Tuesday, January 30, 2007

What are the Medical Journals Saying?

Medical Update - This weeks brief synopsis from Medical Journals:

(Antidepressants and Fracture)
1. Adults over age 50 who take SSRI antidepressants (like Prozac, Zoloft, Effexor and others) had twice the risk of bone fracture as those not on antidepressants. These patients had lower bone mineral density in the hips and spine. It was not recommended that patients stop taking their antidepressants. (Archives of Internal Medicine)

(Falls in the Elderly)
2. Falls are common in people over the age of 65 and lead to severe injuries and death. If a patient has had a fall within the last year, the chance of a future fall within one year is 50%. Falls are a treatable geriatric syndrome. Screening for fall risk is as easy as asking "Have you had any falls in the past year?" and watching a patient's gait. In patients who have fallen, treating the patient's risk factors for falls reduces falling by 30-40%. Falls can be reduced by physical therapy for gait and balance problems, home evaluation of activities of daily living, eye exams, removing environmental hazards and doing medical work-ups for cognitive impairment. (Jama)

3. New research suggests that intestinal microbes may play a role in the regulation of body weight. Two types of beneficial bacteria - Bacteroidetes and Firmicutes - reside in the gut and the balance of the two seems to be important in determining an individuals propensity for obesity. In both genetically obese mice and their lean litter mates, as well as obese and lean human volunteers, the researchers found an association between obesity and an increased amount of Firmicutes compared with Bacteriodetes. Many questions remain. (Nature)

(Kids Eating Magnets)
4. Ingestion of non-food objects is common in toddlers. Building sets and toys with powerful magnets have been marketed for use by children as young as 3 years. Twenty cases of magnet ingestion injury were noted by the researchers and boys accounted for 80% of the patients. While most small objects will pass through the gastrointestinal tract without a problem, the magnets can hook together in the bowel and cause perforation, obstruction and peritonitis. One child died from volvulus (twisted bowel). Ten of the children swallowed magnets from their own toys, three swallowed magnets from an older sibling's toy, and three swallowed magnets from toys at day care or school. Caregivers should keep products with magnets away from children under age 6 and be aware of the unique risks when magnets are swallowed. Immediate medical attention is needed. (Jama)

Sunday, January 28, 2007

Nutrition for Dummies

We weren't born food dummies. We have been given such conflicting, erroneous, mind-numbing information from the "Experts" it is no wonder so many people are confused about what is the right thing to eat. Every day we read "New Scientific Studies Show...". From low-fat, to saturated-fat, to trans-fat, to low-carb, to high-fiber, to carrots are good, to carrots are bad, to potatoes raise the glycemic index....and on and on. The result of all of this nutritional advise and ever changing food pyramids is that the three leading health concerns in America (Heart disease, diabetes and obesity) are soaring.

If you have time to read Michael Pollen's fantastic article in 1/27/07 New York Times, Unhappy Meals, go for it. If you are too time challenged to read the full 12 pages, I will summarize here the high points for your reading pleasure. Forget the ever changing recommendations of the experts. Think simple:

1. Eat foods your great-great grandmother would recognize as food. Would granny recognize a Go-gurt , breakfast bar or non-dairy creamer? There are 17,000 new food products introduced very year. Avoid them.

2. Avoid food products that come bearing health claims. They are apt to be heavily processed. (read my first post on this blog). Did you know that the American Heart Association charges food makers for their endorsements?

3. Avoid food products that are unfamiliar, unpronounceable or contain more than 5 ingredients.

4. Use farmers markets. The soil is important to the nutrients in the food (duh!). Every tomato is not the same and farmers markets are seasonal. That is how our bodies are designed to eat.

5. Pay more, eat less. That $1.29 happy meal is not a bargain. The "eat less" part is a challenge but conscious eating means you slow down, enjoy the taste and feel more satisfied with less.

6. Eat mostly plants, especially leaves. When was the last time you ate winter greens (collard, mustard, spinach)? Greens are really easy to prepare. Here are some recipes to try. winter greens recipes

7. Eat like the French or Japanese or Italians or Greeks. It isn't just the foods they eat. The secret may be in the small portions, no seconds or snacking, communal meals and pleasure taken in food and company. It is the traditional culture that may lead to better health outcomes.

8. Cook at home and take your homemade lunch to work/school.

Lets face it. Americans have too many food choices and easy access to the wrong kinds of foods.
We don't need nutrition experts to tell us what mom always said. "Eat your fruits and vegetables before you have that cookie" We just forgot.

Saturday, January 27, 2007

Reflections from an Older Mom

This post is a reprint from 2005 issue of "San Francisco Medicine"

Something has dramatically changed in the appearance of parents from the 1960s and the parents of children in the 21st century. Looking around at the adults with kids at schools, parks and ballgames, I can't help but think, "Gee, is that the parent or the grandparent?" Most of the time, it is the parent. The older parent (gray-haired, donned in Dockers, holding a cup of Starbucks coffee) who is holding hands with a fourth grader or pushing a stroller seems to be the norm these days at least in the Bay Area.. Perhaps I am more aware of this phenomenon because I am one of these older parents. But I have an unusual perspective because I was also a "young mom" in 1969 when I had my first child, a daughter. There is a 26-year time lapse between my two children, as my son was born in 1995. My daughter is 35 and my son is 9. I feel distinctly qualified to give one perspective on being an older mother.

Most medical journals and lay articles regarding older mothers (defined as over 35!) address conception and childbirth. We know about the aging ovary, increase in multiple births and c-section rates. That's all well and good, but what about the lifetime that occurs after the baby is born?

I listen to questions from my female patients who are in their late 30s or 40s and want to get pregnant but have concerns and fears. Since I've experienced childrearing at both ends of the reproductive spectrum, I thought it might be helpful to address common myths and urban legends about older parenting.

Myth #1 - The older mom won't have the energy or patience for childrearing. The sleepless nights during the first few months and sleep deprivation while waiting for your teen to come home are just as difficult whether you gave birth at 20 or 45. There is no proven data that "energy" declines with age, and in fact, an older, wiser parent might focus and conserve her energy better than a young mom. The wisdom that comes with life experience lends itself to more patience and acceptance, not less.

Myth #2 - The older mom will be less playful and more rigid. Of course this depends on the personality more than the age, but many older moms are highly educated, have an understanding of childhood development and are more willing to participate in their child's growth stages. I spend more time building Legos, playing Stratego and reading with my son as an older mom than I did with my daughter as a young mother.

Myth #3 - The older mom will miss her "me time" because she is more used to being with adult friends. Not true. Older moms have already traveled, stayed out late, and hung out with friends and they are often ready to be less selfish and focus time on a child. Also, the older mom is more likely to have better finances so she can afford more child care and assistance than the younger parent. I have many more options now and much better help than I did when my daughter was young.

Myth #4 - The older mom will be a more anxious mom. The older mother probably has a more realistic view of life based on the experiences of her 20s and 30s. She knows what can go wrong, but she also has the experience of how to deal with challenges. She may well be less anxious than a young mom who is distracted by competing issues.

Myth #5 - The older mom may have health problems that interfere. There is no evidence that older parents' age-related health issues interfere with their parenting in comparison to young parents. Many older moms are more health conscious and knowledgeable about diet and exercise and have already stopped practices that incur harmful health risks. I have no data, but I bet older moms use seat belts and floss more regularly than younger moms.

There are hundreds of variables that combine to make a "good parent," and age is low on the list. As an older mother, I am more focused, aware and emotionally present than I was in my 20s. My actions now are more deliberate and I have many more resources at my disposal. I don't feel alone because in the Bay Area so many parents look my age. I think I'm a better parent now than I was 26 years ago and the joy I experience has been enhanced, not diminished, with age.

Cold Sores - aka Herpes Virus

What strange virus is usually contracted by the age of 12, can lay dormant for years and causes 10 days of misery whenever it emerges on the body?
Answer: It is the old fashoned "cold sore" also known as Herpes Simplex (HSV-1).

Almost everyone has experienced a cold sore or has seen this unappealing swelling on someone's lip. Here is a quick tutorial on HSV-1.

Herpes Simplex causes a small painful blister or cluster of tiny blisters and swelling on the skin. The common cold sore occurs on the lip but HSV-1 can also show up on the genitals or even the finger. Millions of people don't even know they have the virus until it rears its ugly head. Because the virus resides in the nerve root, the symptoms often start with a tingle or a dull ache in the affected spot. It multiplies rapidly and within hours the blister grows with swelling of the tissue around it. Over a 10 day period it drys out and looks crusted and ugly. HSV-1 is so common, it is easy to diagnose visually or with a simple blood test or tissue sample. Once diagnosed, it is easy for the patient to know when it comes back. There can be years between outbreaks but some things are certain to trigger a recurrance in some people: Sunburn or windburn (that means skiing or water sports...kindof covers the whole year), high fever, or stress. And yes, it is contageous.

Tips for dealing with Cold Sores (HSV-1):
When you feel that first tingle or bump, immediately take an aspirin and apply ice.
Valtrex or Acyclovir or Famvir are prescription antiviral medicines that are extremely effective if taken within the first 12-24 hours of an outbreak. They can block the infection from emerging and shorten the duration. The key is to start ASAP when the virus is rapidly replicating.
Blistex or Campho-phenique can help with pain.

Despite claims, Lysine has not been effective in controlled trials.

Herpes virus is annoying but it can be managed and it shouldn't effect your long and healthy life.

Thursday, January 25, 2007

Be Informed-don't believe everything you read

When you read an article that says "Chromium helps maintain immunity", do you believe there is proven science to back up that claim? Think again! These "claims" about nutrients or dietary supplements are often included purely for marketing the product and to make you think the product has value. In 1994 a new law ruled that dietary supplements (vitamins, minerals, botanicals and other ingredients) did NOT need to have scientific studies to prove effectiveness. "The marketing has been quite effective without studies" says Irwin Rosenberg, M.D., senior scientist at the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University.

So make sure you think twice when you see:

"Scientific Studies have shown". It may really mean that there were observations that have not been studied or proven by rigorous controlled randomized clinical trials.

"Includes glycemic, cardio balance and nutra multi". It sounds important but notice that tiny disclaimer that says "These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease". That means the fancy words are for marketing, not real science.

One more little tip. If you are reading the label for a product or vitamin, make sure you read how many tablets you need to take to get the "dose" of an ingredient. Sometimes it takes 4 tablets to get the 1000mg dose on the label. That can be an expensive supplement that might be a waste of your hard earned cash.

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...