Practicing yoga has already been shown to have a positive effect on the overall health of patients with a variety of illnesses including anxiety, depression, cancer and heart failure. Now, a new study by Dr. Dhanunjaya Lakkireddy that was presented at the annual scientific sessions of the American College of Cardiology shows yoga can reduce episodes of irregular heart beats in patients with atrial fibrillation. Dr. Lakkireddy was prompted to study this when he witnessed the improvement in a patient who practiced yoga regularly. Patients in the study participated in a yoga program (which included breathing exercises, yoga postures, meditation and relaxation) three times a week and decreased their irregular heart beat episodes from 2.6 to 1.4. More importantly, they reported an improved quality of life, decreased anxiety and depression.
Here’s another example of how clearing your mind of stress can lead to a healthier body. It’s amazing to me how our physical body is so directly impacted by our mental health. Yoga is just one way to work on improving your mental health. Find what works for you and stick with it…your body will appreciate i
In the March 23rd issue of JAMA, air pollution is highlighted as am emerging global risk factor for strokes.
Air pollution exposure is already considered to have an important association with mortality world-wide. In fact, in high income countries, 2.5% of all deaths are associated with air pollution. It’s important to note that air pollution has an association with strokes and is not a direct cause based on the information we have now. Although, the American Heart Association has updated their statement on air pollution and it’s relationship with cardiovascular disease and deaths (like heart attacks) saying “The overall evidence is consistent with Particulate Matter playing a causal role in cardiovascular morbidity and mortality.”
The role of air pollution in strokes has not yet been studied thoroughly. It will probably be a while before we have further scientific evidence regarding air pollutions impact on strokes. But, it’s important to remember that it’s not just individual risk factors like obesity and high cholesterol that have increased the incidence in strokes. Our environmental risk factors are also changing and may be having more of an impact on our health that we realize.
How often have you been to your doctor only to leave frustrated that you have not had the main reasons you were there addressed? It’s a problem, and one that is getting worse given the pressure on physicians to see more patients in a shorter amount of time. Whether you are seeing your primary care doctor, a doctor in the ER, or a specialist for the first time, here are a few tips on how to get the most out of every visit.
1) Bring a list of all medications that you take, the doses and how often you take them each day.
2) Bring a list of all your medical problems (like Diabetes, High Blood Pressure, High Cholesterol) and surgeries.
3) Bring a list of what medicines you are allergic to, if any.
4) Tell your doctor at the beginning of your visit what you would like to discuss with them.
5) Communicate with your doctor what is the one most important thing to you to be addressed at this visit.
If you bring this information with you, your doctor will not need to spend most of the visit gathering this from you or your medical records and will have more time to discuss with you why you are actually there. Taking responsibility for this information as the patient allows your doctor to more easily address your health concerns. And, communication is important too. A regular office visit usually allows for a doctor to address about 2-3 things with a patient. Any more than that will require a second visit. This is why you must prioritize your most important concerns and communicate that to your doctor.
One of the most common complaints I hear from patients is “I’m not sleeping well.” While there are several different medications that can be used to treat insomnia, I find many people have very poor “sleep hygiene” which can cause or exacerbate sleep problems. Here are a few tips to improve your sleep hygiene.
– Do not watch TV, play video games or use your computer 2-3 hours before bedtime. These types of activities stimulate your brain and make it more difficult to wind down for bedtime.
– Establish a regular sleep schedule.
– Avoid caffeine after lunch.
– Avoid alcohol near bedtime. (While alcohol does make you sleepy, it disrupts your sleep cycles later in the night making it difficult to stay asleep.)
– Stop smoking, especially just before bedtime.
– Exercise regularly (just not right before bedtime!)
– And lastly, if you can’t sleep, get up! Read until you feel sleepy and try again but don’t just lay there getting frustrated that you can’t fall asleep.
While all of these will help, just simply avoiding TV, video games, computers and caffeine prior to bedtime can have a dramatic impact on your ability to fall asleep quickly at night.
In 1999, the American Academy of Pediatrics recommended that children under 2 years old should not have any TV/screen time. None. Despite this, 43% of kids under 2 years old watch TV every day! Not only should 2 year olds not be exposed to adult TV that may be on in the home, but also should avoid exposure to programs that are specifically marketed to parents with children under 2 years old. “Learning videos” like Baby Einstein and cartoons like Blue’s Clues have NO scientific evidence that they will help your child become developmentally advanced. And, there are more and more concerns that these videos may be actually harming your child’s brain development!
A study done at The Child Health Institute at the University of Washington has found a concerning correlation between the amount of TV that 1-3 year olds watch and their later ability to pay attention. For every 1 hour of TV/day before age three, a child is 10% more likely to show ADHD symptoms at age 7.
I have thought the main influence on the rise of ADHD we are seeing in our country is mostly due to the lack of consistent parenting and discipline. But, perhaps another huge factor is that we are actually rewiring our children’s brains from the very beginning to be “ADD.” We already know the best way to help babies develop connections in their brain is with social interaction. Most babies favorite thing to look at is a human face- they can stare at their mom’s face for a long time learning to mimic expressions, see shapes, colors, even emotions. When we substitute that human interaction for screen time (even “learning” screen time), it’s as if we’re telling that brain, go ahead and short circuit all those connections you are trying to develop, you won’t need them. But then that child gets to first grade and we expect them to have the wiring in place to be able to sit still and listen to a story when we haven’t given them what they needed early on to develop it.
Of course every mom needs a few minutes to take a shower or have some “me time.” But, next time you’re about to pop in an educational video for your child under 2, remember you may actually be doing harm and they would rather learn from you anyway!
For more information, I highly recommend Bright from the Start by Jill Stamm, Ph.D.
Have you ever stressed out about something you think other people want you to do? Watch as this man questions the thought, “I’m not living up to my full potential.” Funny how we let our minds convince us our thoughts are true that may not be true at all. And then, those thoughts become beliefs we act on or at least stress and worry about so much it can begin to affect our health and well-being.
I just did a search on PubMed for “artificial sweeteners” and came up with 162,789 resulted published articles. Wow, it’s no wonder there are so many questions out there about which artificial sweeteners are safe and how much is too much. I haven’t even sorted all that out yet myself- except to say that moderation is the key with sugar and artificial sweeteners alike.
However, I have come across a natural plant fiber used as a sweetener called inulin or oligofructose. The main sources of this are Jerusalem artichoke and chicory. It’s a sugar free sweetener with a glycemic index of approximately zero! This means, it does not cause any surges in your insulin levels after eating making it very different from sugar or complex carbohydrates. Studies have shown it to be helpful in stimulating the immune system, decreasing the bad bacteria in the intestine, alleviating constipation, lowering the risk of osteoporosis (by increasing the absorption of calcium in the gut), reducing the risk of plaques building up in your arteries and lowering the risk of colon cancer. In fact it seems to act very similar to dietary fiber in our bodies and some have even proposed classifying it as dietary fiber instead of it’s current classification as a carbohydrate.
If you’d like to try it out for yourselves, check out these ChocoPerfection bars. They are sweetened with oligofructose. That is definitely the best “sugar-free” chocolate I have ever tried with none of the side effects of sugar alcohols. If you’re looking for a way to satisfy your sweet tooth without the sugar rush followed by the inevitable crash, try these. Absolutely delicious!!
Have you ever wondered if it is really necessary for doctors to go through a minimum of 11 years of training to be able to practice their field of medicine? I’m not going to lie- I have. After reading Malcolm Gladwell’s, Outliers, I realize again the value in the length of our training.
He states, “The idea that excellence at performing a complex task requires a critical minimum level of practice surfaces again and again in studies of expertise. In fact, researchers have settled on what they believe is the magic number for true expertise: ten thousand hours. ‘ The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world-class expert- in anything’ writes the neurologist Daniel Levitin.”
Becoming an expert in medicine appears to be the same. A doctor training in primary care has already spent 4 years in undergraduate school then 4 years in medical school learning the basic sciences required to practice clinical medicine. Except for the last 2 years of medical school, these 8 years are not spent actually practicing medicine though. That begins in residency. A family medicine or internal medicine physician will spend 3 years in residency working on average 60 hours a week (seldom <40 hours and by law not more than 80 hours). Working about 49 weeks out of the year at 60 hours a week adds up to 8, 820 hours practicing medicine. Add in 1000 hours from the clinical years in medical school and what do you know- about 10,000 hours. No matter how intelligent someone is upon graduating from medical school they still need the 10,000 hours “practicing” medicine to become an expert.
Interestingly, for specialists the numbers work out too- for example a cardiothoracic surgeon spends the same 8 years in school prior to residency then spends 5 years in a general surgery residency then 2-3 years in cardiothoracic surgery residency. The 8 years of school plus 5 years of general surgery are prerequisites in preparation for the more specialized skill. Then spending 70-80 hours a week (more typical in surgery residencies) over 3 years is just over 10,000 hours.
So, if you’re seeing a young physician or an older, more experienced one, at least you can be assured they have all met their 10,000 hours in their field required to be an expert.
Preventive Medicine refers to preventing medical illness and disease instead of treating a disease after it exists. I continue to be amazed at how many patients I see a day who are physically suffering from diseases that can be prevented (referred to as primary prevention) or at least managed better to have fewer complications (referred to as tertiary prevention). For a doctor this is an important and sometimes overlooked area of practicing good medicine. It’s becoming a more and more recognized part of quality medical care as people are searching for ways to provide good care at a more economical cost. There is even a new field of medical training referred to as preventive medicine. As a patient, I invite you to become more proactive in taking part in your own preventive medicine. YOU are the one that lives your life everyday! You know what you eat and what bad habits you have. Being honest with yourself and your doctor about the effect those habits can have on your health is the first step in looking for ways to stay as healthy as you can.
If our country successfully adopted healthy lifestyles and reduced the incidence of obesity, heart disease and diabetes, our cost of medical care would plummet. Education about healthy diets does not seem to be working. I notice that taking a deeper look at what is driving people to turn to unhealthy food or physical inactivity despite their knowledge about what is good for them is more important. Studying the social determinants of health (for example, those that don’t believe they can afford healthier options or have transportation to get it) and the mental determinants of health (for example, poor coping skills causing a anxious person to turn to food for comfort) I believe is the answer. I invite you to take a look at your own life, what is holding you back from making the lifestyle changes you already believe you should make?
Addressing that is true preventive medicine.
What does it mean to you to be healthy? When so many are concerned with “being healthy,” perhaps it would be beneficial to take a look at what that actually is. Is it merely being free from any disease or ailments? Is it freedom from any physical suffering? Does it mean not having to take any vitamins, supplements or medications…ever? Does it mean you never have to go see a doctor? If we are not sure what the goal is, how will we ever get there?
The World Health Organization defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
“Physical, mental and social well-being.” Physical well-being involves taking care of the body you have to live your life in: nutrition, fitness, medical care. Mental well-being involves a balance of self responsibility and self love, appropriate coping mechanisms to assist you in dealing with stress, freedom from worry, learning you can be happy no matter what circumstance you are in. And finally, social well-being involves having meaningful relationships with healthy communication. When it comes down to it, life is about relationship with yourself and others.
Physical, mental and social well-being are intertwined together. So what do you think, are you healthy? I’ve noticed that if you work on mental well-being first, the rest tends to fall into place.
Next post: how preventive medicine addresses physical, mental and social well-being.
A dear friend reminded me of the importance the mind has on the physical body’s health. When your thinking is contaminated with stressful thoughts, that stress can come out in many different ways and manifest in your body. Your immune system may be weakened and unable to fight off infections. You may not be able to sleep with the thoughts churning in your mind. When you do not have a way to deal with those thoughts, the only alternative is to find a way to escape from them. Maybe it’s with eating to numb the mind, turning to drugs or alcohol, escaping from the pain with prescription medications (narcotics, antidepressants, etc.), sex, smoking, watching TV, too much exercise or not enough exercise. These addictions, where you turn to escape from the pain, may eventually lead to obesity, heart disease, cancer, dependence on drugs and alcohol and the list goes on and on.
If you had to choose, would you rather have a healthy body or a healthy mind? As Byron Katie says, “I hope you chose mind because bodies don’t make it.” Heal your mind and notice if the body follows. Start by just noticing what thoughts you are having in the moments before you turn to your escape, whatever that is for you.
“I’m not good enough.” “My body shouldn’t be hurting.” “I am alone.” “I’m too fat.” “I have too much to do.”
If we are honest, we all have them…just notice.
I’m working at the health department this month and swine flu is certainly continuing to circulate in Jefferson County. See your doctor if you have fever > 100 with cough and/or sore throat. The only treatment are anti-virals (like Tamiflu) which do not cure swine flu but may lessen the severity of the illness or shorten the course of illness by 1-2 days. Some physicians are now even calling in these medicines for children with fever, cough and/or sore throat to avoid them having to wait in the waiting room at their office. Fortunately, thus far, most cases of swine flu have been fairly mild.
When you are swabbed for influenza at your doctor’s office, most can do a rapid test in their office to tell you if you have influenza but it must be sent to the state lab to determine if it is H1N1. Since 8/1/09, of specimens testing positive for influenza in AL, 99% have been confirmed novel H1N1. As of 8/27/09, Alabama has had 1,587 confirmed cases of novel H1N1 influenza (or swine flu).
There is no vaccine available for H1N1 yet. It is encouraged for all to get the seasonal flu vaccine when available. The H1N1 vaccine (separate from the seasonal flu vaccine) is scheduled to be available by mid-October but this will be given to high-risk patients first.
So what can you do? The most important preventive measure is personal hygiene. Wash your hands frequently with soap and water!! Cover your nose and mouth when you cough or sneeze. (If you don’t have a tissue to cover your mouth, cough into the crook of your elbow.) Stay home from school or work if you are sick. Get the seasonal flu vaccine when available. Remember, vaccines work best when everyone gets them.
AL Department of Public Health
4.Chronic lung disease (like COPD)
5.Accidents (unintentional injuries)
6.Diabetes mellitus (diabetes)
8.Influenza and pneumonia
9.Nephritis, nephrotic syndrome and nephrosis (kidney disease)
10.Septicemia (infection in the blood)
Now here’s a list of the top 10 things you can do to maintain your health. If you do the things on this list, you’ll be reducing your risk of all of the diseases on the list above. Do your part to take care of yourself! Don’t wait until you are sick to make changes in your lifestyle. Prevention is key!
1. Do not smoke. If you smoke, quitting is the single best thing you could do to improve your health. (Click here for more info.)
2. Limit your Alcohol intake to 2 drinks a day for men and 1 drink a day for women.
3. Maintain a healthy diet and lose weight if you are overweight.
4. Exercise 30-60 min 5 days a week.
5. Don’t sunbathe or use tanning booths.
6. Practice safe sex.
7. Control your cholesterol and blood pressure with diet, exercise and medication if needed.
8. Keep your shots up to date, including flu and pneumonia (if over age 65).
9. Have yearly health screenings with your primary care doctor even if you don’t feel sick. (You may need to be seen several times a year if you have chronic diseases like diabetes or heart disease).
10. Get help if you are suffering from psychological problems like depression, anxiety, or excess stress instead of turning to addictive habits like smoking, alcohol, drugs, overeating or other self destructive behaviors.
Vitamin B12 is an important vitamin mostly obtained from dairy products and meat. It is a critical ingredient your body needs to make red blood cells and also helps your nervous system work correctly. If you have low B12 levels, you might have anemia, depression, dementia or neuropathy (pain, burning or tingling sensation). Some people with low B12 also have high levels of homocysteine which may increase your risk of heart disease and stroke. Your doctor can run a simple blood test to see if your B12 level is low.
The most common reasons for low B12 are 1) not taking in enough in your diet or 2) a problem with your stomach or intestines that prevents you from being able to absorb the vitamin. This includes Pernicious Anemia (where you do not have the cells needed in your stomach to absorb B12) or long standing heartburn or ulcers or having had surgery on your stomach or intestines.
In the past, everyone who needed B12 supplementation was given shots- initially given several times a week for a couple weeks and then once a month. Now we know that unless you have a problem absorbing B12, it is just as effective to take a daily pill instead of getting a shot. Over the counter Vitamin B12 pills do not have enough B12 to increase your levels- you need to take at least 1000 mcg of B12 everyday. You can get a prescription for this high dose from your doctor if you levels are low.
Even if you’ve been getting Vitamin B12 shots for years, you can switch to the pill and it will be just as effective unless you have a problem absorbing B12 from your digestive tract.
According to a recent study by Nielson, the average American watches about 5 hours of TV per day or 153 hours per month. That’s almost 160 hours per month – equivalent to another 40 hour work week. In a 65 year life, that person will have spent 9 years watching television! That doesn’t even count the time spent playing video games or on the computer. Did you know the average American youth spends 900 hours in school in one year and 1500 hours watching TV in one year?
It is recommended by the American Academy of Pediatrics that children have their screen time (TV, videos, video games, computer time) limited to no more than 2 hours total per day. If yours or yours child’s screen time was truly 2 hours a day, how much time would be left to participate in more stimulating and productive activities? If you only watched 2 hours of TV a day, your children would also be much less likely to watch over 2 hours a day. There would be more time to exercise or be involved in some sort of physical activity, spend more time in conversation with our children, help them with homework, prepare healthier meals and eat them with our family. Essentially, there would be more time to do a huge number of activities that are likely more valuable than watching TV. Next time you say “I don”t have time to exercise or cook my family a healthy dinner” add up the hours that week you spent glued to the TV and ask yourself if that is really true?
Here’s one thing I have noticed about the grocery store. The healthiest foods are located around the periphery of the store. That’s where the dairy, meats, fruits and vegetables are found. The aisles are typically filled with pre-packaged, processed carbohydrates and bad fats. Think about your trips to the grocery store- do you find most of the items on your list around the periphery in the produce and refrigerated sections or do you spend most of your time weaving your way through the aisles? More “aisle time” probably reflects the amount of unhealthy food you are stocking your pantry with which almost certainly reflects what you are eating. Except for an occasional trip to an aisle for a specific item like beans or legumes for example, try spending your next trip to the grocery store only around the periphery and notice the difference in what’s in your refrigerator when you get home.
Wanting to make over your body? The best place to start is your kitchen. Good nutrition is in part about knowing which foods are good to eat but it may be more about altering lifestyle habits. Even if you know what’s good to eat, if those foods are not around, you won’t eat them! So how do you start establishing a lifetime of good nutrition? Well, start at home! Your dietary willpower and discipline will be frequently challenged at potluck dinners, social events, lunch meetings at work, etc. But, what matters more than an occasional non-nutritious meal is the other meals you are eating the majority of the time. Start by making your home a “safe place.”
Here are some excerpts from Gourmet Nutrition by John Berardi, PhD, founder of Precision Nutrition.
“If a food is in your possession or located in your residence, you will eventually eat it. That’s right, if you wish to be healthy and lean; you must remove all foods not conducive to your goals from your residence and replace them with a variety of better, healthier choices. Now, before you go thinking that this is just a suggestion- one way to improve your body- we want to make it clear. This is the only way to improve your body….We assure you that once you makeover your kitchen, your body will follow.”
Take a look in your fridge and pantry- is it filled with soft drinks, fruit juices, processed foods wrapped in colorful wrappers, boxes and containers? If so, it may be time for a kitchen makeover.
Since stress is an activation of our “fight or flight” or sympathetic activity, it is important to balance that with our “rest and digest” or parasympathetic activity. I’ve heard many people say they exercise for stress relief. While consistent exercise is a critical component to overall health and improving your body’s capability of coping with stress, it is yet another activiation of your sympathetic system. In fact, competitive athletes consider recovery a valuable part of their training. They understand the need for rest and relaxation to allow their body to recover from the stress it is put under during exercise and intense training.
So while we are unlikely to find a way to live in our world and eliminate all the sources of stress in our life, we can learn to increase our parasympathetic activity to balance that. Here is the key: take 30 minutes a day to engage in some activity that allows your mind to go into a state of relaxation. Choose activities that help you get quiet, restful and worry-free parasympathetic activiation. Every person’s activity might be different. One person could achieve that state by taking a bath each evening to relax but another might take a bath and allow their mind to spin with worries the whole time- that doesn’t count! The key is to do what allows your mind and body to relax for 30 minutes each and every day.
Here’s a list of activities that might work for you:
Yoga or Pilates
Reading in a quiet spot
Listening to soothing music
Taking a bath
When you do this and have actually relaxed, you may notice tension in your neck, shoulder and back release. You might experience a decrease in your heart rate and blood pressure and a sense of calmness. If you do your activity before bed, you will probably be able to fall asleep faster and achieve a better night’s sleep.
Does it sound too simple? It’s obviously not that easy to do because how many of us get 30 minutes a day of a truly relaxed state of mind. But remember all those effects of stress on your body and health- it’s important to allow your body to recover! This is the best way to get control of stress- start today, make it a habit!
A study done in 2003 showed that 80% of Americans reported feeling stressed out. Are you one of them? Take a look at what being stressed can do to your body. Chronic stress can alter our biochemical state and have major effects on our health.
Being stressed puts our bodies in the “fight or flight” state which leads to high levels of cortisol and adrenaline. When we are under chronic stress, the secretion of these hormones takes precedence over other functions like digestion, cellular repair, immune function, reproduction and liver function and detoxification. So we end up with poor blood sugar control, sleep disruption, carbohydrate cravings (which worsens the poor blood sugar control), reduced metabolism, reduced thyroid function, alterered sex hormone activity, infertility, depression, alcohol and drug abuse. Your immune system doesn’t work as well to fight off infections. Stress has even been linked to heart disease.
Basically our bodies are in a state of hormonal imbalance and we simply are not able to function like we want to. Not only that, but stress is also known to decrease the brains functionality causing difficulty thinking and solving problems or a loss of memory. And, after a long time of your body pumping out so much cortisol and adrenaline eventually it wears out and chronic fatigue sets in.
So as you can see, stress is not something to just blow off by saying “things will calm down when the kids are back in school” or “as soon as I get this project done at work my stress level will be a lot less.” You are just continuing the cycle and setting yourself up for problems that are becoming more and more common in America- obesity, heart disease, infertility, irritable bowel syndrome, depression, alcohol and drug abuse.
The best time to slow down and relax is when you don’t have time for it!
Stay tuned for some tips on decreasing your stress level.
Have you ever been concerned that your doctor makes a quick assumption about what you have without really thinking it through? Or, concerned that he/she has been telling you the same diagnosis over and over but your symptoms persist despite treatments? Well, as advised in Dr. Groopman’s book “How Doctor’s Think,” here is one question you can ask to help prevent your doctor from missing something- “Doctor, what else could this be?”
Our goal as physicians is to arrive at the correct diagnosis, give the appropriate treatment and make the patient better. But, sometimes a misdiagnosis can set you on the wrong path and delay the correct treatment. No single remedy can prevent all mis-diagnoses. But, asking that one simple question, “what else could this be?” can help your physician broaden the number of possibilities to consider with a simple reminder of “the reality of uncertainty in medicine.” It could help your doctor take a step back and think of a cause of your symptom that he might not have previously considered and make the correct diagnosis.
Driving from Birmingham to Huntsville, AL this weekend, I saw this billboard for “Sunset Tanz” encouraging you to tan to get Vitamin D naturally. In the upper right corner, it says “Tanning – look good, feel great.” And, “More Vitamin D than milk” referring to tanning. It was a good example of what I was referring to in “Tanning to get more Vitamin D?” so I thought I’d post it here. Don’t believe the tanning industry’s justification of putting yourself at a much higher risk of skin cancer when you could just take a Vitamin D supplement instead.
Here are some interesting numbers comparing the swine flu (H1N1 influenza) to past influenza outbreaks:
Seasonal influenza has about 3-5 million severe cases each year with 250,000-500,000 fatalities annually. In the 1918 pandemic influenza there were 1-1.5 million fatalities. In the 1968 pandemic influenza there were 1 million fatalities. In the 2009 H1N1 influenza or Swine flu , there have been 40,617 confirmed and probable cases and 263 fatalities (as of July 17th). Alabama has had 477 confirmed and probable cases of swine flu and no deaths.
A brief review of the timeline of the swine flu outbreak:
The first H1N1 patient in the US was confirmed on April 15, 2009. The second patient was confirmed on April 17th. On April 26th, the US Government declared a public health emergency. On June 11th, the World Health Organization activated Phase 6 of their pandemic alert scale meaning that they officially recognized the virus is at the pandemic phase. At that time, more than 70 countries had reported cases of H1N1 infection. By June 29th, all 50 states in the US, District of Colubia, US Virgin Islands and Puerto Rico had reported H1N1 infection.
Nationwise US influenza surveillance systems seem to indicate that overall influenza activity is decreasing in the US. Although the 2009 H1N1 influenza has relatively low infection and death rates, the CDC continues to monitor the situation carefully. They have already begun work on creating a vaccine that will be effective against the Swine flu in preparation for the flu season this fall.
Interestingly, spread of the swine flu through water is not likely this summer because the amount of chlorine used in swimming pools and even tap water is adequate to inactive the virus. Human to human spread is still possible so protect yourself with handwashing and covering your mouth when coughing or sneezing!
You may have heard in the news or from your doctor that there have been studies done that associate a low blood level of Vitamin D with some types of cancers, neurologic disease, autoimmune disease and cardiovascular disease. Let me emphasize- the studies show an association, not that a low level of Vitamin D causes these diseases. However, based on these studies there was an emphasis placed on educating patients to have their Vitamin D levels checked or talk with their doctor about getting more Vitamin D.
The two sources of Vitamin D are through the sun’s UV rays or through our diet by either food or supplements. Some doctors had recommended that people spend more time in the sun without sunscreen to increase their levels of Vitamin D. The American Academy of Dermatology has recently ammended their position on Vitamin D. It is NOT recommended that people increase their unprotected UV exposure from the sun or tanning beds in order to increase Vitamin D. Sun exposure and tanning are known causes of skin cancer. Since there is another method of increasing Vitamin D in our systems through our diet, this is clearly the better choice.
There are currently ongong studies to determine if the current recommended adequate intake levels should be revised but for now we are using the levels shown in Table 2 of this link from The National Academy of Sciences Institute of Medicine (IOM) guidelines for vitamin D.
Some people with higher risk of having Vitamin D insufficiency are “dark skin individuals, elderly persons, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption.”
See the official statement here for further details: American Academy of Dermatology Position Statement on Vitamin D.
Sun and tanning beds cause skin cancer and premature aging (wrinkles). In fact, many skin products that are advertised as “anti-aging” actually have nothing extra but sunscreen added in. In the midst of the summer time sun, here are a few reminders on keeping your skin protected from the sun’s rays.
2. Regardless of skin type or SPF, sunscreen needs to be re-applied about every 2 hours and after swimming, drying off or sweating.
Sunscreens are just lotions, gels, sprays, etc that will eventually wear off- especially when you get wet or are just wiping it right back off when you dry off after a dip in the pool. If you don’t reapply you are most likely loosing the effectiveness of wearing the sunscreen in the first place after the first 2 hours in the sun. Some dermatologists say the higher the SPF the better, but regardless of the SPF you still need to reapply frequently. (Don’t do the math and decide you can stay out in the sun for 12 hours without putting on more sunscreen!)
3. Sunscreens should be applied 30 minutes to 1 hour before sun exposure. Give it time to be absorbed into your skin before you jump in the pool and wash it all off.
4. Spend some time in the shade- especially between the hours of 10 am to 4 pm when the sun’s rays are the strongest.
It’s no surprise we are at a loss for primary care physicians in our nation. Primary care includes the specialties of Internal Medicine, Pediatrics and Family Medicine. Did you know that 98% of residents completing an internal medicine residency subspecialize to become cardiologists, gastroenterologists, pulmonologists, endocrinologists, etc? 85% of pediatric residents subspecialize. On the other hand, 98.9% of family medicine residents stay in family medicine.
This July 284 residents started their training in Alabama. Out of those 146 entered residencies in primary care. 74 in Internal Medicine,25 in Pediatrics, 42 in Family Medicine and 5 in a combined Medicine/Pediatrics program. Given the percentages above that means that in 3 years when these physicians are beginning their practices we’ll have 41.5 family medicine docs entering practice, 1.5 internal medicine docs and 3.75 pediatricians. The rest will be starting fellowships to further narrow their area of expertise.
So when I hear discussions from the powers that be about how to recruit more medical students into the field of primary care and specifically family medicine I am all for it. Not everyone needs a cardiologist or rheumatologist but everyone does need their own doctor that knows their medical problems and medications, can see them when they get sick and also treat their diabetes, congestive heart failure and other chronic diseases. Everyone needs a doctor that they see for routine check ups to order the tests and procedures needed to prevent further disease down the road, and knows when they need to tap into the expert opinion of the specialists. That’s what family medicine doctors provide, we call it a medical home for our patients.
Brooke Uptagrafft, MD
Dr. Brooke is a family medicine doctor.