Black Spots & Blurred Vision- Sometimes a Simple Fix

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!

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

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!

"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?

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)

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

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.