One at a time...Our Surgeon General's Message

Okay, I'm still on a high from meeting our amazing Surgeon General, Dr. Regina Benjamin yesterday! (I hope she doesn't mind that I am posting this picture.) I want to share a story she told us yesterday -you know how I always say stories are more powerful than statistics, right? Here it is:

A girl was out jogging along the beach. She saw an old man meticulously walking along, bending over and picking up starfish stranded from the tide, and tossing them back into the ocean. He was still there, plugging along, on her return. She could stand it no more, and asked him, "Why bother picking up these starfish? Look a the hundreds of them along the beach! The sun is out, the tide has receded, and they are all going to dry up and die." The wise old man looked at her, then deliberately bent down and picked up the next starfish. Holding it gently in his hand, he turned to the jogger and replied "because it matters to THIS one" and returned it to the sea.

Why bother educating our patients to eat more fruits and veggies when fast food heart-attack-on-a-plate is everywhere? Why take the time to educate about the real risks of physical intimacy and the awkward topic of STDs? Because ONE AT A TIME, it makes a WHOLE WORLD of difference, and together, we will turn the tide!

BOTTOM LINE: Let's ALL follow America's Doctor's advice, and MAKE A DIFFERENCE for at least ONE person today (even if that one person is YOU!)!

Proud to Be a Family Physician!

This week I am in Denver at the American Academy of Family Physician's Annual Scientific Assembly. This is a terrific conference, chock-full of the latest evidence-based medical advice. Each year I leave here with new tools to help my patients, although as I have mentioned in previous blogs, today's hot news may be that yesterday's advice was wrong!

Here are a few things that I learned or reinforced today:
1. Using Tylenol (acetaminophen) and Advil (ibuprofen) together is not only safe, but has a more powerful punch for pain relief than either drug alone.

2. Prescribing narcotic pain relievers for acute low back pain prolongs the disability from the back pain (we should use muscle relaxants and less addictive pain relievers.)

3. Using the Framingham risk assessment tool will help me to counsel patients on whether or not they should take a cholesterol lowering medication.

4. Pushing diabetics to lower their Hemoglobin A1C's (a long term measure of blood sugar levels) as low as possible can actually lead to worse outcomes than accepting a mid-range level.

5. I had the pleasure of hearing and meeting our Surgeon General, Dr. Regina Benjamin, as she addressed our academy. I am proud that she is a fellow FAMILY PHYSICIAN and admire her vision of healthier, more FIT Americans!

BOTTOM LINE: Physicians, like all professions, must continue to learn and re-learn what evidence and OUTCOME based studies teach us really help our patients! Stay tuned for more insights from this week...

Did U 4Get? Medication Reminders

Ah, texting- the new language of our youth! As we embrace technology, I believe there will be many beneficial uses of the tiny screens upon which our culture is becoming increasingly dependent. There are multiple "apps" out there, for example, that help people track behavioral changes such as exercise, or count days without junk food (or soda, or alcohol, or cigarettes or candy bars!) In my practice, I have seen these simple electronic tools really help my patients improve their health.

Along those lines, there is an interesting study recently published in the medical journal Obstetrics and Gynecology, entitled Using daily text-message reminders to improve adherence with oral contraceptives: a randomized controlled trial. This was a small, short study with just less than one hundred young, high school female graduates followed over three months. The women were randomized to receive a daily text message reminding them to take their birth control pill, and their compliance was both self-recorded and externally monitored.

The results surprised me, frankly. I would have thought simply participating in such a study, none-the-less receiving a DAILY reminder would have yielded near perfect compliance. Unfortunately, what was seen was that BOTH groups missed a significant number of pills each month (4.9+/-3.0 for the text-message group and 4.6+/-3.5 for the control group.) It's possible the difference in the groups was small because women in both groups used additional reminders such as alarms on their cell phones.

The other disappointment is that the girls' self-reporting of missed pills was markedly below their true number of missed pills, which strongly suggests that they could be underestimating their true risk of becoming pregnant if they are sexually active.

BOTTOM LINE: While technology may be able to help us towards healthy lifestyles, daily text medication reminders may not be an effective tool (at least in this setting.) Physicians need to emphasize (and patients need to implement!) strict compliance with oral contraceptive pills.

Can You Smell That?

Did you know that smells provide your strongest sense of memory? A quick whiff of sunscreen make take you to childhood beach memories, hairspray back to high school, freshly baked cookies back home or perhaps a certain cologne to a special person. Yesterday, I had the pleasure of smelling "fall" as I hiked through a beautiful aspen grove, the path covered in what my daughter calls the "crunchy golden blanket" of leaves. Too bad we can't bottle up that marvelous smell of nature!

Smell might be the sense we think about the least- until there is a problem with it. Without smell, taste is muted, leading to either decreased appetite or overeating (or over-spicing!) as we try to find something to satisfy a craving. If you wonder about your sense of smell, see if you can distinguish some common smells such as cinnamon, peanut butter, vanilla, coffee or lemon.

What causes your sense of smell to decrease or disappear? Some people are simply born without a sense of smell. Most commonly, however, we see transient lack of smell (the medical term is anosmia) from nasal congestion due to colds or allergies. Smoking, of course, not only destroys taste buds, but also decreases the ability to smell. Overuse of nonprescription nasal sprays such as Afrin is another common cause. Less common are medical disorders such as zinc deficiency and hypothyroidism, and rarely loss of smell can be a sign of diseases in the frontal lobe of the brain such as tumors or dementia.

BOTTOM LINE: If you notice you can no longer distinguish smells very well (and have no obvious cause such as a cold, chronic allergies or smoking habit), it's time to head to your doctor for a check up!

Avandia Latest News

Last week, the FDA issued more restrictions regarding the diabetes medication Avandia (rosiglitazone). You can read the full notice at FDA.gov, but I will try and hit the highlights for you.

Avandia is a "TZD" which is a class of medications that helps to increase the body's sensitivity to insulin in diabetics. We have seen that it is very effective at lowering blood sugars. Unfortunately, it was discovered that this class should NOT be used in diabetics who also have congestive heart failure. Now, additional studies have shown that there is also an increased risk of heart attack and stroke in patients who took Avandia. At this time, the other drug in the same TZD class, Actos (pioglitazone) is not proven to have the same risks, though many experts are concerned this will be a class effect. Europe has completely withdrawn Avandia from the market, but in the United States, patients doing well on Avandia may discuss the risks with their physicians before making a decision whether or not to continue this drug.

What should YOU do if you take Avandia? There is no need to panic, but schedule an appointment with your doctor to discuss what is best for you. My advice is to take this news as a wakeup call that it is time to STOP LOOKING TO PILLS for an answer for your diabetes, and get serious about the behavior modifications in your diet and exercise that are necessary to reverse your disease! Yes, there are patients with adult onset diabetes who are thin and fit (I have three such patients in my practice) but the vast majority are significantly overweight. The GREAT news is that I have seen time and time again that when patients really embrace healthy eating and daily exercise ("MORE") the high blood sugars, high blood pressures, and high lipids (cholesterol) not only improve, but often disappear!

In Western medicine, we are conditioned to find the quick fix for disease states by prescribing the "right" pill. We have invented wonderful medications that improve the quality and quantity of life. However, the longer people take them, the more long term side effects we identify. What is safe and the "best" practice today is often the next great lawsuit tomorrow. I am NOT anti-medication, but I am most definitely PRO-behavior modification when that choice exists to treat the same problem.

BOTTOM LINE: If you take AVANDIA, please schedule an appointment with your physician and ask for concrete suggestions for a healthier lifestyle!
PS. For a jump start towards "MORE" health, check out my January 2010 blogs: More, More Exercise Buddies, More Fun, When is a pound really gone, etc.

Menopause Matters! Take a Deep Breath and Read On...

So, yesterday I was talking about night sweats, and I mentioned the night sweats associated with menopause. Other than estrogen, is there anything else you can do for those major power surges that leave you soaking the sheets? Absolutely!

We have several NON-hormonal medications that we can use to improve night sweats and hot flashes. Blood pressure medications, antidepressants, and newer nervous system drugs can all be used.

Additionally, realize that both caffeine and alcohol can trigger night sweats. Often, decreasing or avoiding these substances will significantly improve the problem. Regular exercise, stress reduction, and vegetable-based diets can help as well.

There is a new technique that I learned about from Dr. Julia Edelman's excellent book, "Menopause Matters: Your Guide to a Long and Healthy Life" as well: paced respiration. Amazingly, this technique can reduce hot flashes by 80%, and there are NO untoward side effects! It involves "breathing slowly and deeply. You breathe only 5 to 7 times per minute- much slower than the normal breathing rate".

If you or any woman you love has questions about menopause, this book is chock-full of sound medical advice and I highly recommend buying it. Dr. Edelman clearly addresses the pros and cons of hormone replacement, bioidentical hormones, herbs, and issues affecting women's health from age 35 and beyond.

BOTTOM LINE: For an excellent resource on all things related to menopause, check out Menopause Matters, by Dr. Julia Edeleman.

Can't Sleep? Don't SWEAT it...

Trouble sleeping is one of the most common complaints that we see in family medicine. We all know how lack of sleep affects our performance the next day, and if you go several nights without a good night's rest, before long you are feeling miserable all the time!

Laurie Sanchez, a writer with Lifescript.com (a website that focuses on healthy living for women) asked me for some expert commentary for her article entitled "5 Common Sleep Disorders: Disturbing or Dangerous?" (Check out her full article by clicking on the link.)

Ms. Sanchez focused on sleep apnea, grinding teeth, restless limbs, night sweats and adult bed wetting from overactive bladder. These are each worth discussing, but since she asked my opinion about night sweats, I'll touch on that today.

Night sweats are very common in women, particularly in women over forty (hello, peers!) You do not have to be in menopause to start having these sweats, either. Very often women begin to find that alcohol or caffeine use may trigger episodes of night sweats. Additionally, there are multiple medications that can cause day or nighttime sweats, especially antidepressants. A variety of medical issues such as low blood sugar, infection, and thyroid disease can also trigger these laundry-producing events.

BOTTOM LINE: For the occasional night sweat- DON'T sweat it- but for new onset, frequent, or DRENCHING night sweats, get in to see your family doctor and figure out what's going on!