Back to School Check Ups & Vaccines

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

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

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!

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!

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Another Reason to Enjoy Coffee!

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

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)

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!