iPads to Prevent Dementia?

When I speak about Alzheimer's disease, people often ask what they can do to help prevent this debilitating illness. Although scientists have looked at innumerable medical interventions such as hormone replacement (estrogen), ginkgo biloba, anti-inflammatory drugs (like ibuprofen), Vitamin E, and many others, we have yet to find the right answer. The best evidence medical trials today suggest that our primary prevention lies in all the health maintenance strategies that prevent heart disease, high blood pressure and diabetes- namely a healthy diet high in vegetables and fruits & low in "junk", plus regular aerobic exercise.

Additionally, many studies have shown some benefit from "cognitive activities", meaning brain exercises, through puzzles such as word games (crossword puzzles or word searches) or number challenges such as sudoku. Is there a way technology might help? Why not? I believe the act of learning new skills in any format will help, regardless of whether it is an old-fashioned crossword puzzle from the Sunday paper, or learning to use... well, yes, an iPad. Let me say now that no, I do not have stock in Apple, though perhaps I should. And, I'm sure any electronic tablet will fit the bill. That being said, let me share our family's personal experience.

We gave my mother-in-law (who looks amazingly younger than her actual age, which I am not allowed to reveal) an iPad 2 for Christmas so that we could "face time" (video chat, for those uninitiated) with her, which would feel more intimate than just a phone call. Although she is very educated (a former RN), she has never had a computer or a cell phone, so we were uncertain how much use she would get beyond this function. May I brag that she is now texting like a teen? She is able to read and follow her favorite blogs, listen to Bible verses, enjoy interactive Rosaries, and best of all, "chat" with us throughout the day. We can text her pictures on the spot, and engage her in our daily lives more easily. As she is eagerly learning these new skills, I can picture those neurons firing up like crazy, and I have to think that her brain is reveling in the new stimulation.

BOTTOM LINE: You're never too old to learn a new skill, and when you do- your brain will thank you!

Shingles Vaccine- Starts Now at Age 50

Shingles, also known as Zoster, or Varicella Zoster, is a delayed eruption from the Chicken Pox virus. The chicken pox virus is in the herpes family of viruses, all of which stay in your body after the initial infection, and then show up later along a nerve pathway. In the case of shingles, the secondary eruption typically only happens once (versus herpes simplex that can cause many recurrences for years.) Roughly 10-20% of the population will develop shingles at some point in their lifetime.

What does it look like? Shingles is a very localized rash that occurs in a band pattern that wraps around one side of your body, most often the face, back or chest. The rash is made of clusters of red bumps that turn into blisters, then scab over. There is often tingling, stinging or burning pain in the affected area, starting before the rash even appears. The pain can range from mild to severe, and unfortunately, the pain can persist long after the rash has resolved in roughly 15% of patients- this is called Post-Herpetic Neuralgia (PHN.) The good news is that early initiation of anti-viral medication can not only shorten the duration and severity of infection but also decreases your chance of developing PHN.

Additionally, we have a shingles vaccine available, and the FDA has lowered the age of recipients from 60 to 50. A study of 22,000 patients between the ages of 50-59 showed that receiving the vaccine reduced their chance of having shingles by 70%. Although the FDA has APPROVED it for use starting at 50, I should note that our current guidelines from the ACIP (Advisory Committee on Immunization Practices) still recommends the vaccine be given starting at age 60, so please discuss this with your family doctor.

BOTTOM LINE: Consider adding a Shingles Vaccine to your your health prevention list when you turn 50!

Traveling Out of the Country?

If your approaching Spring Break plans include traveling out of the country, NOW is the time to check in with your doctor to see whether or not you need any special vaccines or preventative medications before your trip. Immunizations take at least a few weeks to "kick in" and protect you, so start thinking about these shots at least a month (or preferably, two months) in advance of your trip. Additionally, there are some medications, such as those for prevention of malaria, that you need to start taking a couple weeks before your trip in order to be effective.

A great resource for medical travel planning can be found through the Center for Disease Control (CDC) at http://wwwnc.cdc.gov/travel/. Simply enter in your planned destinations, and a list of recommended vaccines as well as a plethora of extra information is readily available.

For example, let's take Mexico (think sunshine, beaches and...mosquitoes?) Of course, your routine vaccinations such as measles, tetanus and polio should be current. In addition, both Hepatitis A & B vaccines are recommended, as well as the typhoid vaccine- especially if you are visiting smaller or more rural areas. Rabies vaccine is only recommended for travelers who plan to be very involved with wild or stray animals, such as researchers, vets, or "high adventure" seekers. Besides the shots, travelers need to consider medications to prevent malaria, a serious blood-borne illness that is transmitted by mosquitoes. While not all regions of Mexico are at risk for malaria, people touring Chiapas, Oaxaca, Nayarit, and Sinoloa will need to discuss anti-malaria drugs with their doctors.

BOTTOM LINE: When your travel plans extend beyond our country's borders, check with your family doctor a couple months in ADVANCE of your trip to see if you need updated or additional immunizations or preventative medications.

Too SAD for the Holidays?

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!!

FIRE! Are You Prepared?

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!)

Which Sunscreen is the BEST?

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?

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.

Swimmer's Ear- Home Remedy

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!

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

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!

Can Hormone Therapy Prevent Dementia?

As our population ages and more members are developing dementia (primarily Alzheimer's), scientists are constantly on a quest to look for ways to prevent dementia. In the past, we felt the data supported that estrogen ("HRT"- hormone replacement therapy-given to women in menopause) might prevent Alzheimer's. Subsequently, the tide turned and evidence showed that not only did it not prevent, but it may worsen your risk. What do we think today?

A recently published study in the Annals of Neurology, Timing of hormone therapy and dementia: The critical window theory revisited, represents hope and a bit of a compromise. This study suggests that women who take HRT WHEN THEY BECOME MENOPAUSAL (but not later in life) have a significantly reduced risk of developing dementia!

The study was a good size- around 5500 women. Their pharmacy records were used to verify HRT use in their mid-life (average age around 49) and then evaluated again roughly 30 years later, when the women were in their late 70s and 80s. Over a quarter of these women developed dementia (27%) which may sound shocking, but is consistent with the growing incidence of dementia.

The analysis showed that women who TOOK HRT ONLY IN THEIR MIDLIFE had a 26% reduction in their risk of developing dementia compared with women who never took HRT, whereas those who took HRT only in their later life had a 48% INCREASED risk. Interesting, those women that took HRT BOTH midlife and later life had the same risk as those women who NEVER took it.

BOTTOM LINE: Current evidence-based medicine suggests that taking HRT at the time of menopause may DECREASE your risk of developing dementia, but starting HRT late in life can INCREASE your risk. Women, please factor this in when you have your discussion with your physician regarding pros and cons of HRT!

Going Skiing?

Are you headed to the mountains for some skiing this winter? The powder is definitely calling, especially after the huge storms we've had this week! 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!

Zinc for Colds?

If Vitamin C is not the answer to prevention or treatment of colds, what about zinc? Around 25 years ago, studies showed that zinc lozenges could significantly reduce the duration of the common cold. Since that time, the medical literature has been conflicting, with roughly half of the studies showing benefit, and half appearing equal to placebo.

Zinc nasal preparations were then released, but in 2009, the FDA issued a warning that these intranasal zinc preparations had the potential to cause permanent loss of smell, so they are no longer recommended.

It turns out that you need to have ionic zinc in the lozenges to be effective, and the vast majority of products out there do not have this type of zinc. Taking zinc supplements in pill form doesn't work either, so don't be fooled into swallowing yet another pill.

What DOES work? Well, the best prevention is what your mom most likely taught you growing up: WASH YOUR HANDS! It doesn't matter if you use the hand sanitizer or old-fashioned soap and water, but whatever you use, scrub for 20 to 30 seconds, and try not to touch your face or eyes.

BOTTOM LINE: If you are going to use zinc to try to shorten the duration of your cold, get an ionic zinc lozenge preparation. More importantly, however, WASH YOUR HANDS!

Flu Vaccine- It's Time AGAIN!

Last year's flu season was a scary, challenging time for all of us, 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.

When is flu season? Though typically we say October to January, we'll need to start 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!

WHO should get the flu vaccine this year? The CDC (Center for Disease Control) has recommended that EVERYONE over the age of 6 months receive it this year, so we can avoid the near pandemic we faced last year. It is especially important for people at high risk of serious complications: pregnant women, kids <5 years old, adults > 50 years old, anyone with chronic illness (asthma, diabetes, cancers, etc.) and health care workers. I would add TEACHERS to that list, as well.

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!
(PS If you are a West Lake Family Practice patient, we are expecting our vaccine shipment to arrive next week.)