2. Step on the scale. This advice is directed at the silent majority of Americans who fall into the "overweight" category, but don't realize it. If you are 100 or even 50 pounds overweight, I'm betting you are aware of it (and same goes for underweight.) However, I have found that many of us don't realize just how many pounds we have added over the last year...or two...or decade. If you fall into this category, please step on the scale, own the number, and move forward with an action plan to improve your health in 2012.

3. Clear out the candy! Cheerful red and green M&Ms, candy kisses, or candy canes decorate many offices and homes during December. Before you replace them with Valentines or Easter candies, consider setting out flowers, candles, or scent infusers instead. Or, simply give yourself permission to put the bowls away. Empty bowls will get filled up...and emptied again & again.

BOTTOM LINE: Make HEALTH a PRIORITY in 2012, and create specific, concrete action items on your health to-do list!

New Year's Resolutions- a WEIGHTy Issue

2012-01-01T00:01:00.000-08:00

Happy New Year! Welcome to 2012, the year that holds the potential to be your HEALTHIEST yet! Virtually every list of top 10 New Year's Resolutions leads off with the battle of the bulge- whether it is "lose weight", "get fit", "eat healthy", "join weight watchers", "join a gym" or some other variation. With the vast majority of Americans falling into the "OVERWEIGHT" or "OBESE" categories, these resolutions certainly make sense. Unfortunately, many of us fight the SAME 10, 20, or even 30-plus pounds over and over again. We get motivated, make healthy changes, lose weight...and then gain it back. Ugh. What might we do differently this year?
Here is some food for thought...

1. Figure out the WHY of your eating behaviors, and learn to eat MINDFULLY. Dr. Michelle May's book "Eat What You Love, Love What You Eat" is a FABULOUS start- buy it today. Her focus is how to break the "eat, repent, repeat cycle". AMEN.

2. Speaking of buying- let's put our money where our mouth is- literally! I have heard over and over again that it's too expensive to meet with a dietician, join a gym, or eat fresh fruits & vegetables, or take up a new sport, yet these same people are spending far more discretionary money on their daily Starbucks, hair highlights or a round of golf. Seriously, we need to prioritize our health and be willing to pay for it!

3. Commit to ONE small permanent change each month. Experts say it takes 21 days to cement a new habit, so why not make 2012 the year to develop 12 new healthy habits? Start with something simple, like making sure you eat breakfast every day OR (assuming this was not part of your routine already.) In this case, it can be a granola bar or a cup of yogurt. Remember to keep it simple. If you try to make a change from no breakfast to cooking a veggie omelette and drinking freshly squeezed grapefruit juice- well, I'm not optimistic it will stick!

Whatever you choose, find a way to make yourself accountable. Make a deal with a friend, tell your co-workers, announce it to your family (if you have teens, they will HAPPILY hold you accountable), or simply record it on your smart phone, computer or an old fashioned piece of paper.

BOTTOM LINE: Make 2012 the year you make your New Year's Resolutions last beyond Janaury, and choose GOOD HEALTH!

Watch Out for SKIER's TOE!

2011-12-20T05:00:00.000-08:00

Ever been skiing (or playing soccer, or tennis) and noticed your toenail had turned black and incredibly painful at the end of the day? Was it black in just the base, or all of the nail? This is a very common injury from skiing, and in fact, is often referred to as a "skier's toe".

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 (so your foot slams back and forth) ski boot. These can hurt like crazy, by the way! As the tiny amount of blood builds up under the nail, the pressure escalates and the toe throbs.

The good news is that this can be quickly remedied in a clinic if you head in within hours or a day of noticing the black nail. If you wait several days trying to tough it out, we have less success treating the nail. The doctor typically burns a tiny hole in the nail, which allows the drop or two of blood to come out. (Sorry for the yucky description, but that's what we do.)

The BETTER news is that again, PREVENTION is key! Make sure your ski boots fit properly- don't cram your foot into a friend's boots- and be sure your socks are not bunched up. This painful injury does 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, and if you DO get it, seek treatment as soon as possible!

Neti Pots- Helpful or Harmful?

2011-12-19T07:17:00.000-08:00

In Austin, we feel often like we are the allergy capitol of the world...and we are approaching CEDAR season. One of the homeopathic remedies that works very well for patients with chronic sinus congestion is a Neti pot. Have you heard of these? Basically, they look like little genie lamps, and you use them to pour water into you nose and "flush out" your sinuses. I know- it's not for everyone. That being said, I have many patients that swear these daily washes have minimized their previously awful allergy symptoms.

The public health department in Louisiana has issued an important reminder about Neti pots this month, because their state had a second death this year from an amebic brain infection introduced to the victims via their sinus flushes. While drinking tap water that contains this ameba would not cause an infection in a healthy person, using that same tap water to flush your sinuses does have potential to cause serious infection.

While these infections are VERY rare, this serves as a good reminder NOT to use tap water if you are flushing your sinuses. Use only distilled, sterile, or previously boiled water as your irrigation solution, plus be sure to fully rinse and dry your device after each use.

On the PLUS side for sinus irrigation, a study published in September of this year showed significant improvement in quality of life for kids with chronic rhino sinusitis (nasal congestion & sinus pressure) when they had used daily sinus flushes for at least 3 weeks, whether the solution was purely saline (salt water) or saline plus an antibiotic. (See Safetty and efficacy of once daily nasal irrigation...)

BOTTOM LINE: If you have chronic sinus/allergy symptoms, talk to your doctor about whether daily sinus flushes could be beneficial for you, and remember to always use sterilized solutions!

WAIT! Weight...

2011-12-16T07:06:00.000-08:00

Okay, this is a quickie blog entry, but here's the deal: I can count on one hand the number of patients that I have seen this month that have NOT gained weight. Yes, the average American gains around 10 pounds between Thanksgiving and New Year's Day, but this is not something we should be proud of! It is also a "tradition" to put weight LOSS at the top of everyone's New Year's Resolution list, right?

So, do yourself a favor, and simply pull out the scale today and step on it. And look at the number. This is NOT to chastise you or to make you feel bad, but to give you a quick reality check. If you are part of the majority who has been happily indulging in little extras at work, school, and parties this season, just be AWARE of that- and try not to add on between now and the end of the year. Kick up your exercise a notch, and remember these few party tips:

1. Eat something healthy before you go- grab a Honey Crisp apple (they are in season and delicious!) or a salad, or whatever healthy choice you have handy. Just do not walk in STARVING.

2. Start with a glass of water when you walk in to the party. Hosts love to hand out wine or champagne as you enter, which is lovely, but ask for a glass of water "to start".

3. At a buffet, fill your first plate with healthy choices, THEN go back and have your dessert sampler.

BOTTOM LINE: Let's step on the scale TODAY so we are NOT increasing our..."bottom line".

Headed to the Mountains for the Holidays?

2011-12-15T07:47:00.000-08:00

Are skis mittens and lift tickets wrapped up and placed under your Christmas tree? Ski season is in full swing, and for those of us who aren't lucky enough to LIVE in the mountains, it's time to start planning our annual pilgrimage to the high lands. On the medical front, know that one unexpected and unhappy surprise of a mountain vacation can be the development of symptoms of altitude sickness.

When does it start?
-usually 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

Treatment?
Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

PREVENTION:
Hydration 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, see your doctor and consider prophylactic medications (acetazolamide or steroids).

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

Afraid to Fly?

2011-12-12T03:24:00.000-08:00

Do you have travel plans for the holidays? 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.

Does Your Holiday Travel Include a Flight?

2011-12-11T03:15:00.000-08:00

As the holidays are upon us and travel plans are ramping up, I thought I’d share some health-related flying tips. Since flu season is under way, I’d be remiss not to start with the basic advice that you should NOT fly if you have a fever or a productive cough (or other flu symptoms such as headache, sore throat, and body aches.) That being said, there are many times that you may need to fly when you have mild cold or allergy symptoms, and there are a few tricks that may be helpful.

The one time that I actually recommend over-the-counter nose sprays (like Afrin) is if you have a stuffy head/nose/ears and need to fly. Make sure to put it in ziplock bag to take it through security, but then use it when you are seated on the plane to reduce ear discomfort upon takeoff. Gum, mints or any beverage will help clear your ears as well- whatever helps you to swallow repeatedly.

I also suggest sucking on the zinc lozenges- any variety- I happen to like the ones combined with vitamin C. Zinc oral dissolvable products have been shown to reduce acquisition of respiratory viruses. Unfortunately, simply taking a zinc supplement that you swallow has not been shown to provide equal benefit.

If you have no contraindication to taking aspirin, a baby aspirin taken the day of your flight will reduce your risk for blood clots that can occur with prolonged sitting. Try to get up every hour or two and walk to the bathroom- that will help, too.

Nervous about flying? Talk to your doctor about a short-acting mild sedative or sleep aid (if the flight is long enough.) No need for embarrassment, as fear of flying is very common. I’d estimate I get this request close to once per week (and much more often this time of year!)

Should you wear a mask? I suppose if either YOU have a cough or your seatmate does, that is reasonable.

BOTTOM LINE: If your travel plans include flying, create your own "flying first aid" kit to take with you!

7 Ways to Leave Your Smoking Habit

2011-12-09T03:10:00.000-08:00

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! New Year's Eve is approaching, and QUITTING SMOKING is the single most important thing you can do to improve your health. In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

A WEIGHTy Issue- Quitting Smoking!

2011-12-07T03:03:00.000-08:00

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: As we approach New Years, move QUITTING SMOKING to the top of your list and know that weight gain is NOT inevitable.

Gifts that Keep On Giving

2011-12-04T18:26:00.000-08:00

'Tis the season of giving, and many of us are trying to find the perfect gifts for our friends and families. Before you choose gift baskets loaded with wine, chocolate, and other delicious goodies, though, stop and think. Is this the right gift for your friend who is struggling with her weight or your brother who has high cholesterol and "borderline" diabetes? Well, maybe not, but hey, it's the holidays, right? Doesn't everyone deserve a little treat? And they LOVE chocolate...

Well, yes, I agree that everyone deserves a treat, but is it really a treat if we're giving them something that harms their bodies or works against their health goals? If your friend is fit and healthy, knock yourself out with edible treats with a clear conscience. BUT... if they are NOT, why not focus on gifts that encourage health? Mind you, I'm not suggesting sticking a bow on a bag of carrots, either. How about fun workout socks or a new top? Buy matching pedometers for you and a buddy or two for some friendly competition or at least mutual encouragement. How about a gift certificate for a massage or manicure or pedicure? Or a new healthy cookbook? Out of money (and who isn't?) Make a gift certificate for a outing to a park or walk around the lake or a bike ride. Be creative!

I would be remiss if I also didn't put in a pitch for charitable giving this year. In this tough economy, our non-profits are struggling, too, so consider them as an alternative if you have friends or business associates with whom you typically exchange gift baskets. Our local Hospice, for example, has a program where you can purchase an angel ornament for $25- your gift recipient gets the ornament, Hospice gets the funds, and everyone gets the spiritual health gift of helping others! (http://www.hospiceaustin.org/site/pp.asp?c=bdJPITMyA&b=1556229) Or Meals on Wheels, where $25 provides ten meals plus services. There are so many wonderful charities who can stretch your donation dollars!

BOTTOM LINE: Think twice before sending out edible treats to ALL your friends and family this year, and show you really care by giving gifts that promote physical, mental or spiritual health! Happy Holidays!

Too SAD for the Holidays?

2011-12-01T06:15:00.000-08:00

While everyone around you is humming Christmas songs, pulling out their Hannukah decorations 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 symtoms 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 simples 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, anti-depressant medications (Buproprion is the only one FDA indicated, but SSRI's are also used), and Vitamin D replacement (if low) all have shown effectiveness in improving symptoms.

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

PS. Happy December 1st! Change those air filters!!

Thankful for Special Holiday Dishes

2011-11-21T16:32:00.000-08:00

Getting ready for Thanksgiving? I know I am. Today I was searching for my mother-in-law's fabulous fresh yam and green bean recipes, so I can begin to make some of "her" dishes. However, I am SO grateful that she is still here on earth to be on hand as I prepare them, because her quantities are usually measured by phrases such as "just enough", and "till it looks right", and "well, it depends!"

Isn't it amazing how dependent we've become on prepared mixes or at a minimum, google'd recipes? Truthfully, in the kitchen I tend to alter the vast majority of recipes that I use, even the first time. I substitute apple sauce for oil, or change up flours to make things gluten-free, or create some other "healthy" modification. When it comes to family traditions, though, I usually defer to the high-fat, full calorie version, which is FINE. Not EVERYTHING we eat needs to be pure nutrition! It's perfectly fine within the confines of healthy living to splurge on treats now and then. The trick is to remember that every day or week should not be "that" special occasion!

I have learned from my patients (by doing 24 hour dietary recalls) that what people believe is an unusual day is often a frequent occurrence. Do you grab fast food before every soccer practice or music lesson? Well, I'm guessing that is EVERY Tuesday (or whatever day or dayS your kids have that activity.) Look at your schedule now, and recognize those days that present a challenge every week, and then PLAN AHEAD. Sandwiches, slow cooked meals, and even "breakfast for dinner" might be healthier choices.

BOTTOM LINE: Enjoy your traditional holiday treats this season, but recognize patterns of unhealthy choices in your everyday schedule and make pro-active changes to improve your health!

Women's Breast Friend!

2011-11-13T19:35:00.000-08:00

Today I was totally inspired by the Susan G. Komen Race for the Cure. Our daughters and I were part of a cheering squad at the two mile marker of a 5K race. What an amazing site to behold! Thousands of pink-bedazzled runners, joggers, walkers, strollers and even a few wheelchairs happily plowed through downtown Austin early this morning. The costumes are reasons enough to come and cheer on these participants- pink boas, tutu's galore, crazy headwear and hilarious t-shirts top the list.

The slogans ranged from "Big or Small, Save them All!" to "Save Second Base" and many versions of "Save the Ta-Ta's". Breast cancer survivors wore special dark pink shirts emblazoned with "survivor" down the front- and I can't begin to guess how many hundreds of survivors were sprinkled within the throngs of racers. Every survivor wore a large smile and a fierce, triumphant spirit that made all of us stand up a little straighter and appreciate our own measure of health.

Perhaps the most touching scenes were the families and groups of friends carrying pictures and banners of their dear ones who couldn't beat breast cancer. "Gone but never forgotten", and "You're our Angel" signs and shirts unified these participants, many clearly still keenly bearing their loss. How amazing that they are honoring these angels by helping raise money for breast cancer research to spare others the pain they know too well.

Race for the Cure is one of several foundations that hold races around the country to raise money for medical research. If you are looking for a way to start exercising, I promise you that signing up to WALK in races like these (where the time doesn't matter, so you don't have to be up to running to participate) will make exercise fly by as you surround yourself with such positive energy and zest for life.

BOTTOM LINE: Congratulations to all the participants in the Susan G. Komen Race for the Cure, and let's continue to support all cancer research!

What is BMI?

2011-11-11T04:09:00.000-08:00

Yesterday, I mentioned that discussing your BMI with your doctor might be a less emotionally charged way to discuss your weight. Terms like "overweight" and "obese" tend to make us all shut down and stop listening, but it is really important to understand whether or not your weight is becoming a medical issue. The BMI is your "Body Mass Index", and it is a reflection of your relative body fat. Note that I said "reflection"- the BMI is NOT a precise measure of your body fat percentage.

BMI is simply calculated by using a person's weight and height. Specifically, BMI equals your weight in pounds multiplied by 4.88, divided by the square of your height in feet. There are charts to look at and on line calculators as well. Click on this link to the U.S Dept. of Health & Human Services' BMI calculator to see what YOUR BMI is today.

Now that you've got your number, what does it mean? Well, if you are less than 20, you are underweight. If you are between 20-25, you are considered healthy, or "normal" weight. Please pay attention if you are in the 25-29 segment, because you are overweight! If you are >30, you fall into the medical definition of obesity.

Why did I bold face that 25-29 segment? Because in my clinical experience, no one with a BMI of 30 or more is surprised that they weigh too much. However, I would estimate that over HALF of my patients who fall in the "overweight" category are shocked that they have a medical issue with their weight. After college, people often put on a couple pounds per year, very slowly creeping that scale. During that time, they may only go up a size or two in clothing, especially if they are buying more expensive clothes (which tend to run larger and larger.) Before they realize it, they weigh 20 or 30 pounds more than is healthy, yet they don't "feel fat". I don't care very much about cosmetic issues with weight, but I care deeply about increased risk of diabetes, heart disease, low back and joint pain, all of which come into play when your weight goes up.

BMI's are not flawless. If you are an "ARNOLD" with tons of huge muscles, your BMI will be falsely elevated. If you are elderly and frail, chances are good that your BMI underestimates your body fat. In general, however, the BMI is a great tool to assess your weight.

BOTTOM LINE: Take a moment and calculate your BMI, and take an honest look at your weight: 1/3 of Americans are overweight, 1/3 are obese, and only 1/3 are normal or underweight, so the odds are stacked against you.

Why Don't Doctors Talk about Weight?

2011-11-10T05:17:00.000-08:00

I have often heard people complain that their doctor did not tell their spouse to lose weight. (While I could do a side blog on why it is that people have this complaint more about their spouse than themselves, I will pass on that aspect today.) The CDC reported that in a recent Disease Control and Prevention survey, only 42% of obese patients were advised by their health care providers to lose weight. Interestingly, those who WERE counseled to lose weight were more likely to be actively trying to do so.

Why don't doctors tackle this more often? Obviously, there are many reasons, but let me list the top ones that immediately come to mind.

1. TIME- Doctors are all frustrated with less and less time with our patients. Weight loss conversations are rarely brief (and often loaded with emotional baggage) so doctors may avoid the topic purely from lack of time.

2. FEELINGS- Doctors are human (mostly) too, and we don't want to insult or hurt people's feelings. No one seems to be offended by high cholesterol or blood pressure, but universally people are defensive and/or hurt when say they are overweight or obese. Certainly, our society has made fat a four letter word.

3. MIRRORS- If your doctor is overweight, he or she may consciously avoid discussions of weight (why can't you lose your weight, doc?) or subconsciously avoid the topic because of their own frustration with the issue.

4. EXPERTISE- Not all physicians receive equal training in nutrition, so we have different comfort levels in direct counseling. Having said that, know that we can refer to our wonderful colleagues- our registered dietitians- who specialize in nutrition.

So, on your next office visit, why not ask your doctor about your weight? I think the least stigmatized way is to ask about your BMI- your body mass index. What's a BMI? More on that tomorrow...

BOTTOM LINE: Obesity should not fall into the "don't ask, don't tell" category- ask your doctor if you are at a healthy weight!

Holiday Weight Gain...Again!

2011-11-09T11:01:00.001-08:00

Click! Step away from the Halloween candy. I repeat, step AWAY from the Halloween candy!

Okay, how many times have you walked past the leftover candy and snagged an extra treat today? It is so easy to keep it around just to "finish it off". I'll bet you're even down to the candy you don't even really like, yet you pop one in your mouth because, well, it's there. How do I know? Because I just ate a mini-Snickers, which is my least favorite candy. The Reese's cups were gone last week.

All kidding aside, please take stock of your health TODAY. We are already well into November, which is the heart of "stuff yourself silly" season. Treats and sweets abound, as well as extra adult beverages at every celebration- and those pack on the calories as much, if not more than the edible delicacies! At the office, we are already seeing the extra weight creeping up. The average American gains nearly 10 POUNDS during the holidays. And then what does everyone do? We make a New Year's Resolution to lose weight.

This year, let's be PROACTIVE! Start on that new exercise program right NOW! Take the stairs instead of the elevator. Park a little further away when you go to work or shop. Fill your party plate with healthy choices and eat them first before you head to the dessert buffet. Every bit you do now will make those New Year's Resolutions much easier.

BOTTOM LINE: Do not wait for New Year's to start thinking about improving your health!

CDC Now On Board for GARDASIL for BOYS

2011-10-27T10:11:00.000-07:00

This week the Advisory Committee on Immunization Practices (ACIP) unanimously voted to recommend that 11-12 year old boys be vaccinated against HPV (the Human Papilloma Virus)- hooray! Girls have NO monopoly on genital warts, which affect over one million Americans each year. They are COMMON. Sadly, in my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Genital warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with transmission rate of up to 65%. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

The Gardasil vaccine immunizes recipients against the two strains of HPV (6& 11) that cause 90% of genital warts. Additionally, Gardasil protects against the two strains of HPV that cause the majority of cervical cancers. While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common.

Gardasil was approved for use in males over two years ago, but the public has mainly been aware of the use in females. I'm glad the CDC and ACIP are on board, and hope that with increased education, we can help protect the next generation against HPV-related diseases.
BOTTOM LINE: Gardasil- it's not just for girls! Talk to your family doctor about immunizing ALL your kids.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

Teen Sexting- the Harsh Reality

2011-10-19T06:07:00.000-07:00

If you have a teenager (or if you ARE a teen), please take a few minutes and read this New York Times article: A Girl's Nude Photo, and Altered Lives The gist of the story is that an 8th grade girl sent a nude photo of herself to her 8th grade boyfriend on her cellphone. After they broke up, that boy forwarded the picture to another girl, who labeled it rudely and passed it to her contacts, encouraging every recipient to pass it on. Within hours, this naked photo was seen by thousands of people, including everyone at their school and numerous other schools as well as off into cyberspace.

As a parent, I can only begin to imagine the devastation. Three children were arrested and prosecuted, and could have been held for child pornography charges, complete with the permanent label of sex offender. All this in 8th grade- age 14. How does this happen?

I regularly speak to adolescents about sexually transmitted diseases. Regardless of their social, economic and religious status, what they tell me is that oral sex is NBD- no big deal -(90%) and anal sex isn't really either (50%). They don't "count" these activities as "real sex" and are unaware that these activities are risky for virtually every sexually transmittable disease- especially herpes. While the 40-plus crowd is gasping, let me rephrase- adolescents are very, very desensitized to sexual issues.

As such, it doesn't shock me that sexting (sending sexually explicit messages and/or pictures) is increasing. With that feeling of privacy and anonymity that an electronic device instills, combined with sexual acts being NBD, why wouldn't they feel comfortable sending these messages?

As parents, we have to deal with our own discomfort on the subject, and start having frank discussions with our kids about ALL forms of sexual intimacy- including oral sex, anal sex, and sexting. Please note that I am not saying you can't choose to promote abstinence based on your faith. I AM saying that if you define sex as traditional intercourse, you are leaving the door wide open for these other forms of intimacy...and the kids are walking right through that door with full belief that they are maintaining their virginity.
This is exactly why I wrote Seductive Delusions, which shares stories of "good kids" catching STDs, often despite their "virginity".

BOTTOM LINE: Educate yourself first, then push aside your embarrassment and start talking with your teen.

Doctor, this COUGH won't go away!

2011-10-16T18:58:00.000-07:00

Did you know that a lingering cough is one of the most common reasons people head to see their family doctors? With most "colds", after you get past the headaches, and stuffy nose part, you find yourself coughing. 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? Absolutely, and that is the point of today's blog. "Cough" literally makes the top ten list every year for reasons to visit your doctor. After many upper respiratory viruses, coughs will linger... for up to SIX weeks! 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, they do 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. 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!!

FLU News: 2011 Season

2011-10-12T19:12:00.000-07:00

Flu season can be a scary, challenging time for all of us, especially the last two years, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1. In fact, each year the flu vaccine has three parts, including an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

There are two types of vaccines offered- a live vaccine, which is a weakened version of the virus (this is the nasal spray vaccine) and a "killed" vaccine, the traditional injection. I often hear patients say they "got the flu" from the vaccine, but that is impossible from the injection because those viral particles are NOT ALIVE- they can NOT cause disease. It takes about two weeks for your body's immunity to kick in after the shot, so plan ahead, especially if you are traveling.

In the 2010-2011 flu season, which peaked in early February 2011, was less severe than the pandemic flu season the year before, but still had very significant impact on our population. While most people infected have a miserable several days to a week of symptoms, there were over 300 deaths confirmed to be from influenza, including over 100 pediatric deaths (average age around 6 years.) This is not a disease to be ignored.

WHO should get the flu vaccine this year? The CDC recommends that "EVERYONE 6 months of age and older should get a flu vaccine as soon as the 2011-2012 vaccines are available." And that is NOW! Don't worry about the effects wearing off before the end of flu season, by the way, because the effects last throughout the whole season.

When is flu season? Though typically we say October to January, it really starts with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!

My Halloween TRICK for Treats

2011-10-02T17:43:00.000-07:00

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Before you toss that bag of yummy Halloween candy in your grocery cart this week, recognize that Halloween is still four weeks away. Will that bag still be around at the end of the month? Come on, now, you know if you are buying it now, you are going to be eating it sooner than later. So, let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little chocolate candy bars- how many calories does just one have?"

Okay, you asked, so here are a few of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!

Testing, Testing, 1, 2, 3

2011-09-29T04:37:00.000-07:00

Teens have MANY questions about Sexually Transmitted Infections (STI's). One of their most consistent themes is "do my parents have to know?" Typically, that is followed up with, "my mom would kill me if she found out..." Teens- rest assured, though your parents may not be thrilled, in 15 years of practice I have NEVER seen a truly bad outcome from a kid telling their parent that they are sexually active. Believe me, as a parent, we'd rather have the discussion about your sexual activity BEFORE you have a viral STD like HIV, herpes or warts, and BEFORE you get pregnant. So, back to the questions:

1. Do I have to tell my Mom if I had an STD? In the state of Texas, anyone can be tested & treated for STDs without parental consent. However, if your parent is paying the bill (using their insurance) the doctor cannot lie and say they are treating or testing for something else- that is fraud, and the doctor can lose their license. I would strongly encourage anyone living with their parents to share this information- your parents love you & you will get through this together.

2. Can I get tested without a doctor ordering the test, like from an online source? Yes, there are multiple labs that allow you to order STD tests yourself. You can typically choose a single test you might be worried about (like your new partner tells you they have genital herpes) or a panel, that includes multiple tests. The key here is this: if your test is POSITIVE, meaning that you do have an STD, that lab cannot treat you. You are instructed to take the results to your physician for further treatment.

3. How much does it cost to get tested for "everything" if I pay cash? This has a huge range of answers, depending on where you go for testing and how much income you have. Online tests average around $30 per test, with a full panel being roughly $200. Community clinics and Planned Parenthood offer reduced rate testing, and some places offer free HIV testing. Please do not let cost stop you from seeking testing or treatment- timing is critical!

BOTTOM LINE: There are multiple options for STD testing that will allow anonymity, and work with your financial situation. Get yourself tested!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

MORE Teen Sex Q&A

2011-09-28T03:50:00.000-07:00

More questions I hear from teens...
Which Sexually Transmitted Diseases can be cured? Trichomonas (a parasite), crabs (public lice), gonorrhea & chlamydia (both bacteria) can all be completely CURED if caught early and treated. If gonorrhea & chlamydia sit around for months or years untreated, they can cause permanent damage that leads to infertility or pelvic pain- and though the infection can still be cured, the damage to the genital tract cannot.

Which STDs can NOT be cured? Right now, we have treatments but no cures for the viral diseases: HIV (which causes AIDS), HPV (the human papilloma virus), Herpes (both oral and genital) and Hepatitis A, B & C.

When should I get tested- after how many partners? In a perfect world, you really should be tested after intimacy with any new partner. Since most STDs are silent, the only way you can no for sure that you will not be giving a new partner disease is to go and get tested.

How do they test for these diseases? A simple urine test can be used for gonorrhea, chlamydia, and trichomonas. A blood test is required for HIV, syphilis, hepatitis, and herpes. Pap tests with DNA testing check for different strains of HPV. Pubic lice can be detected by simple visual inspection, sometimes aided with looking at a pubic hair under a microscope.

More on testing tomorrow...too many questions for one post!
BOTTOM LINE: Let's answer teen questions about sex and STDs!

PS. For more details, FAQ, answers & stories, check out Seductive Delusions

Teen Sex Questions

2011-09-26T07:58:00.000-07:00

I really enjoy teenagers. NO, that is not sarcasm, and YES, we have our own at home! Pre-teens & teens have always been my favorite group to work with, as a physician or girl scout leader or school volunteer. I love seeing how much potential they have, and more importantly, seeing THEM recognize their own strengths, and figure out how to most effectively use those talents to ultimately shape their future career choices. I think many adults make the mistake of talking down to teens, dismissing their heartaches, homework loads and stresses as trivial in the scheme of life (which, in fairness, is often how they look from our vantage point.) The reality is that their stress level is enormous, and that even if it is "puppy love" or "just a middle school test", these challenges are the greatest they have faced so far in their young lives. I believe we as adults can give perspective, but it is important not to minimize what they are going through.

All that being said, one of my educator roles is talking to youth about sexually transmitted diseases. I have been speaking to teens on this topic for roughly three years, and every time, I require the participants to write down a question at the end of my talk. I give them index cards (so they all look the same) and have them directly hand me the cards, so no one sees what anyone else has written. Not surprisingly, there are some common themes, though it might surprise you that I am primarily talking to straight A, service-minded, "good kid" student leaders. I thought I would spend the next several blog entries sharing some of their questions (and my answers) so both teens and parents can see what is being discussed. I'll start today with some questions about pregnancy:

1. Does birth control work?
Yes, but it is not foolproof. Oral contraceptives (the pill) are 99% effective when they are taken correctly- at the SAME TIME, every day; no skipped pills. Combining the pill with condom use as well is highly recommended. Remember, condoms alone are only effective 11-20% of the time, but adding them to the pill decreases the chances of conceiving as well as offering some protection against STDs.

2. Is it better to use two condoms at the same time, “doubling up”, in case one breaks?
NO, absolutely not. Using two condoms at once actually decreases effectiveness (due to sliding and breakage.)

3. Can you get pregnant without intercourse?
Usually not, but if semen enters the vagina, which can happen with “outercourse” or in the process of anal sex, it is possible. Young girls are very fertile – that is the take home message.

BOTTOM LINE: Talk with your teens about STDs, LISTEN to their questions, and help them find the correct answers!
PS. For more details, FAQ, answers & stories, check out Seductive Delusions

If You Take "The Pill" to Avoid Pregnancy- READ THIS!

2011-09-22T03:24:00.000-07:00

Are you taking generic birth control? There is a PACKAGING ERROR that has reversed the order of the weekly pills, which significantly decreases the contraceptive effectiveness (translation- you can get pregnant more easily.) Qualitest Pharmaceuticals is recalling multiple lots of the following pills:

Cyclafem 7/7/7, Cyclafem 1/35, Emoquette, Gildess FE 1.5/30, Gildess FE 1/20, Orsythia, Previfem and Tri-Previfem

To find out if your generic pill has been affected, click on the link above to check your lot number, or head to your local pharmacy and ask your pharmacist if your prescription is included in the recall.

This is a great opportunity to talk about birth control effectiveness. When used correctly, oral contraceptives are considered to be 99% effective. If that is true, why do we hear about so many cases of women getting pregnant while they were on the pill? The primary reason is that many people forget to take it. Skipping a day, especially the first day of the cycle, greatly increases your risk of ovulating (and therefore, your risk of conceiving.) Additionally, it is important to take the pill at the same time every day. Taking it "when you get up" does NOT work if you sleep in on weekends! Fluxuating your time by minutes is no big deal, but by HOURS is NOT okay. Additionally, other medications can decrease the effectiveness of the pill, particularly antibiotics or antifungals (like oral medications for yeast infections.) Whenever you receive a new prescription, ask your pharmacist if there is a potential interaction. Finally, do the math- if the pill is 99% effective, but you have millions of women taking it, by sheer numbers there are going to be a significant number of pregnancies from that 1%.

BOTTOM LINE: Birth control effectiveness is maximized by taking the pill at the same exact time every day, and being aware of possible decreased efficacy with other medications. If you take a generic pill, make sure it is not part of this nationwide recall.

Having Trouble Taking All Your Medications?

2011-09-13T12:35:00.000-07:00

Today I'd like to say a few words about medications. Often physicians need to prescribe multiple medications for the same patient. One is each morning, another twice a day, a couple are "as needed" and yet another is recommended at bedtime. One must be taken with food, and another is restricted to an "empty stomach". Before you know it, our patient is supposed to take a half a dozen pills per day- at different times, and with different restrictions- and then we wonder why they are "noncompliant"!

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.

Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

FIRE! Are You Prepared?

2011-09-12T12:08:00.000-07:00

The last week has been a challenging one for Central Texas, as FIRES have consumed the majority of Bastrop (still only 70% contained) and several other communities have lost many homes. The landscape looks like a war zone, with burned grounds and few standing brick fireplaces remaining. The scope of the devastation is mind-boggling- not just homes destroyed, but businesses and many livestock as well as family pets. People are suffering financially, emotionally and physically.

There are always lessons to be learned in tragedies such as this, so today I'd simply like to encourage everyone to make sure their smoke detectors are working. Do you check the batteries on the first of each month? Do you have a "fire plan" for your family?

Many of our patients have shared their stories of the 30 seconds they had to run and grab their most cherished possessions before they evacuated their homes. Some grabbed financial papers (deeds, titles & mortgages or insurance papers), many grabbed computers, and all who were able grabbed photos. Thanks to the bravery and efficiency of our central Texas firefighters, very few human lives were lost despite the magnitude of these fires.

What is the medical fall-out? Obviously there will be emotional trauma. Happily, computerized prescription records at pharmacies allowed us to easily refill patients' medications lost in the fires. What we are seeing the most right now, though, is upper respiratory irritation. The smoke particles in the air are creating allergy-like symptoms with nasal congestion, headaches and coughs. Remember to use a decongestant (phenylephrine, like Sudafed) if you are stuffed up, hydrate with extra fluids to keep the mucus thin, and schedule an appointment with your family doctor if your symptoms are not improving.

BOTTOM LINE: Fires can happen EVERYWHERE. Make sure your home has a working smoke detector, and check that battery every month (when you check your air filters!)

Black Spots & Blurred Vision- Sometimes a Simple Fix

2011-09-04T07:20:00.000-07:00

Have you ever stood up quickly and seen black spots in front of your eyes? The room sways and you might think you are going to pass out, but then it all clears in a few seconds. What's going on? The medical term is "orthostatic hypotension". When you change from lying down or sitting to standing, your blood pressure should increase enough to keep blood flow constant to your brain. When the pressure is not adequate, that's when these symptoms of blurred vision and lightheadedness occur.

What makes it happen? The most common cause for an isolated incident of this in a healthy person is DEHYDRATION. Think about the process like a garden hose filled with water and held upwards. The less water in the hose, the more pressure it will take to push the water to the top, right? You have to squeeze in on the sides of the hose more, or increase the pressure pushing up to get the water to flow upwards. Your blood vessels work the same way, so if your blood volume is depleted from dehydration, voila- not enough blood makes it to your head! The good news here is that simply increasing your water intake will fix the problem.

This process can also be the result of faulty "squeezing" mechanisms, which can occur in diseases like diabetes or Parkinson's disease. Medications can also be the culprit, especially blood pressure , antidepressants and pain pills. How can your doctor test for this process? Often simply taking your blood pressure sequentially in lying, sitting and standing positions will give us the answer. If your systolic pressure (the top number) drops more than 20mm Hg or bottom number drops more than 10mm Hg when standing compared with sitting, you've got orthostatic hypotension. Sometimes more sophisticated testing is required, but the vast majority of the time, these simple office readings are enough.

BOTTOM LINE: If you are getting lightheaded or having temporary blurred vision when you stand up, grab a glass of water- drink it- and call your doctor to schedule an appointment to figure out the cause & cure for your symptoms.

Beware the Scorpions!

2011-09-01T11:24:00.000-07:00

With temperatures still skyrocketing here in Texas, many unwanted critters are showing up in our homes as they seek water and shade, which means more exposure to pests such as scorpions. It never ceases to amaze me how they rear up in full attack mode as I lean forward to kill them...and that each and every time it scares me enough to hesitate before I strike.

So, what do you do if you (or a friend or family member) is stung by a scorpion? First of all, don't panic! Most of the time, a scorpion sting is like a bee sting- pain, burning, mild swelling and maybe numbness locally, that will resolve fairly quickly. If you live in Texas, we are fortunate that our scorpions, scary as they can look, are not severely poisonous. If you live in New Mexico or Arizona, watch out for the dreaded bark scorpion, which can cause more serious reactions such as severe swelling, shortness of breath, shock and even death. If you are stung and your symptoms rapidly escalate, go directly to an emergency room.

For the majority of stings, however, first aid will do. Wash the area immediately with soap and water. Ice and elevate the area if possible. Remove any rings, bracelets, watches or other constrictive accessories. If you are starting to swell up, take a diphenhydramine (benadryl) tablet/capsule. Topical steroid wont hurt, and might help a bit. Ice the area for about ten minutes.
A non-scientifically proven, but much recommended home remedy is to very quickly apply a paste of meat tenderizer (with papaya extract) and a bit of water directly onto the area that was stung. This seems to alleviate the pain more rapidly, and at worst case, it is not harmful. Finally, check the date of your last tetanus shot- if it is more than 7 years ago, go get a new one.

BOTTOM LINE: If you are stung by a scorpion in Texas, wash it with soap & water, apply ice, take some benadryl and see your doctor if symptoms escalate (or if you are behind on your tetanus booster.)
PS. Happy September 1st! You know what to do- change those AIR FILTERS!

Thank You, Glen Campbell

2011-08-24T12:28:00.000-07:00

Many diseases have the face of a celebrity- we think of Michael J. Fox for Parkinson's, or Katie Couric (on behalf of her husband) for colon cancer. Although President Reagan had Alzheimer's, I don't think there is as strong of a link there. Alzheimer's is the disease we don't want to talk about. It's just too uncomfortable, right?

Well, hat's off to singer Glen Campbell & his wife. Mr. Campbell gave a televised interview last night to openly talk about his experience of memory loss and his diagnosis of Alzheimer's Disease. I loudly applaud his public acknowledgement of this relentless disease. I hope that his singing tour will bring increasing awareness to this incredibly common disease. Right now, over 5 million Americans suffer from Alzheimer's disease. I love that Mr. Campbell is highlighting how music memory is something that is preserved...often beyond when the person suffering the memory loss no longer recognizes their family. I have bittersweet memories of singing Christmas carols with my mom- her not skipping a beat nor stumbling on words that I couldn't recall- and she only knew me as a "nice friend," not her youngest daughter.

What's my take-home message here? If you have a loved one with Alzheimer's memory loss, and you struggle to get them to interact with you, consider a song. Old commercials, school fight songs, traditional carols, hymns or anthems are all good choices. I have found in my personal experience that often once the person begins singing, it often "gets the juices flowing" enough that they are able to carry on a conversation (where they were not interested or able when you began your visit.)

BOTTOM LINE: Hitting a communication wall with someone struggling with Alzheimer's? Try a tune!

PS. I recommend sites like ElderSong- a wonderful source for music geared to trigger memories! ( I have no financial interest in this company, but have purchased many sing-along CDs and videos from them.)

25 Grams of Fiber? Yes, You Can!

2011-08-23T11:44:00.000-07:00

"But Doctor, there is NO POSSIBLE WAY that I can eat 25g of fiber in one day!"

I hear this response frequently when I am talking to my patients about a high fiber diet. Yes, we recommend eating 25g of fiber daily. No, it is not impossible! In truth, most Americans average way less than 10 or even 5g of fiber in their daily diet, but that is a reflection of all the convenience food that we consume. If you have coffee & a donut for breakfast, burger & fries & soda for lunch, and spaghetti & meatballs & buttered white rolls for dinner, you don't need a calculator to figure out your fiber was <5g! The good news is that it's really not hard to bump up that fiber. Here are some "tricks" to raise it:

1. Focus on fruits & vegetables (yes, it always comes back to this!) Nearly every serving of these will be at least 2g of fiber. An apple or pear~4g, berries~4-5g, banana~ 3g, broccoli ~3g, carrots ~2g, and corn or a baked potato~ g. Obviously if you get your 5-10 servings of these per day, you've got your fiber covered before you add in ANY bran muffins!

2. Choose whole grains for your breads, pasta & rice (brown)- that will add a few grams of fiber per serving (check the label!)

3. Pick a high fiber cereal that doesn't taste like tree bark, and rotate that in to your diet as both breakfast cereal and snacks (toppings on yogurt or as "croutons" on salads.) Bran Buds, for example, pack a whopping 12g of fiber in 1/3 of a cup!

4. If you like tortillas (and who doesn't?) check out some high fiber choices for your breakfast tacos (instead of toast)- Mission Carb Balance, for example, has tortillas with over 10g of fiber each!

5. Include nuts & beans (think hummus!) in your diet, too- 1/2 c of most beans will be 6-8g of fiber.

High fiber diets help prevent (or treat) constipation, lower cholesterol and triglycerides, and improve your gut health. There is no need to subsist on stale high fiber bran muffins to easily maintain the recommended 25g of fiber per day. Even if you are gluten-free, you can see how this is truly "do-able".

BOTTOM LINE: Push up your vegetable & fruit servings and choose whole grain complex carbs, and soon you'll be on your way to better health through a high-fiber diet!

Should I CLEANSE my colon?

2011-08-17T06:55:00.000-07:00

Yesterday I was talking about constipation, so naturally today follows with a discussion of a "home remedy" for that very problem. Patients often ask me to prescribe something to "CLEANSE their COLON". Typically they have seen an infomercial that suggests that we all are walking around with an extra five to ten pounds of gunk lining our colons, and if we simply buy their miracle product, we will have sparkling clean colons and look a sexy ten pounds lighter. The ad even shows pictures of before and after colons to "prove" their case.

Well, as much as I would love this simple fix, it is not true. Think about it. If you are anywhere near the age of 50 or have friends or parents in that category, you hopefully know people who have had their recommended screening colonoscopy (to look for colon cancer.) Every colonoscopy patient remembers the dreaded "bowel prep" where you typically drink a yucky sweet and salty prescription beverage and then poop until you are passing only clear liquid from your bowels. (As an aside, it's not that big of a deal- simply a couple hours of mild discomfort, compared with the benefits of colon cancer screening and early detection.) Without a doubt, your weight is often down a couple pounds the morning of your procedure, but this is pure water weight loss. Within a couple days, your weight is right back to your baseline. There is no question that your bowels were sparkling clean (check out the pics from the gastroenterologist who performed your procedure), but you have not permanently removed "years of buildup".

Once again, if it sounds too good to be true, it probably is. If doctors knew of an easy way to lose weight without diet and exercise, do you think there would be overweight doctors out there? Heck, we'd take it ourselves before we prescribed it for our patients!

BOTTOM LINE: COLONS do not need to be "cleansed". They DO need to be scoped at age 50 to screen for colon cancer (sooner if you have a family history or other concerns). Let's fill them with a high fiber diet and they will be "cleansed" as much as they need.

Poop or Get Off the Pot! (AKA. Constipation Clarification)

2011-08-15T16:42:00.000-07:00

Forgive the expression, but it's tough to think of a catchy title to talk about CONSTIPATION. That being said, constipation is a really common complaint- from toddlers to toddering elders. When I talk to patients about constipation, the first thing I do is to establish what is NORMAL for the patient. Often folks are surprised to hear that "normal" does not equal "daily" bowel movements. If you go once every few days and have no abdominal bloating or discomfort, then you are NOT constipated, that is simply YOUR "normal". Others have several bowel movements each day, and again, that is "normal" for them if there are no associated uncomfortable symptoms.

So what IS constipation? Constipation is "unsatisfactory defecation" with relatively infrequent and/or painful passage of stool. Typically this means less than three BM's per week, too much time straining (or hanging out reading) on the potty, or a sense that there is either bloating in your belly or that after you go, you feel like you still should poop more. Women suffer from constipation twice as much as men (likely in part from our hormonal swings that may affect the gut.)

Please don't ignore constipation, because there are many medical conditions that can slow the gut and cause constipation, such as diabetes, low thyroid hormones, pregnancy, metabolic disturbances (like low potassium levels), to name a few. Additionally, medications such as blood pressure pills (calcium channel blockers especially), antacids, antihistamines, antidepressants and pain pills also can slow the bowels.

The vast majority of the time, however, constipation is simply the result of a poor diet. Three things are needed to move your bowels: FIBER (goal 25g/day), MOVEMENT (walk, run, skip, bike- whatever works, just get up and move!) and HYDRATION (more water.) Caffeine is a gut stimulant, which is why people often poop right after their morning java, but too much caffeine dehydrates you and actually slows down the process. What's the goal? Whatever frequency is "normal" for YOU, and no abdominal discomfort. That being said, I rarely see a patient who truly averages 20g of fiber per day in their diet (not from supplements) who does not have "comfortable" daily BM's.

BOTTOM LINE: If you've had no change in your diet, medications or activity level, and you notice your bowel movements have become painful or less frequent, go and get checked out at your family doctor.

Lactose Intolerance & Chocolate Milk...the Conundrum

2011-08-10T20:54:00.000-07:00

Does your child tell you they CAN drink chocolate milk, but their stomach hurts after drinking "regular" milk? I'll share that when I told MY parents this, they laughed and thought I was simply asking for more sweets. As an adult, I was often puzzled that certain milk products did not agree with me, while others did. People asked if I was allergic to milk, or whether or not I had lactose intolerance...and I simply said that I do not like milk, because I didn't know the answer.

So, here it is. That kid that can down chocolate ice cream but not skim milk may indeed be lactose intolerant, and she is telling the truth! Lactose intolerance refers to the inability to digest lactose (the main milk sugar). Lactase lives on the inside surface of our intestines. Symptoms typically appear 30 minutes to 2 hours after consuming a product that contains lactose. The degree of symptoms produced (abdominal bloating, cramping, gas and/or diarrhea) depend on several variables:
1. The amount of lactose consumed
2. The level of lactase enzyme present
3. The SPEED of gastric emptying- the faster the gut transit, the worse the symptoms

Higher fat content will SLOW gastric emptying, which reduces the symptoms, so voila! There is your explanation for the chocolate milk. Of course, adding lactase in the form of a powder or capsule will also reduce the symptoms.

Who gets lactose intolerance? 80% of Blacks and Hispanics, nearly 100% of Native Americans and Asians, and roughly 15% of Caucasians develop it. Symptoms usually appear later in childhood or even as an adult. Also, anyone can transiently develop lactose intolerance after a serious bout of diarrhea, because that temporarily strips off the lining of the gut (which houses the lactase). Avoiding dairy products for a few days typically takes care of this type of intolerance.

The easiest way to tell if you have lactose intolerance is to eliminate it from your diet, and see if your abdominal complaints disappear. Remember, though, to read labels carefully, looking for "milk sugar, whey, or curd" as well as plain "milk". Note, too, that many prescription and OTC medications also use lactose as a base. Typically, however, even a lactose intolerant person is fine with SOME lactose (roughly 12 g) so it is not necessary to eliminate lactose 100% to see results.

If you are lactose intolerant, remember you will still need calcium to protect your bones, so talk with a registered dietician to be sure you are getting all you need.

BOTTOM LINE: Lactose intolerance is all about degrees, not simply "yes, you have it" or "no, you don't". Try a simple lactose elimination diet for a few days if you are concerned about abdominal complaints and think you may have lactose intolerance.

Back to School Check Ups & Vaccines

2011-08-09T17:01:00.000-07:00

Where did summer go? We are still having consistent 100-plus degree days here in Texas, but our kids start back to school next week already! In my office, however, we are well aware it's "back-to-school" time, as everyone is realizing that they've got school and sport physical forms to fill out, and our seventh graders are due for vaccines. Please call your family doctor RIGHT NOW and get your kids scheduled for an appointment!

Many people wonder why we prefer for kids to come in to fill out these 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 "Justin" 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. 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 will listen to their doctor, when 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 direct our education.

Finally, be aware that our immunization schedules are always changing. For example, we are now giving the meningitis vaccine and the chicken pox vaccine booster along with a tetanus shot for incoming 7th graders. (We used to wait till kids were headed to college to give the meningitis vaccine, and the chicken pox booster was only recently added in.) The immunization series for HPV (human papilloma virus) is also available for this age group.

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 bring those school & sport forms WITH you when you go!

The ADRENALINE Diet

2011-08-02T13:16:00.000-07:00

ADRENALINE- also known as epinephrine- is a hormone that is secreted by the adrenal glands in response to stress. ADRENALINE increases your heart rate, pulse rate, and blood pressure, and raises the blood levels of sugar (glucose) to prepare your body for that "fight or flight" response. So, ADRENALINE makes your heart pound like crazy, burning up calories by the second. What could be better to lose weight, then, right?

Am I suggesting that you head to your doctor and ask for an EPI-pen to kick off your diet? NO! An Epi-pen is an emergency dose of epinephrine that is used for severe allergic reactions. What I AM suggesting is New York Times Best Seller, ADRENALINE, by Jeff Abbott, for your summer reading...on your exercise bike! (or treadmill, or elliptical, if you can be smooth enough to read on them).

I am always looking for ways to entice people to exercise. One carrot that I use for myself is to get fun, gripping novels, and commit to ONLY READING THEM on my exercise bike. The better the book, the more I find time to squeeze in an extra workout session. My ultimate compliment for a book is that I have deemed it "exercise-worthy", meaning that it dragged me back to the exercise bike for at least a second session in a day. I'll confess that I read ADRENALINE in just a few days...but the last day, I biked over 30 miles, because I was so engaged that I had to see "who done it" and why! Jeff's fast-paced thriller probably would have had my heart pounding at a high rate anyway, but on an exercise bike I was oblivious to the fact that my legs were pumping faster and faster as the action heated up. Jeff Abbott's books always keep you guessing, as he manages to create truly unexpected twists in every plot. I also love how he quietly tucks in sympathetic, humane character details in even the most evil villains.

BOTTOM LINE: Improve your fitness, lose weight, and raise your own ADRENALINE this summer, by treating yourself to Jeff Abbott's latest thriller, ADRENALINE.

PS. Got a favorite GRIPPING book to suggest that is "exercise-worthy"? Share it with us here!

Visiting Someone with Memory Loss

2011-07-26T13:27:00.000-07:00

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.

Simvistatin (Zocor) Warning!

2011-07-08T05:10:00.000-07:00

Are you one of over 2 MILLION Americans who are taking Simvistatin (Zocor) 80mg to lower your cholesterol? The FDA has issued a safety announcement regarding the highest recommended dose of simvistatin, trade name Zocor. The bottom line is that the 80mg dose, has been found to have an unacceptable rate of muscle damage, especially in the first year of use. The FDA no longer recommends STARTING patients on this high dose, even those patients who are tolerating the next highest dose (40mg) but need still better improvement in their cholesterol panel. If you have been on simvistatin for more than a year and you are doing well- low "bad" cholesterol numbers and no unexplained muscle aches- then you are exempt from this rule, and may continue taking the drug at this dose (but I'd suggest you have a conversation with your doctor at your next check up.)

In the last several years, we have switched many patients to simvistatin, because frankly, it became generic and was much less expensive than its name-brand counterparts. Doses are not equal among statins- they are apples and oranges. When you switch, for example, from Rosuvastatin (Crestor) to simvistatin (whether it's name brand Zocor or generic), you will need a much higher dose of simvistatin to achieve the same effects.

The cardiology gurus push us to get those cholesterol levels lower and lower to optimally reduce risk of heart attacks and strokes. In response, we push the dose of our cholesterol lowering medications higher and higher, which obviously increases the rates of side effects. In the case of statins, the most serious side effect comes when there is muscle breakdown (myopathy) so severe that it effectively clogs up the kidneys and can throw them into frank kidney failure. This potentially fatal process is called rhabdomyolysis, "rhabdomyo" meaning skeletal muscle, and "lysis" meaning breakdown. Rhabdomyolysis is a rare dangerous side effect of ALL statins- roughly 4-5 people out of 100,000 on these drugs will be hospitalized from this problem. Unfortunately, the 80mg dose of simvistatin carries the highest risk.

Statins help reduce heart attacks and strokes, but make sure you have optimized your diet and exercise so you can be on the lowest dose that your genetics allow. My pet peeve is seeing people blame medications for bad outcomes, when behavior modification might have prevented that person from ever NEEDING the drug to begin with!

BOTTOM LINE: If you are on a statin, especially simvistatin (ZOCOR), be aware of the warning signs of dangerous side effects (unexplained tender muscles), and take ownership of your part of the cardiovascular risks of high cholesterol by eating MORE fruits and vegetables and exercising daily!

BOTTOM LINE:

Another Reason to Enjoy Coffee!

2011-07-05T15:16:00.001-07:00

Okay, before my patients have a HEART ATTACK, please note that I did not say a fully leaded cup of joe! Caffeine STILL causes headaches, fatigue, insomnia, heart burn, bladder irritation and breast tenderness, BUT...

A new study shows that men with high coffee use (6 or more cups per day) have a decreased chance of getting prostate cancer- specifically in this study of 48,000 health professionals, a 20% lower risk overall of developing prostate cancer, plus a 60% lower risk of developing advanced (lethal) prostate cancer. Happily, even those who averaged a more reasonable 1-3 cups of coffee per day had a 30% lower risk of the severe prostate cancer. For the record, it made NO DIFFERENCE whether or not the coffee was DECAF or regular.

Right now, 1 in 6 men will develop prostate cancer during their lives, with the average age at diagnosis being 71. Prostate cancer is the most common cancer in men, and the second leading cause of cancer death. As such, we are always looking for something that might prevent it! We know that diets high in lycopene (from TOMATOES) may help and that overly high calcium intake may increase risk. Other supplements or dietary modification may have an effect, but the jury is still out.

BOTTOM LINE: Men, if you are already a coffee drinker, enjoy a cup or two of decaf coffee each day with the knowledge that you may be reducing your risk of serious prostate cancer!

And yes, Eddie, apparently there is a Santa Claus...

Independence Day...and When to Give t Up

2011-07-04T14:57:00.000-07:00

If you know an aging independent-living senior, most likely his or her greatest concern is maintaining that INDEPENDENCE. In a perfect world, we would all be able to mentally and physically care for ourselves as we age. Unfortunately, especially with all the advances in medicine that prolong our lives, that is too often NOT the case.

Driving is probably the hallmark of independence. As long as we can find our keys to GET to the car, we feel a strong sense of freedom. Getting groceries, heading to a doctor's appointment, visiting a friend or attending church is simple, because we simply get in the car whenever we feel like it. No one wants to give up driving, but here are some issues to consider:
Hearing
Vision
Limited neck mobility
Slowed reflexes/stiff muscles in arms

If you have trouble hearing, you may not hear that siren or warning honk, or even the loud motorcycle approaching.
Decreased vision (think cataracts and macular degeneration)- well, this seems obvious, but you can see cars with pretty poor vision. However, you need to be able to read SIGNS, too, as well as see colors of lights.
Stiff neck? You can't turn your head to check your blind spots.
Slow or stiff muscles- you can't manuever your car quickly enough to react to sudden changes.

Please check out an earlier blog on Driving Safely while Aging Gracefully.
BOTTOM LINE: There are many options to driving yourself that do NOT involve giving up your independence. Please do NOT wait to give up or limit your driving until you've hurt your car, yourself or another person.

TVs and TIRED KIDS (and Parents)

2011-06-28T15:29:00.000-07:00

Televisions have become so commonplace that we often barely notice their presence. Many families leave the tv on for most of the day, more like background noise than anything else. A article recently published in PEDIATRICS addresses the use of television in preschool aged kids, 3-5 years old. The roughly 600 children in the study showed an increase in sleep problems associated with evening media use (television and computers), especially when that tv was located in the child's bedroom. Additionally, the study found that watching violent programs increased sleep problems, regardless of the time of day that the program was viewed.

Interestingly, the average reported screen daily screen time was a little over an hour, with roughly 14 minutes occurring in the evening. Remember that these were 3-5 year old preschoolers, and the information was obtained from parents filling out media diaries and sleep questionnaires. If this information was accurate, then please note that even kids watching LESS than the recommended maximum of two hours per day were still affected. Nearly one in five parents reported sleep disturbance in their child. (As an aside, please note, parents, that the medical community strongly recommends NO TELEVISIONS in kids' bedrooms!)

We are learning more and more about the impact of computer screens on our brains, and consistently finding that screen evening screen use impairs the quality of sleep. For children, adolescents and adults alike, we need to go back to "the good old days" of READING or relaxing in a warm bath before bed...but remember to read from a BOOK, not an electronic reader!

BOTTOM LINE: Media screen viewing, especially in the evenings before bed, impair your quality of sleep. If you have daytime fatigue, focus on LIMITING your screen time!

FDA's New Cigarette Labels- Wonderfully GROSS!

2011-06-22T14:08:00.000-07:00

Let's hear it for the FDA! Cigarette boxes will no longer carry the simple boxed warning that smokers have come to ignore over the last couple decades. Instead of these simple printed words, now there will be nine different graphic images with accompanying appropriate messages. "WARNING: Smoking is addictive"- showing a man smoking from the hole in his tracheotomy (a hole in the neck surgically created for patients on ventilators long term), or "WARNING: Cigarettes cause fatal lung disease" with a picture of healthy pink lungs next to horribly diseased lungs. I think my favorite, though, is the one I posted above, with the yellowed teeth and cancer sore rotting on the lip.

I believe we need to address tobacco addiction at the age and interest level of the smoker. Teens rightly aren't terribly concerned with emphysema at age 60, nor lung cancers even as early as their 40s. They MIGHT listen, however, to concerns about bad breath and yellow teeth. An older smoker, however, may believe tooth whiteners and listerine will fix any transient problems, but the threat of stroke or heart attack from tobacco-related disease might hit home.

Whatever the age, I am pleased to see new marketing strategies put in place to shake up the routine. The FDA will be rotating pictures/messages to be sure that smokers are barraged with new warnings as they begin to be desensitized to the first batch.
Smoking is VERY addictive, and I have yet to meet a smoker over the age of 30 who doesn't wish they had never picked up that first cigarette- even those who steadfastly maintain they enjoy smoking and "don't care if it kills (them)".

BOTTOM LINE: If you still smoke, PLEASE talk to your doctor and find out what options you have to help you QUIT for LIFE.

Sunscreen Labeling Update from the FDA

2011-06-16T05:43:00.000-07:00

Hooray! The FDA issued a press release this week that will only allow sunscreen products that protect against BOTH UVA & UVB rays to be labeled as "Broad Spectrum" and they must have SPF values of 15 or higher to state that they reduce the risk of skin cancer and early aging. Previously, SPF only addressed UVB rays, which are the primary cause of sunburn. Both UVA & UVB cause skin damage and skin cancers.

Earlier this month, I blogged about "which sunscreen is best", but let me review a couple key issues. SPF- Sun Protection Factor- measures the amount of solar energy required to cause a sunburn on protected skin versus unprotected skin. While in general terms that means a sunscreen with an SPF of 30 should allow you to be in the sun for 30 times the sun exposure before causing damage, realize there are two major qualifying factors. One, the UV radiation is more intense at different times in the day. Fifteen minutes at noon may equal an hour early in the morning. Two, no sunscreen- even when applied correctly- stays fully effective more than a couple hours. What's correct application? A full OUNCE per person, applied thoroughly and reapplied every two hours. Of course, altitude, latitude, cloud coverage and skin type all factor into the degree of solar intensity required to cause damage as well. With this in mind, the FDA is additionally proposing to limit the maximum SFP to "50+" as there is no evidence to show that products with SPF's higher than 50 provide any additional protection beyond those labeled as 50.

What does all this mean for the average consumer? For now, keep reading sunscreen labels more closely, making sure that the product you are choosing protects against BOTH UVA and UVB radiation. Typically, if you look at the active ingredients and see zinc or titanium dioxide along with several other chemicals, you've got the right product. The new labeling wont be obvious on the shelves till next summer, so while this announcement is a step in the right direction, don't assume products labeled "broad spectrum" this year are truly that. Also, please don't forget about hats and protective clothing, especially if you are going to have extended time outdoors.

BOTTOM LINE: Double check your sunscreen to be sure you are protecting your skin from BOTH types of UV radiation- UVA & UVB- because they BOTH cause skin damage that can lead to skin cancers.

Puppy Love & Alzheimers

2011-06-14T14:07:00.000-07:00

This week our family welcomed it's newest member- Tozi (after the Atzec goddess of nature & water), an 8 week old Portuguese water dog (a virtually non-shedding, friendly breed often used as therapy dogs). I want to share a wonderful experience that this young pup has already brought to us. We took Tozi to visit my Dad, who lives in a memory care unit. All of the residents have some form of dementia, primarily Alzheimer's. As we walked in carrying the puppy, we were greeting with smiles, oohs and ahs. Although I was a bit apprehensive about her wiggly body and sharp puppy teeth, I asked if anyone would like to pet her. And did they EVER!

Almost every resident not only wanted to pet her, but asked to hold her. They snuggled her to their chests and chins, encouraging her to give them a "kiss" on their cheeks. I was amazed at Tozi's instinctive, unbelievably CALM response. She went practically limp in their arms, gently raising her head for pats and kisses. One sweet lady balked when we went to remove Tozi from her arms- "Don't rush me! I could hold her and love on her all day!" The joy one tiny six pound pup could bring was immeasurable. I started asking everyone about what pets they had cherished, and all the residents seemed to jump in. One lady had every type of pet you can imagine, and a few I'd never heard of (waltzing mice?!)

Our other dog is a labradoodle, another breed that is often used for pet therapy. Full therapy dog training takes a few years, many courses, and lots of consistent practice. That being said, I believe that a loving snuggle with any cooperative, calm pet goes just as far for most people suffering from dementia. Obviously, you must be careful that the animal does not harm anyone (the lawyers make me add that!) Our pup has already made a second visit, and the smiles & joy keep coming.

BOTTOM LINE: People with dementia are thirsting for love and touch as much if not more than the rest of us. Remember to share some some love & touch- or maybe even some puppy love-on your next visit.

Exercise and Strokes

2011-06-09T08:14:00.000-07:00

Hooray! We have yet ANOTHER great reason to exercise. The journal Neurology has published a study this week that showed older people (mean age 70) who participate in moderate to intense levels of exercise have nearly HALF the risk of silent stroke compared with their less active peers. This study looked at 1200 adults with no clinical signs of stroke. The participants had brain MRI scans, and nearly 200 of them had evidence of a silent stroke. All the study patients were interviewed about their regular activities, from golf to hiking or other vigorous exercise. In fairness, 43% who had normal brain studies did no regular exercise at all. However, it is impressive that those people who regularly had significant aerobic activity had a 40% DECREASED RISK of silent stroke- even when this risk factor was isolated from other risks such as high blood pressure or cholesterol.

Exercise has so many benefits- from improving our mood, to increasing energy, to decreasing stroke risk. And it's never too late to START exercising! The more "out of shape" you are, the more important it is for your overall health to get moving. Simply "start low, and go slow" to avoid injury. In practical terms, I'd suggest starting with WALKING and consider getting a PEDOMETER (grab a pedometer app on your iPhone and get started counting steps right now!)

BOTTOM LINE: Exercise benefits include decreasing your risk of silent stroke, so if you value your brain cells, get moving!

Cell Phone DANGER

2011-06-08T12:32:00.000-07:00

Last week, the buzz in much of medical media centered around cell phone use and risk of cancer, because an early release of a study published in an oncology medical journal noted that cell phone users had a 40% INCREASE in gliomas, which are a type of brain tumor. To put it in perspective, though, the baseline glioma risk in the general population is 1 in every 200,000 adults. The potential cell phone increase would increase that risk to 1 in 120,000. However, given the 5 BILLION cell phone users worldwide, everyone is understandably concerned with whether or not they can cause cancer in humans. The World Health Organization International Agency for Research on Cancer (WHO/IARC) has indeed now classified these radiofrequency electromagnetic fields as "possibly carcinogenic to humans (Group 2B)". Of course, these fields can come from microwaves, tv's, and radars, as well as cell phones.

When are the phones considered dangerous? When the phone is used on the same side for 30 minutes/day for > 10 years. (Lancet Oncology; July, 2011). Previous studies showed no increased risk if you alternate ears as you talk on the phone, and the jury is still out regarding blue-tooth and other wireless devices.

What is my level of concern? As usual, I think overuse of nearly anything can be harmful to your health, whether it's chocolate, french fries, wine or cell phones. I know that cell phones are causing far more harm RIGHT NOW as people chat on the phone nonstop as they drive, and heaven forbid, TEXT. I was nearly hit in a parking garage today by a driver busily texting as she negotiated the tight ramps. Apparently simply dialing your phone while driving TRIPLES your risk of a car accident, and texting increases that risk by a factor of 28!!

As a side note, my kids know that I am always looking for pictures for this blog. We were driving the other day, and a young woman passed us (in the right hand lane, mind you!) while she was looking at her cell phone AND smoking a cigarette. Immediately everyone in our car (EXCEPT THE DRIVER) reached for a phone or camera to grab her picture as the health "DON'T", and the kids launched into "my" speech about driving safety. She sped away before we caught her picture, so this is me POSING as the driving "DON"T".

BOTTOM LINE: PLEASE, leave your CELL PHONE in the BACK SEAT (or your purse, or the trunk- whatever is safely out of reach) when you drive, so you wont be even tempted to look at your latest text, none the less, respond.

Which Sunscreen is the BEST?

2011-06-03T04:45:00.000-07:00

There are so many sunscreen products available that it often feels impossible to choose which type of sunscreen to purchase. I know most kids (& moms) prefer the sprays, because it makes the process so much faster. Unfortunately, I have yet to find a sunscreen with all the ingredients that I look for to ensure the best protection.

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? You might be surprised to hear that 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!

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...for me, there is not an acceptable spray yet, for several reasons. Primarily, there are few with 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. There is some debate 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 minute portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF.

What do I buy? Our family typically uses Banana Boat's "Baby" lotion. 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 measure of success! Probably more importantly, we all use swim shirts, and most of us 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.

PS. NO, I do not have any financial ties to sunscreen makers!

Getting that "Base Tan" for Summer Vacation?

2011-06-02T05:15:00.000-07:00

Marketing is everything, isn't it? How many of you have headed to a tanning booth to get that "base tan" before heading out for a beach vacation? Here's a note- that notion has no scientific basis, nor support from dermatologists. In fact, the American Academy of Dermatology (AADA) testified recently at FDA hearings about the risks of indoor tanning. These devices have shared the same low risk category as bandaids and tongue depressors, yet we have had medical evidence for years that they clearly cause skin cancers.

Melanoma rates are increasing across the board, and melanoma is now the number one cancer in young people aged 25-29, and the second most common cancer in 15-29 year olds. Use of a tanning bed before the age of 35 increases your risk of developing melanoma by a whopping 75%! I can personally attest in my own practice that I have diagnosed 3 cases of melanoma just in the past few months, primarily in people younger than I am- which really hits home. (I'm 45.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Tanning beds are not "safe", and they target young people (especially women) with their ads. Many tanning salons promote their "safe" or "harmless" type of UV radiation, but the UVA rays cause damage in the same fashion as UVB rays- only a bit more slowly and more deeply.

The American Academy of Dermatology hopes the FDA will ban indoor tanning devices all together, but at the least, should require a minimum age of 18 for ANY indoor tanning and should mandate obtaining informed consent from clients AFTER educating them about the real risks of skin cancer. The AADA also strongly recommends changing the risk category of these machines to match the health risks they create.

BOTTOM LINE: TANNING is NOT SAFE! Use sunscreen and stay away from tanning beds all together.

Happy Memorial Day, 2011!

2011-05-30T04:53:00.000-07:00

Happy Memorial Day! We give special thanks today to every man and woman who has served in our armed forces, allowing us so many freedoms here in the United States. Let's take a moment from our busy lives to reflect on those freedoms that we take for granted...including the right to vote (are you participating in your local elections as well as the national ones?) and freely worship. Reach out and thank a current or former member of the military today.

From the medical perspective, we see our veterans returning from tours with numerous serious and challenging "battle scars"- from the instantly obvious traumatic amputations, to unusual parasitic diseases and skin rashes, to the far more penetrating post traumatic stress disorders. Of course, many men and women never make it back at all, and their families are left to carry that heartache.

BOTTOM LINE: I'm thankful to live and work and raise a family here in the United States. God Bless the USA!

PS. As you head out to picnics and other outdoor celebrations, don't forget the sunscreen- regardless of the number of clouds in the sky. Melanoma is a deadly skin cancer, and it's numbers are on the rise. More on this tomorrow.

Swimmer's Ear- Home Remedy

2011-05-23T17:10:00.000-07:00

Here in Texas we are nearly done with school, and thoughts are veering away from finals and towards days filled with swimming, boating and all kinds of water activities. Austin boasts terrific natural swimming spots, including our lakes and our famous spring-fed Barton Springs pool, where the refreshing water stays at a cool 65 degrees even when we are baking in 100-plus temperatures. Not surprisingly, we tend to see an increase in swimmer's ear infections (otitis externa), which can not only be painful, but can limit your water fun. The good news is that prevention works extremely well, and even when that fails, you may not need to head straight to the doctor. The solution is EAR DROPS.

What drops do we use? We make our own home brew of half and half, alcohol and vinegar. (Yes, rubbing alcohol and generic cooking white vinegar.) To be honest, I like the convenience of the over-the-counter little bottle, so I actually buy one and pour out the contents, replacing it with our home remedy. An extra tip is to set it outside (in the shade in Texas) where it will warm up a bit before you put drops in your ears, so it's not cold and irritating.

This mix will actually work both for prevention and for treatment, if you forgot to use it ahead of time. Nine times out of ten, this will be all you will need! The vinegar kills the fungus, and the alcohol dries up any moisture that remains.
If you are an ear-wax-builder-upper, you may need to flush your ears periodically (such as once per month) using an infant bulb syringe and luke warm tap water, to remove packed in ear wax prior to putting in the home brew drops.

BOTTOM LINE: As always, an ounce of prevention is worth a pound of cure, but remember vinegar/alcohol ear drops for swimmer's ear and you'll be set!

The Perfect Diet Pill

2011-05-20T09:47:00.000-07:00

Ready to sign up? I think we're all looking for that pill that let's us skip exercise and eat whatever we want, but still allow us to lose weight effortlessly- and oh yes, with no side effects. Sigh. I hate to disappoint you, but no such pill exists. I often think patients believe we doctors are hoarding this mysterious pill somewhere, keeping it for our own use! But seriously, if there were such a pill, there would be no overweight or obese doctors, right? And look around...doctors struggle with their weight as much as the next person.

What IS out there, and why don't we use it more? The main drug still on the market for weight loss is phentermine. The common brand names are Adipex, Fastin, Obenix, and Oby-Trim. Phentermine is a very effective appetite suppressant. It is a stimulant (similar to amphetamine) and can be addictive. It doesn't magically speed up your metabolism, it simply suppresses your appetite so you consume fewer calories. In the past, it was combined with another diet medications (fenfluramine and dexfenfluramine) but this combination turned out to potentially cause pulmonary hypertension- a very serious and possibly fatal lung disease. By itself, however, phentermine is usually well-tolerated, though it has it's own list of side effects, and it cannot be taken along with many antidepressants. Phentermine is thought to raise blood pressure, increase heart rates, and increase your risk for heart disease. A study published last month in Obesity, however, suggests that these cardiac effects may not be significant, or in fact, may not be there at all. While this was not our highest quality study, its numbers (300 patients) and methods are enough for us to take note.

So, if you don't have heart risk factors (beyond obesity) and you are not taking an antidepressant, should you rush to your doctor for a phentermine prescription? Probably not. If you need to jump start a weight loss program and you are ready to really improve your diet quality and quantity along with pursuing a solid exercise program - maybe. It's worth a discussion. However, you need to know from day one that most people REGAIN the weight when they go off the drug. Again, not magic, just they quit suppressing their appetite so they are more hungry, and they eat more.

I rarely prescribe phentermine, probably less than five patients per year. My personal standards are that the patient needs to be seeing a registered dietician and demonstrate that they are exercising daily for a least a month. I see the patient back monthly, and will not prescribe phentermine for more than six months. This is not a "cure all" drug, but in selected patients, it can be a wonderful jump start towards better health.

BOTTOM LINE: If you feel overriding hunger is truly keeping you from losing weight, open the discussion with your doctor about considering a prescription appetite suppressant.

How are the Poor Obese?

2011-05-19T11:16:00.000-07:00

When did it become the norm that poor people are obese? Right now, 1 in 3 Americans are obese, and nearly 2 in 3 are overweight or obese. Throughout history, the poor have been HUNGRY...and thin. Meat has become cheaper than grains and vegetables, while we super-size and sugar everything. Check out the CDC's latest info on obesity in America for some shocking statistics...

Remember when going to the ice cream store meant picking out a single scoop of your favorite one of 31 flavors? Now the ice cream is simply the base, and we put multiple toppings of fudge and CANDY on top of our multiple scoops. In simply the past decade, fast food sales climbed from $107,147 BILLION to $164,836 BILLION dollars per year. Hmm...what if we spent some of those BILLIONS on health promotion, instead?

Obesity has numerous health consequences: Type 2 Diabetes, heart disease, high blood pressure, stroke, cancers (such as colon, breast and uterine), liver disease, sleep apnea and joint problems (especially knee and hip.) Our estimated obesity-related medical costs as a nation are $147 Billion annually. The obese INDIVIDUAL spends at least $1400 more on their medical care than a normal weight person.

BOTTOM LINE: Stop looking for the perfect diet, diet pill, or most amazing gym, and start making common sense small changes, like focusing on eating MORE vegetables and fruits and getting MORE active!

A Step (or Pedal) in the Right Direction!

2011-05-14T10:04:00.000-07:00

Good news! Americans are slowly but surely getting MORE mobile. Research studies utilizing national household travel surveys from the last decade reveal that we walked on average 9 miles more than we did back in 2001. We also biked about 5 miles more. I'm pleased to see that 8% are walking 30 minutes per day- that's my "magic number" for daily exercise, because 30 minutes of getting your heart rate up each day will give your heart, brain and body a boost. In fact, 30 minutes of daily exercise helps improve your mood as much as a low dose of an antidepressant!

I find it interesting that 75% of walking trips and 50% of biking trips in 2009 were purely a mode of transportation (to the store, school, see friends, etc.) rather than for the pleasure or intent of exercise. The wonderful part is that you get the same benefits of exercise, regardless of your intent when you are in motion. With gas prices going up through the roof, I hope we will see a continued trend that bicycling will be used in place of cars for short travel distances.

Why not take a step in the right direction and make a commitment to walk or bike to at least one nearby destination instead of driving? Perhaps your family could walk to a neighborhood yogurt shop or diner, or you could bike to the grocery store for those one or two forgotten items.

BOTTOM LINE: Congrats, America, we're starting to move MORE- keep it up! And please...WEAR HELMETS & visible clothing!

Top Two Secrets for Permanent Weight Loss

2011-05-11T10:32:00.000-07:00

As the seasons change, and bathing suit season is staring us right in the face (or other, more sensitive body image spots), many of us are focusing on what we can do to make some positive and permanent dietary and lifestyle changes. Yesterday, I mentioned several successful strategies used by folks who have kept off over 60 pounds for many years. In my practice, the two most important strategies include eating breakfast each morning and exercising daily. Let me expand on these two points for a moment.

First of all, breakfast. Yes, your mom probably taught you that you must "put fuel in the tank" and that breakfast is the most important meal of the day. Guess what? She was RIGHT! When you get up in the morning and charge into your day without true nutrition (coffee does NOT count as breakfast), your body assumes there must be a food shortage and goes into conservation mode. To maximize your metabolism, you simply need to eat. Does it need to be a hot, four course meal? Nope! How about a cup of yogurt, or a banana with some peanut butter, or cereal with berries? In a hurry? Grab a granola bar (and a banana or other piece of fruit, in a perfect world.) It never ceases to amaze me that I have at LEAST one patient per month come in with impressive weight loss since their last office visit, and they tell me that the ONLY change they made was to start eating breakfast!

Okay, how about that daily exercise? Really, EVERY DAY? Yes, again. I prefer to think about it like brushing your teeth. Do you wake up each day and struggle with the decision of whether or not to brush your teeth? Do you really enjoy brushing your teeth? I'm guessing the answer to both of those questions is "no". Exercise should be the same deal. Again, it doesn't have to be fancy, just consistent. Pull on your sneakers & head out the door for a brisk walk, or flip on your tv and join in on an exercise program. If you start each day with a quick 30 minutes of some type of aerobic activity, I'd bet you'll find not only a much higher rate of consistency, but extra energy and a better attitude.

BOTTOM LINE: Commit to EATING BREAKFAST and DAILY EXERCISE to keep those extra pounds off for good!

How Do You KEEP the WEIGHT Off?

2011-05-10T17:12:00.001-07:00

Many people lose the SAME 10, 20, or even 50 pounds over and over again. How frustrating is that? What can you do to PERMANENTLY lose weight, so you're not fighting that same battle? The first answer is obvious- stop DIETING. When you go on a super restrictive DIET, certainly you will lose weight, but if you never really look at your eating patterns and exercise habits, you are doomed to repeat the cycle.

I always encourage my patients to make changes they can live with for the REST of their lives. Typically this does not involve permanently eliminating ANY particular item from their diet- whether it's chocolate, butter, or even soda. Should you limit these high calorie items? Sure! But really, if you focus on MORE fruits and vegetables and water, then truly, you'll begin to notice you ARE eating less of these higher ticket items.

There is a wonderful website dedicated to people who have not only lost more than 30 pounds, but KEPT THOSE POUNDS OFF for at least a year- the National Weight Control Registry. In fact, the average weight loss is 66 pounds, and they have kept it off an average of 5.5 years! Both men and women are enrolled, with the average ages being 49 and 45, respectively. About half lost the weight on their own, while the other half joined programs. What do they have in COMMON?

1. 94% INCREASED their activity level, most commonly by WALKING
2. 78% EAT BREAKFAST daily.
3. 75% WEIGH themselves once per week
4. 62% Watch less than 10 hours of TV per week
5. 90% EXERCISE DAILY

BOTTOM LINE: If you want to stop battling the same pounds, take a look at the success stories of people who have KEPT their weight OFF, and see what simple changes you might be able to make to keep YOUR weight off.

World’s Best Mother’s Day Present (Even After the Fact)

2011-05-04T14:27:00.000-07:00

What if I told you it was possible for you to give a present to your mother (or arrange for your kids to give a present to their mother) for Mother’s Day that had four characteristics: (1) it costs only a few pennies, (2) it takes little effort for most people to create it, (3) it had a high probability of making her cry (in a good way) and (4) it would be one of the things she’d be sure to grab in the (hopefully unlikely) event of a house fire? Interested? Well that gift is to write her [or arrange for your kid(s) to write her] a gratitude letter.

Gratitude letters are usually around 300 words in length, but can be as long as you’d like. (Kids in elementary school might write briefer letters and/or draw pictures instead.) The letter is in the first person (i.e., “you are so loving in how you treat me when I am sick” not “my mom is so loving when I’m sick”). To be more personal, write it out by hand. The letter should express only positive thoughts and feelings and should not include direct or indirect statements regarding your mom’s failings or opportunities for growth.Try to include examples of specific things that your mom has done or said that cause you to feel gratitude; these examples can be recent or from a long time ago. When it’s time to share the letter it’s best to read it to her (kids might rotate doing this one-on-one on Mother’s Day); don’t chicken out and hand it over for her to read. You may start to tear up or get emotional. That’s okay (you'll probably find you're not the only one). When you’re finished give it to your mom. Allow the positive moment to linger as long as she’d like (i.e., some of us, though we enjoy it, may start to feel a little uncomfortable with the intimacy that can emerge); in other words, your mom should decide when to end the moment or change the topic. (If you are reading this after Mother’s Day don’t let that stop you from trying it!)

You can also find a lot of satisfaction in writing gratitude letters for others, in your family or otherwise, towards whom you have unexpressed gratitude, be it ancient or recent. The experience is usually very positive, and often to a surprising degree.

BOTTOM LINE: Surprise your MOM or ANYONE you love with a "gratitude letter", and I'll bet YOU will be delighted as well. Thanks to Dr. Palmiter for today's guest blog entry.

Dr. David Palmiter is a practicing clinical psychologist and psychology professor in Scranton, PA. He is also the President-Elect of the Pennsylvania Psychological Association and the author of Working Parents, Thriving Families: 10 Strategies that Make a Difference His blog can be found at www.hecticparents.com.

Mother's Day Gifts- Get Ready!

2011-05-04T13:50:00.000-07:00

Mother's Day is coming this weekend, just as we are polishing off the last chocolate eggs from the Easter basket. Hmm...sounds a bit like Halloween and also Valentine's Day, right? Why is it that most of our American holidays focus on CANDY? Mind you, I love chocolate, but the truth is that I have been popping beautiful pastel peanut M&M's into my mouth each time I pass through my kitchen and hear the Easter candy bowl calling my name.

At the same time that we are fretting about trying on swimsuits and fitting into summer clothing, we are working to "finish up" the Easter candy. Kind of counter productive, isn't it? So, first of all, let's give away the rest of the candy (if it's still sitting around.) Secondly, let's pamper Mom with gifts she'll enjoy that promote her health- physical, mental or spiritual.

So, what do moms like? Are you feeling rich? Offer her spa certificates or maybe a gym membership. Not quite so loaded? How about a simple manicure (usually around $15) or a lovely smelling candle or body lotion, or a new exercise outfit? Totally broke? No worries- go for HOME MADE; a simple meal (that MOM does NOT have to prepare OR clean up), cleaning her car inside and out, or jumping in and doing "her" jobs for the day, like a load of laundry or walking the dog.

If you REALLY want to touch your Mom's heart, check back tomorrow see what my guest blogger, psychologist David Palmiter,PhD, thinks is the PERFECT gift for Mom or anyone you truly love...

BOTTOM LINE: Skip the chocolate this year and celebrate MOTHER's DAY with a health-promoting gift!

Working Parents, Thriving Families- Possible? YES!

2011-05-02T17:08:00.001-07:00

Time is flying faster and faster these days...If you have kids, you realize that the month of May is fast becoming as booked as December. Band recitals, track meets, sport tournaments, dance shows and all conceivable types of end of year banquets merge together with semester and year-end finals, packing overflowing stressors onto already busy families. If you feel like your family is crammed together on a giant version of a hamster wheel, running frantically and getting no where, then I've got the first book for your summer reading list: David Palmiter's Working Parents, Thriving Families: 10 Strategies that Make a Difference.

The best part of this "edutaining" family self-help book is that it is literally laugh-out-loud funny, so it is not a chore to read. Face it, the last thing an overextended parent needs is a dry psychology text- unless, of course, you suffer from insomnia. David brings to life common, potentially emotionally hazardous situations, and then OFFERS PRACTICAL SOLUTIONS. From coaches manipulating unequal playing time on team sports, to kids requesting violent video games, to challenges of single/divorced parent dynamics, this book offers concrete, proven effective strategies that you can add to your emotional toolbox.

Who should read Working Parents, Thriving Families? Every busy parent who has a robust sense of humor! If you are looking for a serious book on academic parenting theories, this is not it. If you are looking for a book that can seriously help you learn (or even simply better prioritize) positive family interactions and parenting skills, then grab your NOOK or Kindle and order it now, or grab a hard copy at amazon or your favorite local bookstore. Whether you're having one of those exhausting "what IS my kid THINKING?" weeks, or simply enjoy learning new nurturing skills, I think you'll enjoy and benefit from reading Working Parents, Thriving Families.

BOTTOM LINE: Crazy-busy lives with over-extended parents AND kids have become the norm. Stop racing and create some "special time" with your kids today.

PS. It's MAY- a new month- CHANGE THOSE AIR FILTERS (especially here in Austin, the Oak was out of control!)

Alzheimer's Disease- Why So Hard to Diagnose?

2011-04-25T05:32:00.000-07:00

Alzheimer's disease (AD) should be simple to diagnose, right? How hard can it be for a doctor to decide if memory loss is a normal part of aging, or if it is severe enough to "count" as Alzheimer's? Well, if diseases only occurred one at a time, it might be simple. Unfortunately, as old Texas doc's say, when you itch, it's possible you've got ticks AND fleas. I find in family medicine, it's rare we see any disease state by itself, and Alzheimer's is no exception.

Many different issues can affect memory. Depression and/or anxiety very frequently preoccupy the brain so much that short term memory loss can be a predominant issue. Low thyroid levels can decrease memory. B12 deficiency is another cause. The list of medications that can affect memory seems to be growing each year as well.

When my mother first noticed significant memory issues at the age of 61, she was convinced she had Alzheimer's. I literally laughed when she told me her concerns...We had no family history of early or even late onset dementia. She had recently started a medication known for impairing memory (Digoxin.) As her medical workup progressed, I was relieved to find out she had not only that medication as a possible cause, but literally every cause I listed above- B12 deficiency, hypothyroidism and depression. I felt confident that as we addressed each of these problems, her memory would improve. In many cases, that would have been true, but unfortunately for Mom, she did indeed have underlying Alzheimer's, which took roughly another two years to fully decipher.

If you are concerned about memory loss, please make an appointment with your family physician to address your concerns. Head to the Alzheimer's Association website and review the 10 Warning Signs of Alzheimer's. Until those biomarkers for AD become more refined, physicians will not have a quick or simple answer, but a thorough history and exam, combined with possible neuropsychiatric testing, will take us a long way in the right direction.

BOTTOM LINE: Memory loss can have many different causes, and these causes can and frequently do overlap.

Alzheimer's Biomarkers- What ARE They?

2011-04-21T17:27:00.000-07:00

In yesterday's post about the new Alzheimer Disease (AD) guidelines, I talked about how Alzheimer's biomarkers represent hope for future early diagnosis and treatment of AD. But what the heck ARE biomarkers? Today I will clarify...

Biomarkers - short for biological markers-are any naturally occurring substances in the body that reliably predict or indicate a disease. Cholesterol, for example, can be considered a biomarker for heart disease. We know when cholesterol levels are very high, it is likely that plaques of cholesterol could be building up in the heart arteries, making it more likely that that person could have a heart attack. In the case of Alzheimer's disease, the pathological changes in the brain involve the buildup of certain types of protein around the nerve cells in the brain, as well as degeneration and breakdown of other nerve cells. The combination of these two problems makes it hard for the brain to function correctly, as messages can't be passed effectively from one part of the brain to another.

Biomarkers for AD include beta-amyloid protein (that builds up in plaques) and tau protein, which is part of "neurofibrillary tangles"- clusters of protein that block nerve conduction. Right now, these proteins must be measured in spinal fluid, which means the patient must have a spinal tap (aka. lumbar puncture) which involves a needle in your back near your spinal cord. The hope is that measuring levels of these proteins in blood or urine may also prove to be accurate predictors of AD, so the more invasive procedure is not needed.

Not all of today's biomarkers require spinal fluid. Genetic testing for APOE-e4, as well as other genes that increase risk for AD, can be done by a simple blood test. Additionally, imaging of the brain using MRI and PET scans can provide valuable information as well.

Unfortunately, the diagnosis of Alzheimer's disease is not black and white, even with use of biomarkers and the new guidelines. I'll delve more into the challenges of diagnosis tomorrow.

BOTTOM LINE: Biomarkers for Alzheimer's include blood tests, spinal fluid tests and brain imaging, and these procedures are primarily restricted to research settings in 2011.

Breaking News about ALZHEIMER's

2011-04-20T11:22:00.000-07:00

Over 5.4 million Americans suffer from Alzheimer's dementia (AD), and we believe that an equal number of people are in the early, yet UNdiagnosed stages of Alzheimer's. If you don't know someone affected yet, you will soon. My mother battled AD for over a decade, so I have a very personal face for this disease. For the first time in nearly three decades, there are new criteria for the diagnosis of this challenging disease. What's new?

Now there are THREE stages, with the first stage existing before there is any memory loss, called PRE-Clinical AD. This is based on research settings ONLY, where levels of biomarkers can be measured. The second stage is Mild Cognitive Impairment (MCI), where there are early memory and other cognitive changes, but these developments do not significantly impair the person's ability to perform daily tasks. The final stage is Dementia, where there are not only memory, orientation and judgement difficulties, but they are to a level that affects the patient's daily life.

Biomarkers represent a very exciting FUTURE for Alzheimer's disease research and treatment. Right now, these tests are not readily available to those of us in private practice, and even if they were, we have not established solid reference points to allow for accurate interpretation of the data. The importance is THIS- just like we can measure and treat cholesterol levels BEFORE someone has a heart attack, or see rising blood sugars before full diabetes, elevated AD biomarkers may warn us of impending AD. Obviously, the next step is then to develop medications that will PREVENT the full development of dementia, if they are started during the earliest stage.

We're making progress! Go to the Alzheimer Association website and see how you can help make a difference.

BOTTOM LINE: We are learning more and more about the early stages of Alzheimer's disease, and biomarkers represent an exciting new diagnostic tool...but they are still ONLY IN RESEARCH protocols.

The Secret to a Successful Exercise Program

2011-04-18T15:22:00.001-07:00

Here in Austin, the temperature is already climbing into the upper 80's, so our swimsuit season has officially arrived. Unfortunately, most of us still have a bit of "winter fat" on us that we'd like to shed. If you have kids, it's easy to get caught up in the end of school year rush and push aside your own health priorities. After all, who's got the time?

Let me encourage you to MAKE the time. Make exercise a DAILY habit- just like brushing your teeth. Take away the whole "am I going to exercise today" dilemma. If you got out of bed, YES, some form of exercise will happen today. Period. You don't have to have an elaborate work out plan that consumes an extra hour simply to get to and from the gym! If you have the time, grab that gym bag, but if not, START MOVING. The "BEST" exercise is the plan you will follow every day. Extend that dog walk and make it two miles in a half hour; pull the clothes off the treadmill or exercise bike and hop on it to watch your favorite show; pull out your favorite exercise DVD or flip channels till you find a new one.

What's the secret to exercising every day? Do it FIRST THING in the morning, and don't give yourself a "choice" to hit snooze. Let me assure you, when my alarm goes off at 5:00am, I do NOT leap out of bed with a smile on my lips and a song in my heart! I grumble to myself, moaning and groaning a bit while I throw on weather appropriate clothes, leash the dog, and head out the door. That being said, by the time I reach the top of the first hill, I'm pleased with myself for getting out there, and I feel energized and ready to take on the day by the time I hit the shower.

BOTTOM LINE: START EVERY DAY with 30 minutes of exercise, and you'll stop worrying about whether or not you can "fit" exercise into your schedule!

Confirmed Contagious: Silent Herpes

2011-04-13T13:51:00.000-07:00

The current issue of JAMA, the Journal of the American Medical Association, includes an important study: Genital Shedding of Herpes Simplex Virus Among Symptomatic and Asymptomatic Persons With HSV-2 Infection. We know that the vast majority of people who are infected with genital herpes are UNAWARE that they have this disease, so it is critically important to know whether someone who has disease, but doesn't KNOW it, can still pass that disease on to a partner. How can infected people not know?

First of all, not all herpes infections are obvious. The classic herpes lesion is a painful cluster of blisters sitting on a bright red base. However, these blisters may not be visible, especially on a woman, since they can be hidden up inside the vagina. Additionally, many people have very mild symptoms, such as intermittent burning, itch, or discomfort with intercourse. If you are not checked for herpes with a specific antibody blood test, both you and your medical provider can easily miss this diagnosis!

Back to the research...This study was done on roughly 500 patients, both men & women, all of whom tested positive for Herpes Simplex Type 2 (HSV-2) by a blood test, though only 82% were already aware that they had herpes symptoms. Those that did know they were infected averaged 4 break outs per year, and had ~8 years history of having the disease. Every participant swabbed their genital area daily, regardless of symptoms. None of the patients were allowed to take anti-viral medications during the trial.

The results? Yes, people who experienced obvious herpes lesions shed MORE virus- translation, they were potentially infectious to partners. However, here is the important part: People who only knew that they had herpes because of the positive blood test STILL SHED VIRUS (meaning were infectious to others) 10% of the time, and the amount of virus present was the same quantity in people aware or unaware of their lesions.

BOTTOM LINE: This study again confirms that you are infectious to other people if you have a positive blood test for herpes, whether or not you have any symptoms. GET TESTED, and be sure your PARTNER GETS TESTED, too!

Teen Pregnancy- New CDC Report has Good News & Bad News

2011-04-06T18:57:00.000-07:00

The CDC released "Vital Signs: Teen Pregnancy" this week, which looks at teenage pregnancy statistics over the last two decades. On the plus side, the total national teen birth rate in the United States was the lowest we have recorded, down, in fact, by 37% from 1991. Unfortunately, we still had over 400,000 teenage births, which is 4% of female teens aged 15-19, and the annual estimated cost of teen childbearing is- gulp- over $9 BILLION. The USA birth rate is up to 9 times higher than most other developed countries.

Please note, my fellow southerners (Texas, Oklahoma, Arkansas, New Mexico and Mississippi), that we have the very WORST rates of teenage pregnancy in the country: >60/1000 females vs. <20/1000 for the best states, up in New England. Not something to boast about...

Today, and every day, 1,100 teenage girls will give birth in the US. That's 1 out of 10 new mothers. The cycle continues as 1/3 of kids born to teenage moms become teenage parents themselves. Not surprising, only half of teenage moms earn their high school diplomas- even by age 22.

The media is still portraying teen motherhood and sex in general as glamorous, fun, and enticing, which is far from the truth. Unpaid bills, screaming kids and exhausted parents are more the rule. We are slowly creeping in the right direction, but we've got much work to do to effectively educate our kids.

BOTTOM LINE: America has embarrassingly high rates of teenage pregnancy, costing our nation billions of dollars and heartache. We can do better.

Social Media Impact- from Disney to Facebook

2011-04-01T13:20:00.000-07:00

The Journal of Pediatrics recently published a timely clinical report—The Impact of Social Media on Children, Adolescents, and Families. Kids are entering social media at earlier ages, logging on to Disney websites such as Club Penguin. Soon they progress to websites intended for more mature audiences, such as Facebook and Youtube. Once again, we need to be aware of a desensitization process- this time, in the parents! We are used to our kids being ON the computer, and may not be watching closely enough as they evolve beyond cartoons characters. The minimum age on Facebook is 13, but that doesn't mean all teens should have free rein on FB without supervision.

The report noted that up to 20% of teens log on to their favorite social media site 10 times per day. Most teens have smart phones that allow them constant access. Ever notice how few teens use their phones...to make PHONE CALLS? Cell phones are cameras and instruments to TEXT or IM (instant message). The significance is that a good chunk of teens emotional and social development is occurring through these screen communications.

There are absolute advantages to the social media for youth, including anonymous access to health education that they might not otherwise seek- depression, anxiety, and sexually transmitted disease, for example. This report did not offer shocking news, but is an excellent reminder for parents to stop, look and listen to our kids' social media. And I mean that- go on the sites, read what your child and their friends are saying, and follow up with real live conversation with your kids. BTW, this is a great time to remind everyone that the total recommended daily screen time (ALL screens, big and small) is LESS THAN 2 HOURS, and yet most youth are surpassing 6 or more hours.

BOTTOM LINE: Recognize the role social media is playing in your child's development, and play an active role in setting time and boundary (privacy setting) limits.

Can You Hear Me Now??

2011-03-27T19:02:00.000-07:00

What's that? Are your ears filled up with wax, making it difficult to hear? Well, the good news is that a recent study has validated our long standing recommendation regarding use of a bulb syringe to remove pesky ear wax. The study, Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization was published in the Annals of Family Medicine this month. The trial was performed in the United Kingdom, with 237 patients who showed up at primary care clinics. They were randomly assigned to receive supplies and education on how to flush out their own ears, or simply treated by staff in the clinic. Not surprisingly, the study found that those who learned how to clear their ears with a bulb syringe had half the number of return visits for the same problem in the next couple of years compared with those who were treated but not educated on home therapy. Obviously this saves time and money for all involved!
What is the technique? You simply fill a sink with luke-warm water; cold or very hot water will cause dizziness, so check that temperature. Then, fill up your bulb syringe with that water, and lean over the sink, pulling the earlobe out and towards the back of your head (which straightens/opens the ear canal). GENTLY insert the tip of the bulb syringe into the ear canal and squeeze the bulb so the water squirts into your ear canal and spills into the sink, carrying waxy particles with it. Repeat this process up to roughly a dozen times. You will typically see the offending wax particles floating in the water, telling you that your mission was successful.
I advise following this process with adding a few drops of half and half vinegar and rubbing alcohol, which removes any remaining moisture from the canal. If you STILL feel the sensation of a blocked ear canal the next day, go ahead and schedule an appointment with your doctor and let her take a look inside. And oh yes, please STAY AWAY from the q-tips! They either pack the wax in tighter or cause damage to the ear canal and/or ear drum.
BOTTOM LINE: Using a bulb syringe to remove earwax is a simple, proven remedy that doctors officially recommend.

ADD- Is Zinc the answer?

2011-03-22T19:26:00.000-07:00

We are always looking for more and better solutions to Attention Deficit Disorder, so I was pleased to read a study published last month in the Journal of Child and Adolescent Psychopharmacology, entitled Zinc for attention-deficit/hyperactivity disorder: placebo-controlled double-blind pilot trial alone and combined with amphetamine, that looked at the role of ZINC in treating ADD. There have been some studies published in other countries that suggest supplemental dietary zinc may improve symptoms of ADD. This pilot study was small (as pilot studies should be) including just over 50 children.

The kids received zinc or placebo alone for the first two months, and there was no consistent, statistically significant advantage to taking zinc alone (vs. placebo). Then, the children were randomized to receive either zinc plus amphetamine (such as Ritalin) or a placebo plus the amphetamine for the next five weeks. Here is where the results are encouraging. Although the symptoms of inattention were not better for the kids who received the zinc plus amphetamine, the good news is that those receiving the zinc supplement required 37% less amphetamine to receive the same results compared with those taking amphetamine plus placebo.

Simply restated, the zinc seemed to help the amphetamine work more efficiently, so that a LOWER DOSE of the amphetamine achieved the desired results. Why is this important? Because lower effective doses mean LESS SIDE EFFECTS. So, should you rush out and buy zinc to supplement your child's ADD medications? No, I wouldn't do that based on a study with only 50 kids. However, while we're waiting for future studies with more significant numbers, why not be sure your child is meeting the recommended daily allowance for zinc? (~10mg per day for teens) What foods contain the most zinc? Seeds (pumpkin, sesame, watermelon), wheat germ, chocolate and peanuts. Hmm...maybe Snickers had the right idea! Or a healthier choice would be to head for the hummus (made with tahini- sesame seed paste.)

BOTTOM LINE: Zinc may help reduce the amount of amphetamine medication needed to improve symptoms of ADD.

Melanoma's "Ugly Duckling" Appearance

2011-03-20T19:28:00.000-07:00

Do you have your ducks in a row when it comes to scanning your body for skin cancer? You may be familiar with the ABCDE's of melanoma (Asymmetry, Border, Color, Diameter, Evolving), but do you know about the "Ugly Duckling" concept? I love this one, because it echoes what I often say to patients when they ask why a certain mole looks "suspicious"- I tell them it's like the old Sesame Street concept that "one of these things is not like the others...one just doesn't belong"!

Like everything in medicine, each body has its own version of what we describe in textbooks. While diseases have a distinctive pattern, the actual specifics will vary from person to person. Along those lines, what we are looking for in melanoma is a mole that simply does not fit the PATTERN that your body has developed. For example, if you are covered in large brown moles, but you notice one small dark black one- it's that small one we worry about. If you have no moles at all except one medium light brown one, we worry about that medium-sized one, not because it is medium or brown, but because your "pattern" is NONE, and this is breaking that pattern. Make sense?

Here is a a graphic from the Skin Cancer Foundation that illustrates this concept. The arrows point to the odd man out, which is the mole that we would tend to prefer in a pathology lab than staying on your body.

BOTTOM LINE: Take a good look at your skin from top to bottom (use mirrors!) and learn to recognize the pattern of TYPES of moles that you have, so you will recognize that "ugly duckling" mole before it turns into full blown skin cancer!

Travel First Aid Kit Recipe

2011-03-15T20:30:00.001-07:00

What do doctors pack when they travel with their families? If you are heading out for Spring Break, you might wonder what first aid supplies you should pack. There are really only a handful of supplies that I routinely take on trips. Truthfully, if we are traveling in the United States, I often head out with the bare minimum, because I know a pharmacy or grocery store will be available. However, especially if I am chaperoning a group of kids, I always carry the following supplies:
1. Ibuprofen- for headaches, muscle aches, fevers or menstrual cramps.
2. Tylenol- to supplement the ibuprofen if the ache or fever is severe.
3. Antacid tablets (TUMS or Rolaids)- still the fastest relief from heartburn/stomach acid.
4. Hydrocortisone cream (steroid such as Cortaid)- for anything that itches (bug bites, allergic skin reactions.)
5. Triple antibiotic cream- for cuts/scrapes (after washing with water.)
6. Bandaids- the GOOD kind that really stick, with specifics for knuckles, knees, and most commonly, HEELS (for those blisters!)
7. Benadryl tablets- for an intense allergic reaction to food, stings, etc; also may be used to help nausea.
8. ACE wrap- handy to limit swelling of a sprained ankle, knee or wrist.
9. Aspirin- honestly, I only keep this in case an adult has symptoms of a possible heart attack.
BOTTOM LINE: These few basic first aid supplies should get you through 99% of the illnesses and injuries that crop up on your trips, and this entire first aid kit should take up very little room in your luggage. Remember the creams count as "liquids" so slip them into your airline-specified ziplock baggie!

How Safe is Gardasil?

2011-03-08T17:18:00.000-08:00

Parents are appropriately concerned about vaccines, but I get frustrated with the enormous amounts of negative popular press that immunizations are receiving these days. Vaccines are not only saving lives, but they are improving the quality of our lives dramatically with every decade. Today I'd like to discuss the statistics with Gardasil, a vaccine that protects against four strains of the human papilloma virus which cause genital warts and cervical cancer.

Gardasil was FDA approved and recommended in June of 2006. Since that time, over 32 million doses of the vaccine have been administered. There have been over 17,000 "adverse events" reported, including roughly 1000 "serious" events. The mild to moderate events (over 90%) include transient local swelling or pain, mild and moderate fevers, and nausea or fainting.

So what about the serious events, including 56 deaths? The serious events included primarily Guillian-Barre syndrome (a severe neurologic disorder) and blood clots. The numbers of GBS are no higher than expected in the age group receiving the vaccine, and the girls with blood clots typically had other risk factors for clotting, such as taking the birth control pill. Though deaths in young people are tragic REGARDLESS of the cause, there has been no identifiable pattern in these deaths to suggest that the vaccine caused them. If you look at any age population of 10 million people (32 million doses divided by the 3 shots in a series), sadly, you will see certain lethal cancers, neurological diseases, and other rare ailments.

It is important to understand that in order to figure out side effects from vaccines, any and ALL events that happen within a month (or up to a year) after receiving an immunization can and should be reported- even if it looks like they are completely coincidental. For example, if you get a flu shot today, and are diagnosed with advanced leukemia tomorrow, it gets reported as an "adverse event" of the flu shot- even though it obviously was going on before your shot. Why do this? Because we want to be SURE that there is NOT a relationship between any serious diseases and vaccines, and the only way to know is to collect all the data.

BOTTOM LINE: For Gardasil, look at these numbers and remember there are 1 million new cases of genital warts per year, 12,000 cases of cervical cancer and 4000 deaths from cervical cancer. You do the math. We are choosing to immunize our daughters.

Let's GO! Rap with tha Hip Hop Doc & Get Healthy!

2011-03-07T02:57:00.000-08:00

Last week I was blogging on heart disease in women, and the American Heart Association's new guidelines calling awareness to the NUMBER ONE KILLER of women here in the United States. Today, I'm excited to bring you a HEART-PUMPING song that will stick in your brain and keep you moving and dancing all day!

Meet the Hip Hop Doc- Dr. Rani Whitfield- a very cool FAMILY PHYSICIAN who has found a unique way to reach his patients. His Youtube video "Let's Go!" speaks directly to us women, telling us to "Wait-FREEZE- Don't eat that! Fatty foods cause heart attacks!" (Click on LET"S GO to see the video!)I love it! Our whole house is now dancing and singing these words as we open the fridge and scout around.

Dr. Whitfield didn't stop with just the video, though. Check out his website, www.h2doc and you'll be amazed with all his efforts. From his six month campaign of heart runs and walks to raise awareness about heart disease, to his innovative new comic book and the Legion of Health- super-sized super heroes with names like Suga Free, Six Pack, and of course, h2d (that's Hip Hop Doc, if you're not following closely...)- his message engages everyone, with a special appeal to youth and those young at heart.

BOTTOM LINE: Check out tha Hip Hop Doc, and come on everyone, Let's GO!

Where Did My Favorite Cold Medicine Go?

2011-03-02T14:52:00.001-08:00

Today the FDA (US Food & Drug Administration) is removing many allergy, cough and cold products from the shelves of your pharmacy. If you have a favorite that has worked for you, perhaps you should stock up. What's going on? Well, it turns out that there are a ton of drugs out there that lack FDA approval, yet doctors and patients alike are unaware.

Why does it matter? Our FDA actually does a great job of collecting and reacting to adverse events related to medications, acting swiftly to remove products that could cause danger. Though there are not oodles of reports with this group of products, there are enough, especially considering that because most are over-the-counter, adverse events are much less likely to be reported.

Frankly, as I went through the list, I was very surprised that some drugs that I have previously written prescriptions for (like Entex PSE and Bromfed) are NOT FDA approved. The main reason I don't routinely recommend herbal treatments is their lack of FDA regulation, which means there is no guarantee of the amount of ACTIVE product in each tablet or capsule. Turns out, this could be true for any of these allergy, cough & cold remedies as well. Additionally, in the past couple of years, pediatric recommendations have changed greatly, especially for kids younger than two years. Many of these medications do not issue any such precautions.

Here are a few, but go to the FDA website for a full list: Accuhist DM, Aerohist, Allerx, Aquatab, Bromfed, Biotuss, Brovex, Carbodex, Deconamine, Duravent, Entex, Guaifenesin, Histex, Lodrane, Rescon, Ru Tuss, ZCof, etc.

Note that the Triamic brand and Robitussin brand are NOT on the list.

BOTTOM LINE: Go to the FDA WEBSITE and scan the list to be sure YOUR upper respiratory medicine of choice is NOT on the list!

Can't Lose Weight? Count LIQUID Calories!

2011-02-27T08:30:00.000-08:00

Many times when people are frustrated with weight loss, they look and look again at their food records and insist that they are eating only healthy food in small portions, yet the scale wont budge. There are certainly multiple reasons for this, not the least of which is the scientifically proven human tendency to record LESS than we consume and MORE than we exercise. It's not purposeful cheating, but small things such as forgetting the handful of M&M's off a co-worker's desk, or chips at a Mexican restaurant (we didn't ORDER chips, right?) or assuming we must have walked "at least a mile" during the day (without counting steps on a pedometer.)

My focus today, however, is on the portion of calories that we all tend forget- the LIQUID calories! Yes, Virginia, the liquid calories count, too...and often way more than you'd expect. Let's review some common ones:

Soda: 1 can of Coke is 140 calories
Starbucks:Tall Cafe Latte with Nonfat milk: 126 calories (Grande: 168 )
Caramel Frappuccino Blended Coffee with whipped cream: Brace yourself- 430 calories!! (Note a McD's Quarter pounder is 410)
Wine: 4 oz- a HALF CUP- glass of Chardonnay~90 kcal. MEASURE your glass once- most of us drink at least 6-8oz- check the picture above!
Frozen Margarita: 180 kcal for 4 oz...but most Margarita glasses hold 12 oz, which is over 500 kcal!
GATORADE: 12 oz is 310 kcal.

Recognize that 3600 calories equal one POUND, which means your simple morning coffee may be adding a pound or more per month. Or your workout drink, ironically, can easily do the same.

BOTTOM LINE: Focus on WATER the most, and low or no calorie drink options if you are trying to lose weight!

On Blood Thinners? READ THIS!

2011-02-24T07:15:00.000-08:00

Typically when there is a drug recall, it is not too serious. The last several that I have noted were voluntary recalls by the manufacturers, and there were no adverse patient outcomes even reported. This one, however, could have immediate and disastrous consequences.
Warfarin (Coumadin) is a blood thinning agent that many people take to prevent blood clots. We use it in the treatment of atrial fibrillation, pulmonary embolisms and deep vein thrombosis (clots in your legs that can go to your lungs) as well as with patients who have artificial heart valves. Patients who take this drug must have their blood drawn regularly to make sure that they have proper drug levels in their system. Too much warfarin can cause bleeding- from a nuisance of easy bruising or bleeding gums, all the way to a serious bleeding event in your brain- a stroke.
The FDA and Usher-Smith Laboratories have issues a recall on Warfarin Sodium Tablets (Jantoven), 3mge. A bottle of the drug was found to have 10mg pills mislabeled as 3mg, which means the patient could potentially receive three times their appropriate dose. While there has only been one bottle identified so far with this risky error, they have appropriately recalled the entire batch.
The 10mg pills are white, and easy to tell apart from the 3mg ones, which are tan. There are also different markings on the pills, but most of us do not routinely check the fine print.
With concern for patient safety, the company has admirably voluntarily recalled their other products from that same packaging line over a six month period, including these medications: Amantadine, Amlodipine, Androxy, Baclofen, Bethanechol, Jantoven® and Oxybutynin.
BOTTOM LINE: Check your prescriptions if you are on any of these medications to be sure you've got the correct dose, but more importantly, BE AWARE of the color and shape of your prescription medications, and QUESTION the pharmacy when you notice a change! Most of the time it will be a change in brand- likely to a different generic- but ASK and BE SURE!

Heart Disease in Women- New AHA Guidelines

2011-02-23T07:47:00.000-08:00

The American Heart Association has recently published an update to their Guidelines for the Prevention of Cardiovascular Disease in Women, so I thought I would highlight a few issues that may surprise you. Did you know that women are more likely to have a stroke than a heart attack? My patients with risk factors such as high blood pressure or high cholesterol worry far more about having a heart attack than having a stroke, yet at every age, women truly are more likely to suffer a stroke. (The opposite is true for men.) Sadly, in the United States, one woman dies every minute from cardiovascular disease.

The numbers of young women (aged 35-54) dying from cardiovascular disease is rising, paralleling the rise in obesity in our country. Now 2 of 3 women over the age of 20 are overweight or obese. This is why I spend so much time counseling patients and blogging and talking about weight loss and healthy lifestyle changes!

Women who had any pregnancy related complications such as premature birth, pre-eclampsia or gestional diabetes are now known to have higher risk of future cardiovascular events- possibly doubling their risk- despite blood pressures and sugars returning to normal after childbirth. We need to treat these women more aggressively to reduce their risk factors both with behavior modification and with medications.

BOTTOM LINE: Women, recognize that YOU are at risk for strokes and heart attacks as much, if not more than the men you are worrying about! Schedule a check up with your family doctor today.

How Fast Can You Lose 30 Pounds?

2011-02-21T09:51:00.001-08:00

You only have to drive around town, flip open a magazine or your computer, and you will see an ad promising weight loss of "30 Pounds in 30 Days". And of course, all you have to do is buy this brand new miracle pill. You don't have to exercise or eat healthy foods. Ready to sign up? I hope not!

Our parents taught us that if it sounds too good to be true, it probably is. Yet, as Americans, we have become so used to instant gratification, we are convinced that somewhere out there exists a pill we can pop for easy, quick weight loss. Let me ask you this- do you think there would be any fat doctors (especially women, forgive my bias!) if such a prescription existed?

So, what is realistic? Well, obviously, it depends on your starting weight. If you are only 20 or 30 pounds overweight, though, a good rule of thumb is a half to one pound per week. It takes a 3600 calorie deficit to lose a pound. Period. If you can burn an extra 250 calories a day (walk 2 -3 miles, for example) AND delete another 250 calories from your usual diet (give up two sodas or one loaded latte per day), then you can expect to lose a pound per week.

Try to look at the big picture. There are 52 weeks in a year. If you make healthy changes such as eating MORE fruits and vegetable servings and moving MORE, you can easily take off those extra 20 to 50 pounds in a year...and KEEP THEM OFF because you did it through small, permanent changes!

BOTTOM LINE: Fast does NOT equal good, nor permanent, weight loss. Realistic, EXCELLENT weight loss is ONE POUND per week, so it will take 6 months to lose 30 pounds.

What Works for Weight Loss? MORE!

2011-02-18T04:44:00.000-08:00

MORE, MORE, MORE! That is chant I want you to hear in your head as you focus on FITNESS. Yesterday I talked about MORE fruit and vegetable servings- 5-10 per day. Today let's shift to MORE MOVEMENT.

Many of my patients started 2011 with the resolution to go to the gym EVERY DAY after work. Guess what percentage are still doing that? Hmm...not too many. Why is that? It is a setup for failure. While exercising EVERY DAY is absolutely possible, and indeed, what I do and what I encourage everyone to make a life habit, exercising in a specific place outside your home- like the gym- is very difficult. Say today you wake up and your child has a fever, so you can't leave the house. Tomorrow you have a business meeting in the evening (no time to workout, shower and clean up between work and that meeting) and boom, then it snows/rains/floods...you get the picture!

I think planning a day or two per week at the gym (or the track, or walking the mall) is wonderful, but please, set yourself up for success by having backup plans AT HOME. I am a big fan of exercise bikes and DVDs for this reason. Grab your tunes and/or your dog and head out the front door. Set a timer for 30 minutes, turn on some music, and dance! OR- I got this idea from another woman physician last October- set the timer for 30 minutes, turn on music, and CLEAN YOUR HOUSE- actively! Vigorously scrub the counters, alternate hands, squat up and down unloading the dishes, mop quickly, whatever it takes to keep your heart rate up. Which exercise is best? The one you will DO.
The main idea is to MOVE MORE. Check out my blog on PEDOMETERS- they work great, too!

BOTTOM LINE: Switch your focus to MORE: MORE movement, MORE fruits & veggies!

MORE Ways to Lose Weight in 2011

2011-02-17T06:00:00.000-08:00

As promised, in keeping with the new USDA guidelines, I am returning to talk about my MORE philosophy that has helped many patients lose weight. When people decide they want to lose weight, what is the first thing that pops into their mind? DIET, right? So what's next- which foods am I going to cut out of my diet? Followed closely by feelings of deprivation, and then frustration and disappointment when they give in to a craving for that off-limits food.
What if, instead of focusing on LESS, you focus on MORE? I encourage my patients to simply INCREASE their fruit and vegetable servings. The goal is 5-10 servings per day, total, of either veggies or fruit. A serving is what comfortably fits in your cupped hand. Therefore, a salad like the one pictured here is roughly four servings- 2 handfuls of lettuce, one of shredded carrots and one of tomato. Easy, right?

What happens when you focus on MORE vegetables & fruit servings is no secret. You FILL UP on "nutrient dense" foods that are GOOD for you, and eat less of, well, everything else! It tends to be the complex carbs (think breads, crackers, muffins, cookies, chips) that pile on the calories, NOT the fruits, vegetables and protein.
Does this mean you are not "allowed" to eat those complex carbs? Absolutely not! What it means is that you will be focusing on MORE quality in your diet by pushing up those F&V servings, and that typically will automatically decrease your total calorie intake, which POOF- "magically" helps you lose weight.
BOTTOM LINE: It's not rocket science, my friends- simply consume less calories than you burn, and yes, you will lose weight. But do it RIGHT, and make sure you are not skipping any meals, and that you ARE eating foods packed full of vitamins and fiber...our friends, the fruits and veggies.

New USDA Guidelines

2011-02-15T04:19:00.000-08:00

On January 31, 2011, the United States Department of Agriculture (USDA) released their updated guidelines for the American diet. A panel of 13 nutritional experts, chaired by Linda Van Horn (who has a doctorate in addition to being a licensed and registered dietician) reviewed the available evidenced-based data regarding the impact of diet on wellness and disease prevention. Their findings come as no surprise, with an emphasis on MAINTAINING a HEALTHY WEIGHT (through calorie balance- energy OUT equalling or exceeding energy IN) and focusing on consuming NUTRIENT DENSE foods and drinks.
What does this mean? In short:
MORE: vegetables, fruits, nuts, seeds, seafood, low- or no-fat milk products, eggs, poultry and whole grains.
LESS: Everything else. Seriously! Less solid fats, complex/refined sugars (crackers, cookies, breads, sweets), fatty meats, and drinks with empty calories like sodas, many fruit drinks and alcohol.

So none of this is shocking. Perhaps the one controversy is the level of salt recommended. The USDA okays up to 2300 mg of sodium for the general population, but the American Heart Association (worried appropriately about high blood pressure) suggests that really everyone should max out their salt around 1500mg. The reality is, however, that if people change their diet from highly processed foods to more plant-based and whole foods, their sodium content will fall as well.

WIth more than 1/3 of American children and 2/3 of our adults falling in the overweight or obese category, the USDA is rightly shifting the emphasis of their guidelines towards calorie balanced diets and LIFETIME weight maintenance, through increasing activity as well as increasing vegetable and fruit consumption. Tomorrow I'm going to return to focusing on the MORE philosophy that has successfully helped many of my patients reach their healthy weights.

BOTTOM LINE: (Straight out of the USDA's Press Release)"The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease. Improving our eating habits is not only good for every individual and family, but also for our country." Cheers.

My Valentine to YOU!

2011-02-14T14:45:00.000-08:00

Happy Valentine's Day! I have decided to give you, my patients, AND myself a special Valentine- a free "do-over" for any New Year's Resolutions that have perhaps fallen to the wayside. Did you promise to head to the gym after work three days per week, but now a heavy snowstorm blocked your way for a few days, and you simply dropped the whole thing after missing a week? What about walking your dog each morning- same excuse? In Austin, we had SNOW on the ground last week, but today it is literally 73* and SUNNY, so we need to head back outside.

How about eating more plants and less processed stuff? If the main GREEN in your diet is a Girl Scout Thin Mint Cookie, it's time to focus on more color. Even if your choice today is a chocolate covered strawberry vs. chocolate truffles, take that step and grab the luscious strawberries.

Whatever derailed YOUR good intentions, please use this "get out of jail free" card to cut yourself some slack, and START OVER TOMORROW (or better yet, TODAY!) And if your sweetheart asks what you'd like for Valentine's Day, ask for something that will promote your health, like new work out shoes or clothes, a pedometer, a heart rate monitor, or even a gym membership or an exercise bike! If you are still deciding what to get YOUR Valentine, and he or she hates the idea of exercising and you think a gift like that would offend them, at least choose a pampering gift that wont undermine their weight loss efforts, such as a gift certificate for a manicure or massage.

BOTTOM LINE: Enjoy this Valentine's Day and refocus on your HEART healthy habits for 2011!

An AGGIE Wearing ORANGE? Join Tamika and the Fight Against Cervical Cancer

2011-02-11T14:11:00.000-08:00

This week I am talking about HPV (Human Papilloma Virus) and the diseases it causes. The most serious consequence of HPV infection is CANCER, and there are roughly 12,000 American women diagnosed with cervical cancer (caused by HPV) each year.
A couple weeks ago, while I was a guest on a Doctor Radio show that focused on cervical cancer, I met an amazing woman: Tamika Felder.
Tamika was diagnosed with cervical cancer at the very young age of 25, just as she was beginning to enjoy a successful career as a television producer in our nation's capitol. Her treatment included not only chemo and radiation, but also a complete hysterectomy. While friends were planning weddings and baby showers, Tamika was fighting for her life and giving up the dream of having children.
Lucky for the rest of us, Tamika's amazing spirit and talents emerged through her therapy, as she created a nonprofit organization to increase awareness about HPV and cervical cancer. In addition to public speaking, Tamika & Friends offer an online support group for women diagnosed with cervical cancer. Her mission is to spare those women newly diagnosed the shame and isolation that she endured over a decade ago. Click on her website: TamikaandFriends.org and read all the amazing survivor stories! Women from all backgrounds have bonded together to help other women face this challenge.
So why ORANGE? Every cancer seems to have its own color now, and Tamika wanted a color that reflected hope and positive energy, like a sunburst. Why not wear some orange this week, and pass on Tamika's message?
BOTTOM LINE: Cervical cancer is a very serious disease, and PREVENTION plus EARLY DETECTION are key! Remind your girlfriends to SCHEDULE their PAP TEST and get vaccinated against HPV!

Dodge This Bullet...HPV

2011-02-08T04:53:00.000-08:00

Yesterday I mentioned that the New England Journal of Medicine recently published a study regarding HPV vaccine efficacy in boys. Today I'd like to explain the study. The title is "Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males". "Quadrivalent" refers to the fact that the vaccine targets four strains of the Human Papilloma Virus: strains 6 & 11, that cause 90% of genital warts, and strains 16 & 18, which cause the majority of cervical cancers (roughly 70%).
I'll start by saying that yes, the study was partially funded by Merck, the manufacturer of the vaccine. That being said, I do not feel it negates the study, although obviously it introduces some bias. They took over 4000 boys/young men age 16-26, from 18 countries, and gave half a placebo vaccine series, and half real. The study was double blind (no one knew what they were giving or getting), and randomized (which raises the quality of the study.) Some of the participants were fully screened initially to determine if they already HAD any HPV strains, and others were not. Note that in "real life medicine", we have no way to test people ahead of time to see if they have already contracted HPV.

In the young men with unknown prior HPV status, the vaccine had an efficacy of 60%. In those known to be HPV negative initially, the efficacy was 90%. It is not surprising that the vaccine would appear to work better in those that did not already have some strain of HPV, and this supports the reasons to vaccinate youth BEFORE they are sexually active. I thought it was interesting that they ended up with 1% of the placebo subjects developing genital warts- the same as in the general population. I am encouraged that the incidence in those vaccinated dropped to 0.1%.

The devil is always in the details, and how people pull out statistics. I could note, for example, that 3 patients in the placebo group received gun shot wounds, while only one in the vaccine group did- but obviously the vaccine did not prevent gun shot wounds! The good news here is that true adverse events were minimal and of uncertain relationship to the vaccine.

BOTTOM LINE: HPV vaccination can significantly reduce the incidence of genital warts in young men as well as young ladies, with minimal side effects.

HPV Vaccine (Gardasil)- Don't Forget the BOYS!

2011-02-07T06:12:00.000-08:00

I'll bet you could quote the commercial for the HPV vaccine, Gardasil, about choosing to be "one less"- one less woman to get cervical cancer. This is one time where I am pleased that the media is playing a role in pharmaceutical awareness! We absolutely want EVERYONE to know about cervical cancer and the exciting news that we now know not only how this cancer is caused and spread, but most importantly, we know how it can be PREVENTED.

Did you know, though, that this vaccine also protects against genital warts? Two strains of HPV (6& 11) cause 90% of genital warts. Every year there are over a MILLION cases of genital warts in the United States alone. They are COMMON. These warts are transmitted by direct skin-to-skin contact, and though this usually occurs during sex, actual intercourse is certainly not required to pass them on. They are very contagious, with estimates up to 65% transmission. Warts typically recur despite treatment, and frankly, the treatment is unpleasant at best- we burn the warts chemically or with liquid nitrogen. If you've ever had a wart frozen/burned off your knee, you know what that feels like, and the genital area has more nerve endings. Enough said!

While males don't have a cervix to get cancer, they do have other parts that get HPV-related cancers (anal & penile, as well as some head and neck cancers,) although certainly these cancers are less common. Obviously, males can also get genital warts. In my clinical experience, little harms self-image like a young person developing these genital lesions, especially because we cannot simply cure them and make them go away forever.

Gardasil was approved for use in males over a year ago. A study recently published in the New England Journal of Medicine demonstrated that the vaccine had good efficacy in prevention of genital warts in males. More on this study tomorrow...

BOTTOM LINE: PREVENTION is KEY for HPV disease- talk with your doctor (or your child's doctor) about HPV vaccinations for your SONS & DAUGHTERS.

PS. I am NOT on anyone's payroll for this vaccine- but I absolutely do recommend it.

XRAY X-pectations

2011-02-03T05:22:00.000-08:00

When you hurt your back (or ankle, or wrist) and head to the doctor, do you expect an x-ray? I find that many patients are surprised if I do not insist on an x-ray for an acute injury. Mind you, I certainly order plenty of x-rays when I believe that the results will change our management (is it a broken bone or a sprained ligament), or even if the results simply tell us what to expect about the time-frame for healing, such as a minor fracture in the foot or toe.

By the way, while we're on the subject, a SPRAIN happens to ligaments, the tissue that attaches bone to bone. A STRAIN occurs in muscles or tendons (tissue connecting muscles to bones.)

So back to XRAYs. XRAYS look at bones. They do not "see" cartilage, muscles, tendons or ligaments, though sometimes distance between bones suggests lack of cartilage. The vast majority of injuries that send patients to their doctors are not from broken bones, but strains and sprains and spasms of muscles and supporting tissue. As we try to limit both unnecessary radiation and expense, the world of medicine is taking a closer look at when interventions such as taking xrays are really needed to improve patient outcomes. Medical centers are developing guidelines for different injuries that help physicians determine when an xray is truly needed, such as the Ottowa rules for ankle injuries.

RICE: Rest, Ice, Compression and Elevation (plus a bit of pain-reliever/anti-inflammatory medicine such as ibuprofen) go a long way towards treating injuries. Your doctor can show you the best way to compression wrap an extremity, plus possibly prescribe muscle relaxants or stronger anti-inflammatory medicine. Perhaps most importantly, your doctor may prescribe PHYSICAL THERAPY- where you will learn strengthening, flexibility and stability for your injury to fully rehab.

BOTTOM LINE: XRAYS are helpful diagnostic tools for bone injury, but don't assume your treatment of an injury isn't complete without one!

B Vitamins and Omega 3 Fatty Acids vs. Heart Disease

2011-02-02T14:23:00.000-08:00

We are always looking for ways to prevent heart disease, the number one killer in the United States. As we gain technology, we are able to look at more and more components in our blood that lead to clot formation and heart attacks. You'd have to be hiding under a rock to not have heard about cholesterol levels, right?

Well, the trick in medicine today is to make sure that we are focusing on PATIENT OUTCOMES more than LAB VALUES. This is the premise behind evidence-based medicine, where we try to look at specific outcomes (did he have a heart attack or stroke) versus did we lower his cholesterol numbers. My patients hear me whine that so many people are willing to spend money on vitamins, supplements and prescription medicines to "lower their numbers" but are NOT willing to change their behavior to eat more fruits and vegetables and to exercise daily. Why do I complain? Because we DO have evidence-based medical data that shows convincingly more exercise and healthier diets not only lower weight, blood sugars and cholesterol numbers, but they decrease the number of heart attacks, strokes and deaths- and isn't that what we're looking for?

Along those lines, a study was published last month in the British Medical Journal that looked at whether or not giving B Vitamins and Omega 3's to patients who had already had a cardiovascular event (heart attack, stroke, or unstable chest pains) would reduce their subsequent numbers of additional cardiovascular events. What they found was that although the supplements worked better than placebo to change some blood tests, there was no difference in actual heart attacks and strokes.

What is the take home message here? Am I saying B Vitamins and omega 3 fatty acids are useless? NO, I am not. It does appear that they don't have great benefit when started AFTER you've already had a heart attack or stroke. Might they help prevent disease in a healthy person? Maybe.

BOTTOM LINE: Let's focus on the common sense changes that we KNOW benefit our health (MORE fruits and vegetables and exercise) and spend less time, money and energy chasing down lab values.

Brand New FDA- Approved Antidepressant

2011-02-01T18:40:00.000-08:00

The stock market is very aware that the FDA has approved a new antidepressant (see the FDA News release here)- a drug called Viibryd (vilazodone hydrochloride.) The manufacturer claims that this antidepressant did not cause weight gain, nor did it affect sexual function. If that turns out to be true once large numbers of people are taking the medication, I know I will be flooded with requests for this drug, because weight gain and decreased libido or sexual function are the major complaints that I hear about this class of medications.
Before we all jump on the bandwagon, however, let's go back to a blog I did last week- "Doc, Have you heard of this new drug" and look at the "STEPS" pneumonic.
S: Safety-Side affects appear to be at reasonable incidence, and I cannot find information regarding drug interactions.
T: Tolerability- side effects include "diarrhea, nausea, vomiting and insomnia"
E: Effectiveness-Honestly, I cannot tell from a brief perusal of the medical literature. I found many studies in rats, from the years leading up to the human trials, but only one good size (400 patients) of humans. There was some effect at one week (which is early for anti-depressants) compared to placebo, but no studies yet comparing it to other antidepressants.
P: Price- Don't know yet, but it's a new drug. This means coupons the first year, but a new drug is always a higher price than old ones. The business world, however, is excited and projecting over $2 MILLION in sales.
S: Simplicity- Sounds like it will be once per day, though again, I never found a product information sheet.

BOTTOM LINE: Yes, there is a new antidepressant, which MAY provide good improvement in patients with major depression, while having fewer adverse side effects (weight gain and sexual dysfunction)...but let's not storm the pharmacy yet.

Food Allergies

2011-01-28T05:13:00.000-08:00

How many times have you heard someone say that they are allergic to a specific food? Food allergies are indeed common, affecting roughly 8% of kids and around 4% of adults. A true food allergy is an immune reaction to a food protein. There are many food REACTIONS (such as lactose intolerance, for example) that are not true allergies.The most common allergens are PEANUT, FISH, SHELLFISH and other TREE NUTS.

What are signs and symptoms? Food allergies show up within minutes to a couple hours after exposure to even small amounts of the offending protein. Itchy, red rashes, swelling, flushing, nausea, abdominal cramping and diarrhea, stuffy nose, wheezing, racing heart and metallic taste in your mouth are some of the possible presentations.

How do we diagnose food allergies? Mainly by history, to be honest. We combine the history with either skin or blood testing for more accuracy. Skin testing CAN be helpful, but there are many false-positives (which means the test says there IS an allergy, but there is not.) NEGATIVE results on a skin test, however, are very accurate that there is NO food allergy, so that can be very reassuring. Blood tests are also poorly predictive, being accurate only roughly half of the time. We do know, though, that high levels of blood tested antibodies are very suggestive of an allergy to that food.

We do not have a CURE for food allergies, but we can use antihistamines and epinephrine to treat acute reactions.
Of course, the mainstay of treatment is prevention through avoidance of that food protein.

BOTTOM LINE: If you think you may have a true food allergy, discuss it with your doctor and consider additional testing before permanently restricting your diet.

What a Chef! Sicola's in Austin

2011-01-27T16:18:00.001-08:00

I need to take time today to have a "commercial" for Sicola's: A Culinary Experience in Austin, TX. Last night I was at a Journal Club meeting there, and the before our talk, the waitstaff was circulating with luscious looking appetizers. Since I am still GF (Gluten Free), I will admit to feeling a bit deprived as I politely passed them up. Not wanting to appear rude for turning down multiple choices, I told one of the waitresses that if I were not gluten-free, I'd grab them in a moment.

Within a few minutes, the same lovely waitress returned, letting me know that indeed, the rest of the evening's menu was completely GF. I was pleased she would go to that trouble, and happily sipped my wine. However, that was not all. A little bit later, another waitress came over and told me that the chef was excited to CREATE a GF appetizer just for me! Can you believe that? In the throws of preparing a gourmet meal for fifty people, he stopped and literally experimented simply to allow someone with a special diet to enjoy an appetizer. Amazing!

I wish I could tell you exactly what the appetizer was, but I CAN tell you that it involved goat cheese and a non-wheat crumb coating, and it was DELICIOUS! I have never felt so pampered. Apparently, Stephen Sicola (the amazing chef) is creating specialized dishes to cater for all kinds of special diets, including youth with diabetes. Very cool!

BOTTOM LINE: If you live in Austin and have a private dining party to plan, call Sicola's and book it now!
PS. If you follow a special diet, it never hurts to ASK for something a bit off the menu when you dine out, so give it a try!

The Flu: When to Treat?

2011-01-25T14:58:00.000-08:00

Yesterday, I had a discussion with some friends about whether or not to treat the flu with antiviral medications (Tamiflu or Relenza). Conveniently, today the CDC posted expert commentary on the latest guidelines, so I thought I'd share them with you.
Basically it boils down to this:

People at risk of more severe illness should definitely be treated: pregnant women, the very old or very young, people with underlying medical issues that suppress their immune system (cancer, HIV)
People with severe or rapidly progressive flu symptoms should be treated.
Anyone hospitalized should be treated.

For the rest of the public- the otherwise healthy, non-pregnant population- the CDC has wisely left it up to the DOCTOR's discretion, as long as treatment is started within 48 hours of the onset of symptoms.

The antiviral medications have been shown to shorten the course of the flu by one day, and can limit the severity of the flu. However, side effects often include significant nausea or vomiting, as well as headache. It really depends on how sensitive you are to side effects as to whether or not it is "worth it" to treat for the flu.

Don't forget, though, that prevention with the flu vaccine and consistent hand-washing are your best first lines of defense!

BOTTOM LINE: If you develop flu symptoms (fever, chills, cough, sore throat, runny nose, muscle aches and headaches), see your doctor quickly so if you ARE a candidate for antiviral therapy, you can start it with 48 hours of your symptoms.

Cranberry Juice and Your Bladder

2011-01-24T03:03:00.000-08:00

Once again, cranberry juice and its role in possible prevention of urinary tract infections is in the news. Several studies published recently tried to address whether or not cranberry juice or cranberry extracts are effective in prevention of recurrent bladder infections. The results? Not too impressive...and the jury is still out.

Urinary tract infections are relatively common, especially in women. Once you have an infection, the relapse rate is nearly 30%, so we are always looking for non-antibiotic methods to reduce that number. Cranberry juice is known to decrease the ability of bacteria to stick on to the surface of the bladder lining. If fewer bacteria stick, they are less likely to multiply to the point of establishing an infection. Scientists have tried to narrow down the active ingredient that yields this result, and most believe it to be the PACs (proanthocyanidins). However, recent trials based on this theory have not demonstrated success in reducing the number of infections.

What CAN you do to reduce bladder infections?
1. Stay well-hydrated by drinking plenty of WATER.
2. Limit caffeine (it is a diuretic).
3. Women, make sure you wipe front to back after urination (to avoid bringing the rectal bacteria forward)
4. Urinate soon after sex (again, don't leave the moisture for the rectal bacteria to float forward)

Signs and symptoms of urinary infections are burning when you urinate, and urgency and/or frequency of urinating. As the infection progresses, you could develop back pain, nausea, vomiting and fever- all serious signs that it's past time to see your doctor!

Should you drink cranberry juice if you think you have an infection? Sure! But not to CURE it, just drink it because you ought to really hydrate with anything that does not have caffeine. It might help you (along with an antibiotic) to cure the infection, and it does no harm unless you don't like the taste.

BOTTOM LINE: Cranberry juice may slightly help to clear urinary tract infections, but there is not solid evidence that it helps prevent recurrences if you take it daily as a preventative treatment.

Doc, Have You Heard of This New Drug?

2011-01-19T04:15:00.000-08:00

Often patients ask me about a new drug they heard or read about, and would like a prescription to "try it out". Sometimes, the new drug works wonders, but most of the time, there is no such luck. Obviously pharmaceutical companies are spending more money on direct advertising to the public, and it's working! Our country spends staggering amounts of money on drugs.
Today I'd like to share a pneumonic from the AAFP that helps doctors assess new medications: STEPS.

S: Safety- what are the drug interactions and side effects?
T: Tolerability- how many people stop taking the drug because of side effects?
E: Effectiveness-this may seem obvious, but really: does this drug not only change a LAB VALUE (or blood pressure, etc.) but DOES IT IMPROVE PATIENT QUALITY OF LIFE or HELP PATIENTS LIVE LONGER?
P: Price: Is it worth the cost?
S: Simplicity: How many times per day is it required? With or without food? Can it be taken with other medications?

BOTTOM LINE: Together with your doctor, discuss these issues before you add another medication to your daily routine. </span>

To Pap, or Not to Pap...

2011-01-18T03:11:00.000-08:00

When I was in medical school (not THAT long ago), there was no question about when women should get Pap smears. We knew that this valuable test to screen for cervical cancer saved lives, and every woman should be tested at her annual exams. Subsequently, we learned that all cervical cancer comes from HPV- the Human Papilloma Virus, which is transmitted by intimate skin-to-skin contact, primarily through sex. With that knowledge, we modified the Pap requirements to only those women who had become sexually active.
Now we know that the majority of HPV infections occur upon initiation of sexual activity, and that most of these infections are cleared by the immune system within a couple years, and do not result in cancerous changes. We also realize that invasive cervical cancer is very rare in women younger than 21, and so the current guidelines tell us that women should start having Pap smears when they turn 21 (and have had intimate relations.)
Happily, we also have vaccines to help our immune systems fight off the HPV more effectively, so with Gardasil and Cevarix immunizations, we should be seeing even less cervical cancer!
What if you are over 21? Women aged 21-29 without high risk factors (HIV, organ transplant patients, DES exposure or previous abnormal Pap smears that showed early cancerous changes) should get screening Pap tests every other year in their twenties, and every third year beyond their 30's.
Women over 30 will be tested with both the traditional Pap test and a specific test that checks for the strains of HPV that cause cancer. If you test positive for these high risk strains, your screening will be more frequent (annually.)
When can we STOP? By 70, if you have had a decade of normal results, you are done. Yea!
BOTTOM LINE: Pap tests do not need to be an automatic part of your annual pelvic exam- but YOU STILL NEED ANNUAL PELVIC EXAMS to check for sexually transmitted diseases and other gynecologic concerns (ovaries, etc.)