This is written in reference to Let's Talk Medical with Doctor Gigi as it was broadcasted live on Friday March 23, 2012.
Lessons Learned from Whitney Houston:
First let me say that I absolutely loved Whitney Houston! She was a beautiful person with an unrivaled talent, & I am very saddened by her struggles in life & her untimely death!
Recently the autopsy results were released which showed what many of us expected: Whitney 's death was at least partially due to drugs. Though she had water in her lungs which showed that she "drowned," she also tested positive for a cocktail of drugs, both prescribed & illicit. The report showed she had Xanax, Flexeril, Benadryl, Marijuana, & Cocaine in her system. Xanax is an anti-anxiety medication which calms a person's "nerves," whereas Flexeril is a muscle-relaxant & Benadryl is a sedating anti-histamine. The first 2 are prescription meds, whereas Benadryl is over-the-counter (OTC). All are sedating products which means that they make you sleepy & relaxed... great idea if you're going to bed, but terrible idea if you're going to try to accomplish activities of daily living such as taking a bath or attending a party! Marijuana also has sedating properties, so you can easily see that Whitney was likely sleepy beyond belief, & in fact possibly nearly comatose which would have allowed her to slip quietly below the bathtub water without awakening, resulting in her breathing in water which resulted in her drowning. That is of course one possibility, though I propose a more ominous cause for Whitney's death. The cocaine which was found in her system, was the most deadly drug... not because it is illegal, but because of it's cardiac effects. You see, cocaine is like speed - it causes the blood pressure to go up & the heart to beat very fast. If the heart beats very fast, it never relaxes to fill with blood, & as a consequence, though the heart is beating, it is not pumping blood. After a brief time, the brain gets low on oxygen (we call this hypoxia) & this causes the person to pass out. Though your brain might not be functioning, the automatic functions such as breathing would continue. So I propose that Whitney took cocaine which caused a very fast heart beat causing the heart to pump ineffectively... causing her to pass out, at which point she went limp & slipped beneath the water, but she continued to take a few breaths... thus the autopsy showed that she drowned. For those who wonder why she could not arouse enough to get her head out of the water, I think this is a plausible explanation. Sadly, I will add that many addicts who "slip" often over-dose because they resume their drug use at the last dose they used... yet after a dose of sobriety they have lost their tolerance & cannot handle that high of a dose. So in Whitney's defense, perhaps this was a fresh "slip" with cocaine... unfortunately we will never know!
This whole issue brings up the fact that of course we should not be using drugs of abuse, but it also brings to light perhaps a much more rampant problem in our society... a lack of respect for medications as a whole! Many people every day do just what Whitney Houston did in regards to combining prescription & over-the-counter drugs without regard to the toxic effects of these combinations. Heath Ledger over-dosed on a combination of sleeping pills & other prescription drugs, but I am certain that he never intended to die. Michael Jackson was so desperate for sleep that he began to use medication that is only used as anesthesia for surgery... strange, but I also doubt he wanted to or expected to die! How many people, in a search for sleep or relief from pain, take multiple medications at doses higher than prescribed by their doctors? And how many of us take over-the-counter meds on top of prescription drugs without getting advice from our physicians? And this is not even addressing the sharing of drugs with our friends & family, much less the parties where teens each bring a pill from home & then take them just for fun! So, before we pass judgement on Whitney, perhaps we need to look at ourselves... & certainly we need to realize that medication is wonderful when used appropriately, but deadly when used inappropriatly! Always speak with your physician before you change doses of meds, add OTC meds, or "share" your meds! Be respectful, as it is not just illegal drugs that kill!
Effects of Medications on the Liver:
Dawn had a question regarding the effect of multiple medications on the liver. First, not every medication is metabolized by the liver, as many are degraded by the kidneys, & some by other metabolic processes. The problem occurs when a person takes multiple medicines that use the same pathway for metabolism, thus the liver might have a problem if you take several of the following: cholesterol medications (such as statins), diabetic medications (such as Metformin), rheumatologic meds (such as Methotrexate), anti-seizure meds (such as Tegretol or Depakote), or even Tylenol, as they are all "digested" by the liver. As you can see, these are very common meds, & often people take several of these at once. You should not worry about combining them, but you should speak with your doctor to insure that you get proper monitoring, which generally involves blood tests such as an AST or ALT (previously known as an SGOT or SGPT respectively). If these are elevated, your liver is showing signs of being irritated, & your doctor will probably first do further labwork to rule out viral hepatitis as a cause... & he might even do an ultrasound of your liver & gallbladder if you have abdominal pain or other symptoms. If there is no other explanation for the increased liver tests, he will likely try to decrease or stop one of the medications that requires the liver to metabolize it. Generally the damage is not permanent, & getting rid of the offending agent or agents usually results in the liver healing quickly. Of course, if you have a sick liver due to Hepatitis or cirrhosis, you have to be even more careful with medications. As a last thought, remember that Tylenol & alcohol are both metabolized by the liver, so be sure to limit these products if you take prescription drugs that go through the liver. Similarly, anti-inflamatory meds (such as Aspirin, Ibuprofen=Advil, Naproxen=Aleve, & Meloxicam=Mobic) are degraded by the kidneys, so they should be used with caution if you have renal impairment or lots of meds that use the kidneys for degradation.
Allergy Season:
Of course we have all heard about the early Spring & it's high pollen levels, & many of us have been aware of this for several weeks as we have been suffering with allergy symptoms. These include itchy eyes & nose, watery eyes & nose, stuffy nose, & generally the feeling that you have a "cold" which comes & goes for weeks. There are many choices for treating these symptoms, but many people don't understand those options. In general, if you have a runny or itchy nose or eyes, try an anti-histamine as this type of medicine will dry things up & decrease the itchiness. There are great over-the-counter anti-histamines such as: Claritin (=Loratidine), Allegra (=Fexofenadine), Zyrtec, or even Benadryl. Claritin & Allegra are not likely to cause sedation, though Zyrtec might & Benadryl almost certainly will (so take them at night!). Also, note that the first 3 work for 24 hours, whereas Benadryl works for only 4-6 hours, so you will need to take it more than one time per day, & you will likely be very sleepy! On the other hand, if you have a stuffy nose, you probably want to try a decongestant such as Sudafed (=Pseudoephedrine) or Phenylephrine which are both OTC. You need to know however that decongestants often cause an increase in blood pressure, heart rate & anxiety, so you might want to ask your doctor if they are safe for you! If you cannot take decongestants, your doctor can prescribe Astelin (which tastes horrible but will both dry & unstuff your nose), or perhaps a nasal steroid such as Flonase (=Fluticasone), or even Singulair or Accolate which decrease inflamation in the respiratory tract. As a last thought, remember if a medicine name includes "D," that medication includes a decongestant, so beware that it might increase your blood pressure, make your heart beat fast, &/or cause you to feel anxious! Such is the case with Claritin D, Allegra D, & even Mucinex D (which has a decongestant, whereas Mucinex DM has a cough suppressant called Dextromethorphan).
A cost-saving tip: Claritin is over-the-counter, but you can buy the generic version (Loratidine) from the Pharmacy with a prescription. The Loratidine from the Pharmacy should cost only $4 for 30 pills at WalMart, KMart, Sweetbay, Publix, Target, Sam's Club, & Costco. Thus the prescription med is a lot cheaper than the OTC med, so ask your doctor for a prescription! This is the case with several meds, so ask your doctor or Pharmacist, or even check the $4 WalMart list!
Medication Side-effects on Commercials:
A listener commented that he doesn't understand how the FDA would ever approve medications given the horrible side-effects listed on commercials. Well, I certainly understand the comment, but there is some information that lay people need to know. When a drug is being tested in clinical trials, the patients are told to report any & all changes in their health while enrolled in the study. Thus headaches & "flu" are frequently reported, as are heartburn & back pain. Obviously these are common problems in the general population, so it is no wonder why they are frequently reported. Realize that these reported "adverse events" are then listed on the drug's list of "side-effects" even though cause & effect have not been proven! Therefore drugs which are studied during the flu season, often list "flu" as a side-effect. Again, that does not mean that the drug "caused" the flu, though the commercial will not make that distinction as the FDA does not allow that! If you have concerns, ask your doctor which side-effects are most likely, as we know that information & use it to help us prescribe appropriately.
Also, remember that some disease processes, rather than the medicines themselves, cause the side-effect. You might remember the recent concerns involving Zoloft which was accused of causing people, especially teens, to commit suicide. Though I can't prove it, I would suggest that the failure of Zoloft to fully treat the depression is more likely what caused the person to commit suicide as depression itself is usually the cause for suicide. In my opinion, the failure of Zoloft to work well or to be appropriately managed is a better explanation for this "side-effect." Similarly, diabetics are more likely to have heart attacks & strokes than the general public, so it is likely that diabetic meds will show more of these adverse events than meds like antacids which are used in healthy people as well as diabetics. There is a question in many people's minds as to whether or not statin medications (which are used to treat high cholesterol) cause forgetfulness. The problem is that once again, high cholesterol itself can cause mini strokes which can cause forgetfulness... so if a person with high cholesterol takes a statin & gets confused or forgetful, do we blame the medicine or the high cholesterol itself? Obviously, if you stop the statin & the patient's memory returns to normal, I would be convinced that the statin was the culprit, but if nothing changes, I would resume the statin medication to help lower the cholesterol & hopefully decrease the risk of further cardiovascular events, including tiny strokes!
So take the commercial disclaimers with a grain of salt! Talk to your doctor to get more appropriate information & to make better decisions. Remember, if you read the side-effects of aspirin, Tylenol, birth control pills, or even alcohol, you would likely never take any of them!
On that note, I'll end, so here's to our health!
Doctor Gigi
PS Don't forget to check out the live radio show on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1:00PM Eastern time, or on the computer via www.SkipShow.com where you can listen live or to the recorded podcasts. And I would love to hear from you regarding any medical concerns or comments you might have. You can reach me via phone during the radio show (866-TAN-1340) or any time via e-mail (DoctorGigi@SkipShow.com).
Tuesday, March 27, 2012
Monday, March 19, 2012
Gastroparesis; Pre-Menopause; Teens & Birth Control Pills; Foot & Ankle Pain
The following is information we discussed on Let's Talk Medical with Doctor Gigi on Friday March 16, 2012. Feel free to refer to the podcast version posted on www.SkipShow.com, & please contact me via DoctorGigi@SkipShow.com if you have comments or questions.
GASTROPARESIS:
Gastroparesis is a slowness of the stomach to digest food, or what I often call a partial paralysis of the stomach. It results in food staying in the stomach for a long time after you eat it. This results in nausea, a sense of fullness which lasts a long time, & sometimes belching (which might be reminiscent of food you ate HOURS ago). The symptoms are sometimes confused with ulcer problems, but they don't get better with typical ulcer medicines. It is most often seen in people with diabetes, but can be associated with many medications, especially medications known as "anti-cholinergic" medications. These are meds that block the neurotransmitter acetylcholine in nerves, & they are commonly used for many different disease processes. They often cause dry mouth & drowsiness. The following is a list of some anti-cholinergic meds:
Anti-histamines = Benadryl, Atarax
Anti-depressants = Elavil, Pamelor, Paxil
Anti-nausea meds = Phenergan, Compazine
Anti-psychotics = Clozaril, Zyprexa, Mellaril
Vertigo meds = Antivert, Scopolamine
Heart meds = Lasix, Digoxin, Procardia
Stomach meds = Bentyl, Lomotil, Levsin, Librium, Tagamet, Zantac
Muscle Relaxants = Flexeril, Norflex
Urinary meds = Ditropan, Detrol, Sanctura
If you have symptoms of gastroparesis, it can be confirmed with a gastric emptying study or perhaps an upper GI series with small bowel follow-through. If you have diabetes, you should aim for good diabetic control, but you will likely need medication such as Reglan or Domperidone. Reglan is an old drug which is cheap, but it has odd side-effects, the strangest of which is a tightening of the neck muscles which causes a person to feel as though his head is stuck turned to the right or left. Of course this is frightening, but resolves when the drug is discontinued. I would suggest trying the Reglan, but start with a low dose & increase according to your tolerance of the med & how well it works for your symptoms. Some people get by with Reglan 10mg with the largest meal of the day, whereas some need the highest dose which is 10mg with each meal & at bedtime. If you are on medications which might be causing the gastroparesis, you should ask your doctor to change them to something else if at all possible.
PRE-MENOPAUSE:
Menopause is an absence of ovarian function, so this occurs when the ovaries are removed during surgery (surgical menopause)or when the ovaries get old & "die" which usually occurs between the ages of 48-52. If you have a natural menopause, meaning that the ovaries die, this will be evidenced by the fact that you will go one year without a period. Before you stop having periods, you get irregular periods. Early on they get closer together... every 2-3 weeks... whereas later they get further apart... every 2-4 months. Once you go one year without a period, we call you "menopausal," & once you are menopausal, you are always menopausal. And if there is anything good about menopause, it is the fact that when the ovaries stop working, they also stop releasing eggs, so menopausal women cannot get pregnant... at least not with their own eggs, though they can carry a pregnancy as a surrogate!
Pre-menopause or peri-menopause is the time BEFORE the menopause when the ovaries are "sputtering" & thus not producing their hormones appropriately. This means that the lady's estrogen, progesterone, & testosterone levels are variable due to the failing health of the ovaries. It is like being on a rollercoaster ride due to the fluctuating hormone levels, & unforunately it can last for 1-5 years! It is during this time that women are most symptomatic with hot flashes, mood swings, & poor sleep. Thin women suffer the most, whereas heavier women are less symptomatic. This is due to the fact that fat cells produce some estrogen... so if you have fat, those cells continue to produce estrogen so you are not entirely without estrogen when your ovaries stop working. It is interesting to note that this is why heavy men have breasts... their fat cells produce estrogen which stimulates breast development!
As the peri-menopause can cause both physical & psychological problems, many women chose to treat this syndrome with birth control pills. These pills basically give the body estrogen & progesterone, which in turn shuts the ovaries off. In doing this, the ovaries do not release an egg, so one cannot get pregnant. Additionally, the rollercoaster ride stops as the hormone levels are predictable & smooth. As you get older, the doctor will change the birth control pills to menopausal hormone replacement, & over time the doses will be decreased. Not everyone wants or needs treatment, but birth control pills are generally considered safe if used at low doses & if used in women who are non-smokers, have no history of blood clots (pulmonary embolus or deep vein thrombosis), & have no history of stroke. If you have miserable peri-menopausal symptoms (or if those around you think you do!) talk with your doctor about options to lessen those symptoms as you really don't have to suffer through it!
BIRTH CONTROL PILLS FOR YOUNG WOMEN WITH PAINFUL PERIODS:
We received a note from a father whose 15 year old daughter was placed on birth control pills due to painful periods. It is not uncommon for young women to have painful & irregular periods for several years, as the ovaries are young & trying to figure out how to do their job properly! This can lead to the young lady having unpredictable periods which can lead to embarassing accidents. Sometimes there is so much discomfort that she will miss school or other functions. As noted above, there is no reason to suffer with period problems when the young lady can take birth control pills which effectively shut the ovaries off & provide predictable, hopefully less painful periods. With proper timing, we can even make the periods begin on weekends so there is less effect on school attendance.
Of course, a parent might fear that this looks as if they've granted permission to their daughter to go out & have sex. Certainly this is not the case, but if you think it, she might think it... so use this as an opportunity to speak with her about sex. And realize that pregnancy is not the worst thing that she can get from sexual activity! Sexually-transmitted diseases such as HIV, Hepatitis B or C, & even HPV (Human Papilloma Virus) are worse than pregnancy as they can be deadly! Even Chlamydia can be a life-altering disease as it can lead to internal scarring which can make her unable to conceive in the future!
So parents, if your daughter suffers with her periods, do not fear putting her on birth control pills, but do seize the opportunity to educate her about sex & reiterate the need for SAFE SEX practices despite her being on birth control! So enlighten her regarding the absolute need for using condoms, & consider getting the Gardasil vaccine series to protect her from HPV (which is the cause of cervical cancer).
FOOT & ANKLE PAIN WITH RUNNING:
One person complained about foot & ankle pain when he runs, as well as afterwards. He wants to keep running as he knows this is great for his cardiovascular system. He has tried orthotics, but has never seen a Podiatrist.
Certainly, running is great for the heart, but if your feet hurt a lot after running, I suggest you should see the Podiatrist so you can run without hurting yourself. The Podiatrist specializes in feet & ankles, & I recommend a Podiatrist instead of an Orthopediast for this reason. The podiatrist can x-ray your feet to look for problems such as arthritis or fractures. This is best done with you standing up on the foot. Note that most x-ray offices do not do foot x-rays in a standing position, but most Podiatrists will do standing x-rays in their offices! The Podiatrist can also look for bunions & flat-footedness, as well as ankle sprains. He might recommend & fit you for orthodics which should align & support your foot so it functions properly & is less prone to pain or injury. If you have orthodics, realize that they do get old & also that your foot does change over time, so they might not fit properly after a while. Be sure to bring them with you to the Podiatry appointment so they too can be checked! And realize that all orthotics are not created equal. If they were purchased over-the-counter or fitted in a shoe store, they might not be as effective as a custom-fitted pair from the Podiatrist.
If you want to delay spending the money on the Podiatrist, you might try running on a soft surface, as concrete & asphalt are hard on the feet & legs. I suggest that you find a running track at a high school or college as these are rubberized & thus absorb some of the pounding. If these are not available, try running in the grass, just to the side of the sidewalk... but watch for holes & sprinkler heads which can trip you or cause ankle sprains! If you live near a park or forest, find a running trail there... & enjoy some nature during your run!
As always, thanks for reading my blog! If you find it interesting or helpful, please share it with your friends & family! And don't forget, you can listen to Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1PM Eastern, or via computer at www.SkipShow.com (live or podcasts). Be a part of the show by calling me at: (727)-441-3000 or toll-free at: (866)-TAN-1340.
Until next week, here's to our health!
Doctor Gigi
GASTROPARESIS:
Gastroparesis is a slowness of the stomach to digest food, or what I often call a partial paralysis of the stomach. It results in food staying in the stomach for a long time after you eat it. This results in nausea, a sense of fullness which lasts a long time, & sometimes belching (which might be reminiscent of food you ate HOURS ago). The symptoms are sometimes confused with ulcer problems, but they don't get better with typical ulcer medicines. It is most often seen in people with diabetes, but can be associated with many medications, especially medications known as "anti-cholinergic" medications. These are meds that block the neurotransmitter acetylcholine in nerves, & they are commonly used for many different disease processes. They often cause dry mouth & drowsiness. The following is a list of some anti-cholinergic meds:
Anti-histamines = Benadryl, Atarax
Anti-depressants = Elavil, Pamelor, Paxil
Anti-nausea meds = Phenergan, Compazine
Anti-psychotics = Clozaril, Zyprexa, Mellaril
Vertigo meds = Antivert, Scopolamine
Heart meds = Lasix, Digoxin, Procardia
Stomach meds = Bentyl, Lomotil, Levsin, Librium, Tagamet, Zantac
Muscle Relaxants = Flexeril, Norflex
Urinary meds = Ditropan, Detrol, Sanctura
If you have symptoms of gastroparesis, it can be confirmed with a gastric emptying study or perhaps an upper GI series with small bowel follow-through. If you have diabetes, you should aim for good diabetic control, but you will likely need medication such as Reglan or Domperidone. Reglan is an old drug which is cheap, but it has odd side-effects, the strangest of which is a tightening of the neck muscles which causes a person to feel as though his head is stuck turned to the right or left. Of course this is frightening, but resolves when the drug is discontinued. I would suggest trying the Reglan, but start with a low dose & increase according to your tolerance of the med & how well it works for your symptoms. Some people get by with Reglan 10mg with the largest meal of the day, whereas some need the highest dose which is 10mg with each meal & at bedtime. If you are on medications which might be causing the gastroparesis, you should ask your doctor to change them to something else if at all possible.
PRE-MENOPAUSE:
Menopause is an absence of ovarian function, so this occurs when the ovaries are removed during surgery (surgical menopause)or when the ovaries get old & "die" which usually occurs between the ages of 48-52. If you have a natural menopause, meaning that the ovaries die, this will be evidenced by the fact that you will go one year without a period. Before you stop having periods, you get irregular periods. Early on they get closer together... every 2-3 weeks... whereas later they get further apart... every 2-4 months. Once you go one year without a period, we call you "menopausal," & once you are menopausal, you are always menopausal. And if there is anything good about menopause, it is the fact that when the ovaries stop working, they also stop releasing eggs, so menopausal women cannot get pregnant... at least not with their own eggs, though they can carry a pregnancy as a surrogate!
Pre-menopause or peri-menopause is the time BEFORE the menopause when the ovaries are "sputtering" & thus not producing their hormones appropriately. This means that the lady's estrogen, progesterone, & testosterone levels are variable due to the failing health of the ovaries. It is like being on a rollercoaster ride due to the fluctuating hormone levels, & unforunately it can last for 1-5 years! It is during this time that women are most symptomatic with hot flashes, mood swings, & poor sleep. Thin women suffer the most, whereas heavier women are less symptomatic. This is due to the fact that fat cells produce some estrogen... so if you have fat, those cells continue to produce estrogen so you are not entirely without estrogen when your ovaries stop working. It is interesting to note that this is why heavy men have breasts... their fat cells produce estrogen which stimulates breast development!
As the peri-menopause can cause both physical & psychological problems, many women chose to treat this syndrome with birth control pills. These pills basically give the body estrogen & progesterone, which in turn shuts the ovaries off. In doing this, the ovaries do not release an egg, so one cannot get pregnant. Additionally, the rollercoaster ride stops as the hormone levels are predictable & smooth. As you get older, the doctor will change the birth control pills to menopausal hormone replacement, & over time the doses will be decreased. Not everyone wants or needs treatment, but birth control pills are generally considered safe if used at low doses & if used in women who are non-smokers, have no history of blood clots (pulmonary embolus or deep vein thrombosis), & have no history of stroke. If you have miserable peri-menopausal symptoms (or if those around you think you do!) talk with your doctor about options to lessen those symptoms as you really don't have to suffer through it!
BIRTH CONTROL PILLS FOR YOUNG WOMEN WITH PAINFUL PERIODS:
We received a note from a father whose 15 year old daughter was placed on birth control pills due to painful periods. It is not uncommon for young women to have painful & irregular periods for several years, as the ovaries are young & trying to figure out how to do their job properly! This can lead to the young lady having unpredictable periods which can lead to embarassing accidents. Sometimes there is so much discomfort that she will miss school or other functions. As noted above, there is no reason to suffer with period problems when the young lady can take birth control pills which effectively shut the ovaries off & provide predictable, hopefully less painful periods. With proper timing, we can even make the periods begin on weekends so there is less effect on school attendance.
Of course, a parent might fear that this looks as if they've granted permission to their daughter to go out & have sex. Certainly this is not the case, but if you think it, she might think it... so use this as an opportunity to speak with her about sex. And realize that pregnancy is not the worst thing that she can get from sexual activity! Sexually-transmitted diseases such as HIV, Hepatitis B or C, & even HPV (Human Papilloma Virus) are worse than pregnancy as they can be deadly! Even Chlamydia can be a life-altering disease as it can lead to internal scarring which can make her unable to conceive in the future!
So parents, if your daughter suffers with her periods, do not fear putting her on birth control pills, but do seize the opportunity to educate her about sex & reiterate the need for SAFE SEX practices despite her being on birth control! So enlighten her regarding the absolute need for using condoms, & consider getting the Gardasil vaccine series to protect her from HPV (which is the cause of cervical cancer).
FOOT & ANKLE PAIN WITH RUNNING:
One person complained about foot & ankle pain when he runs, as well as afterwards. He wants to keep running as he knows this is great for his cardiovascular system. He has tried orthotics, but has never seen a Podiatrist.
Certainly, running is great for the heart, but if your feet hurt a lot after running, I suggest you should see the Podiatrist so you can run without hurting yourself. The Podiatrist specializes in feet & ankles, & I recommend a Podiatrist instead of an Orthopediast for this reason. The podiatrist can x-ray your feet to look for problems such as arthritis or fractures. This is best done with you standing up on the foot. Note that most x-ray offices do not do foot x-rays in a standing position, but most Podiatrists will do standing x-rays in their offices! The Podiatrist can also look for bunions & flat-footedness, as well as ankle sprains. He might recommend & fit you for orthodics which should align & support your foot so it functions properly & is less prone to pain or injury. If you have orthodics, realize that they do get old & also that your foot does change over time, so they might not fit properly after a while. Be sure to bring them with you to the Podiatry appointment so they too can be checked! And realize that all orthotics are not created equal. If they were purchased over-the-counter or fitted in a shoe store, they might not be as effective as a custom-fitted pair from the Podiatrist.
If you want to delay spending the money on the Podiatrist, you might try running on a soft surface, as concrete & asphalt are hard on the feet & legs. I suggest that you find a running track at a high school or college as these are rubberized & thus absorb some of the pounding. If these are not available, try running in the grass, just to the side of the sidewalk... but watch for holes & sprinkler heads which can trip you or cause ankle sprains! If you live near a park or forest, find a running trail there... & enjoy some nature during your run!
As always, thanks for reading my blog! If you find it interesting or helpful, please share it with your friends & family! And don't forget, you can listen to Let's Talk Medical with Doctor Gigi on WTAN 1340-AM in the Tampa/St. Pete area on Fridays at 1PM Eastern, or via computer at www.SkipShow.com (live or podcasts). Be a part of the show by calling me at: (727)-441-3000 or toll-free at: (866)-TAN-1340.
Until next week, here's to our health!
Doctor Gigi
Sunday, March 11, 2012
Colorectal Cancer Awareness Month; Tinnitus
The following information reflects highlights of Let's Talk Medical with Doctor Gigi as it broadcasted live on Friday March 9, 2012.
Colorectal Cancer
March is Colorectal Cancer Awareness month. Colorectal cancer is cancer which affects the colon or the rectum. The colon is your "large bowel" whereas the rectum is the pouch at the end of the colon where you store your poop (or stool) until it passes. Though they are slightly different cancers, they are similar enough to lump together. Though colorectal cancer is common & potentially deadly, the reason we harp on routine screening for it is that it is usually very slow-growing. Thus, screening will often find it in a pre-cancerous form (which is treated during colonoscopy as opposed to major surgery) or at an early stage when surgery itself is curative. When it is diagnosed later, treatment will likely also involve chemotherapy, & a "cure" is not as easy to achieve. Obviously, if you get colorectal cancer, you hope to find it early, so let's talk about that.
Usually we begin screening with stool cards which look for "occult" blood... which is blood that is in the poop, but which you cannot see with the naked eye. You take these cards home & follow the instructions to collect the samples. The usual cards test for any blood, so you must follow a diet which eliminates other sources of blood such as red meat, especially if not fully cooked. These cards usually require 3 different stool samples. There is another occult blood test which tests for blood which has human DNA, so this is a more specific test, & you need not worry about red meat or your diet. Usually these cards require 2 stool samples, so in general they are better & easier to collect, but more expensive. Most people should begin doing ANNUAL stool cards at 40-45 years of age, though if colorectal cancer runs in your family, you might begin as early as 35. If your stool cards are positive, this means that you have blood in your stool, but it does not mean that you have colorectal cancer... it means you need further studies, such as a colonoscopy, to look for a source of the blood, as hemorrhoids & anal fissures, as well as many other things can cause bleeding in the GI tract! If your stool cards are negative, it does not mean you do not have colorectal cancer, but in the absence of other signs or symptoms, it is likely that you do not.
So let's say you've done your cards as recommended & they have been negative, but now you turn 50 years old or perhaps a family member develops colorectal cancer. Well, now you need to proceed with the more definitive test for colorectal cancer... a colonoscopy! This is a procedure usually performed by a Gastroenterologist (or occasionally a Surgeon or even a Family Practitioner) which involves pushing a scope with a camera on the end through the anus & into the rectum, then through the entire large bowel. As it literally goes from your rectum, up the left side of your colon, across your belly & down the right colon to your appendix area, it requires that you be under sedation. Thus, a colonoscopy should not be painful, as the doctor will give you anesthesia. This is different from a flexible sigmoidoscopy which uses a shorter scope & thus does not evaluate the right colon, nor does it necessitate the use of anesthesia. I almost never request a patient undergo a flex sig as they are potentially painful & not as complete as a colonoscopy. Either procedure will require the patient have a bowel prep the day before... this is to empty the bowel of stool so the doctor can see the bowel wall fully. The bowel prep is actually the worse part of the colonoscopy, as it sometimes makes you nauseated, & almost always makes your anal area sore. I recommend you ask for a prep called "Movie Prep" as it requires you drink 8 ounces of the prep every 15 minutes for 1 hour, then you rest for about 4 hours & repeat the process once. Thus the prep involves a total of 64 ounces of fluid, which is less than in some preps. Also, your anal area will thank you if you rub Vaseline around it before the prep starts & after each loose bowel movement!
There is a thing called a "virtual colonoscopy" which is a CT scan of the bowel. It eliminates the need for anesthesia yet still looks at the entire bowel. Sounds great, but it has limitations! As it is only an x-ray study, it can only show an abnormality or not. If there is an abnormality such as a mass in the bowel, you will still need a colonoscopy so the doctor can actually see the mass AND so he can biopsy or remove it. Remember, you will need a bowel prep for the virtual colonoscopy, & if you have an abnormality, you will need a real colonoscopy... and that likely means a second bowel prep!
The above information refers to things we do to screen for & to diagnose colorectal cancer, but what should you look for as warning signs or risks for this type of cancer. Obviously, physicians recommend screening for everyone, but we worry even more about people who have one or more of the following:
1) bowel changes - such as diarrhea or constipation or just something different from your usual,
2) thin or flat stools - which can be due to pressure on the stool as it passes a mass or stricture,
3) blood in the stool - though this can be from a benign cause so don't freak out, just get further studies to determine the cause,
4) unexpected weight loss - which to a doctor is worrisome for a cancer of any type, not just colorectal cancer,
5) anemia - which means you are bleeding or not producing enough blood cells, so again it does not mean you have cancer, but it is a clue that something is wrong & needs further study such as a colonoscopy,
6) abdominal or pelvic pain, &
7) risks, which include:
a) family history of colorectal cancer,
b) previous glandular cancer, such as breast cancer or prostate cancer,
c) a diet high in fats,
d) being overweight, &
e) smoking - which is associated with lung cancer & bladder cancer, as well as heart attacks & strokes!
As a final helpful hint, when you attempt to collect your stool sample for the occult blood cards, I recommend you start by turning the water off at the toilet. Then you flush the toilet to empty it. After you poop, you can easily collect the sample for the card, then turn the water back on & flush! This is easier & less messy than using the paper supplied with the kit!
I have one last point to make. If you have a normal colonoscopy, you likely do not need another one for 10 years... UNLESS something changes, such as new symptoms, a family member being diagnosed with colon cancer, or stool cards which are positive. So you still need to check the occult blood stool cards YEARLY! If you have benign polyps or tumors, you probably won't need a repeat colonoscopy for 3-5 years. And if you have pre-cancerous or cancerous polyps you will likely need a repeat colonoscopy in 1 year.
Tinnitus
Tinnitus is a ringing or other noise in the ear. It is very common & many times it has no specific cause... which unfortunately means there is often no great treatment. It can be due to: wax in your ears, pressure in your ears (such as with Eustachian tube dysfunction), or Menierre's syndrome, or other hearing problems. Aspirin in high doses can cause tinnitus, so be sure to cut back on aspirin use if you have this problem! Though a cause is often not found, you should see an Otolaryngologist (Ear, Nose, & Throat doctor) for an evaluation, as some of these things are easily treated. If no treatable problem is found, the only recommendation which I have is to never be in quiet places! You need to find a way to always have "white noise" in the background, such as that created by a sound machine like the one sold at Brookstone's. This creates sounds which will make you unaware of the ringing in your ears without engaging your brain. So listen to the sound of waves or sounds of a thunderstorm, & you will be less likely to notice the ringing. Note that music is not white noise if it engages your brain, so music is OK only if it is instrumental & you don't know or want to sing the words.
By the way, there is an app for that! The iPhone, iPad, & iPod have an app called White Noise Lite which is free. It plays white noise such as thunderstorms, waves, an oscillating fan, chimes, & true white noise. You can set the timer so you can try to fall asleep with it on. They also have an upgraded app which costs a little, & I am certain the other Androids, etc. have a similar app!
Hopefully this helps you or someone you love! If you find the information useful, please become a "follower" of my blog, & please share with your Facebook & Twitter friends, as well as with your family! Remember to always discuss with your own physician, as this blog is meant to educate you & prepare you better for those doctor visits! And until next week, here's to our health!
Doctor Gigi
PS Remember to listen live to the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Petersburg, Florida area. If you are not local, you can listen live or to the podcasts via the computer at: www.SkipShow.com. If you want to speak with me about a medical question, please call during the live show via: (727)-441-3000 or toll-free at (866)-TAN-1340. And if you are too shy to talk to me, you can e-mail your questions to me at: DoctorGigi@SkipShow.com.
Colorectal Cancer
March is Colorectal Cancer Awareness month. Colorectal cancer is cancer which affects the colon or the rectum. The colon is your "large bowel" whereas the rectum is the pouch at the end of the colon where you store your poop (or stool) until it passes. Though they are slightly different cancers, they are similar enough to lump together. Though colorectal cancer is common & potentially deadly, the reason we harp on routine screening for it is that it is usually very slow-growing. Thus, screening will often find it in a pre-cancerous form (which is treated during colonoscopy as opposed to major surgery) or at an early stage when surgery itself is curative. When it is diagnosed later, treatment will likely also involve chemotherapy, & a "cure" is not as easy to achieve. Obviously, if you get colorectal cancer, you hope to find it early, so let's talk about that.
Usually we begin screening with stool cards which look for "occult" blood... which is blood that is in the poop, but which you cannot see with the naked eye. You take these cards home & follow the instructions to collect the samples. The usual cards test for any blood, so you must follow a diet which eliminates other sources of blood such as red meat, especially if not fully cooked. These cards usually require 3 different stool samples. There is another occult blood test which tests for blood which has human DNA, so this is a more specific test, & you need not worry about red meat or your diet. Usually these cards require 2 stool samples, so in general they are better & easier to collect, but more expensive. Most people should begin doing ANNUAL stool cards at 40-45 years of age, though if colorectal cancer runs in your family, you might begin as early as 35. If your stool cards are positive, this means that you have blood in your stool, but it does not mean that you have colorectal cancer... it means you need further studies, such as a colonoscopy, to look for a source of the blood, as hemorrhoids & anal fissures, as well as many other things can cause bleeding in the GI tract! If your stool cards are negative, it does not mean you do not have colorectal cancer, but in the absence of other signs or symptoms, it is likely that you do not.
So let's say you've done your cards as recommended & they have been negative, but now you turn 50 years old or perhaps a family member develops colorectal cancer. Well, now you need to proceed with the more definitive test for colorectal cancer... a colonoscopy! This is a procedure usually performed by a Gastroenterologist (or occasionally a Surgeon or even a Family Practitioner) which involves pushing a scope with a camera on the end through the anus & into the rectum, then through the entire large bowel. As it literally goes from your rectum, up the left side of your colon, across your belly & down the right colon to your appendix area, it requires that you be under sedation. Thus, a colonoscopy should not be painful, as the doctor will give you anesthesia. This is different from a flexible sigmoidoscopy which uses a shorter scope & thus does not evaluate the right colon, nor does it necessitate the use of anesthesia. I almost never request a patient undergo a flex sig as they are potentially painful & not as complete as a colonoscopy. Either procedure will require the patient have a bowel prep the day before... this is to empty the bowel of stool so the doctor can see the bowel wall fully. The bowel prep is actually the worse part of the colonoscopy, as it sometimes makes you nauseated, & almost always makes your anal area sore. I recommend you ask for a prep called "Movie Prep" as it requires you drink 8 ounces of the prep every 15 minutes for 1 hour, then you rest for about 4 hours & repeat the process once. Thus the prep involves a total of 64 ounces of fluid, which is less than in some preps. Also, your anal area will thank you if you rub Vaseline around it before the prep starts & after each loose bowel movement!
There is a thing called a "virtual colonoscopy" which is a CT scan of the bowel. It eliminates the need for anesthesia yet still looks at the entire bowel. Sounds great, but it has limitations! As it is only an x-ray study, it can only show an abnormality or not. If there is an abnormality such as a mass in the bowel, you will still need a colonoscopy so the doctor can actually see the mass AND so he can biopsy or remove it. Remember, you will need a bowel prep for the virtual colonoscopy, & if you have an abnormality, you will need a real colonoscopy... and that likely means a second bowel prep!
The above information refers to things we do to screen for & to diagnose colorectal cancer, but what should you look for as warning signs or risks for this type of cancer. Obviously, physicians recommend screening for everyone, but we worry even more about people who have one or more of the following:
1) bowel changes - such as diarrhea or constipation or just something different from your usual,
2) thin or flat stools - which can be due to pressure on the stool as it passes a mass or stricture,
3) blood in the stool - though this can be from a benign cause so don't freak out, just get further studies to determine the cause,
4) unexpected weight loss - which to a doctor is worrisome for a cancer of any type, not just colorectal cancer,
5) anemia - which means you are bleeding or not producing enough blood cells, so again it does not mean you have cancer, but it is a clue that something is wrong & needs further study such as a colonoscopy,
6) abdominal or pelvic pain, &
7) risks, which include:
a) family history of colorectal cancer,
b) previous glandular cancer, such as breast cancer or prostate cancer,
c) a diet high in fats,
d) being overweight, &
e) smoking - which is associated with lung cancer & bladder cancer, as well as heart attacks & strokes!
As a final helpful hint, when you attempt to collect your stool sample for the occult blood cards, I recommend you start by turning the water off at the toilet. Then you flush the toilet to empty it. After you poop, you can easily collect the sample for the card, then turn the water back on & flush! This is easier & less messy than using the paper supplied with the kit!
I have one last point to make. If you have a normal colonoscopy, you likely do not need another one for 10 years... UNLESS something changes, such as new symptoms, a family member being diagnosed with colon cancer, or stool cards which are positive. So you still need to check the occult blood stool cards YEARLY! If you have benign polyps or tumors, you probably won't need a repeat colonoscopy for 3-5 years. And if you have pre-cancerous or cancerous polyps you will likely need a repeat colonoscopy in 1 year.
Tinnitus
Tinnitus is a ringing or other noise in the ear. It is very common & many times it has no specific cause... which unfortunately means there is often no great treatment. It can be due to: wax in your ears, pressure in your ears (such as with Eustachian tube dysfunction), or Menierre's syndrome, or other hearing problems. Aspirin in high doses can cause tinnitus, so be sure to cut back on aspirin use if you have this problem! Though a cause is often not found, you should see an Otolaryngologist (Ear, Nose, & Throat doctor) for an evaluation, as some of these things are easily treated. If no treatable problem is found, the only recommendation which I have is to never be in quiet places! You need to find a way to always have "white noise" in the background, such as that created by a sound machine like the one sold at Brookstone's. This creates sounds which will make you unaware of the ringing in your ears without engaging your brain. So listen to the sound of waves or sounds of a thunderstorm, & you will be less likely to notice the ringing. Note that music is not white noise if it engages your brain, so music is OK only if it is instrumental & you don't know or want to sing the words.
By the way, there is an app for that! The iPhone, iPad, & iPod have an app called White Noise Lite which is free. It plays white noise such as thunderstorms, waves, an oscillating fan, chimes, & true white noise. You can set the timer so you can try to fall asleep with it on. They also have an upgraded app which costs a little, & I am certain the other Androids, etc. have a similar app!
Hopefully this helps you or someone you love! If you find the information useful, please become a "follower" of my blog, & please share with your Facebook & Twitter friends, as well as with your family! Remember to always discuss with your own physician, as this blog is meant to educate you & prepare you better for those doctor visits! And until next week, here's to our health!
Doctor Gigi
PS Remember to listen live to the radio show on Fridays at 1:00PM Eastern time on WTAN 1340-AM in the Tampa/St. Petersburg, Florida area. If you are not local, you can listen live or to the podcasts via the computer at: www.SkipShow.com. If you want to speak with me about a medical question, please call during the live show via: (727)-441-3000 or toll-free at (866)-TAN-1340. And if you are too shy to talk to me, you can e-mail your questions to me at: DoctorGigi@SkipShow.com.
Sunday, March 4, 2012
Obesity - is it Your Fault?; Food Labels; Nighttime Leg Cramps; Overdose on Supplements; Lactose Intolerance; Insomnia.
Let's Talk Medical with Doctor Gigi aired live on Friday March 2, 2012. Following are the highlights of which we spoke, with a bit more educational content. As always, I hope this information is useful to you & your loved ones, & please feel free to respond here or via e-mail (DoctorGigi@SkipShow.com) if you have further questions or concerns. The blog is not simply a transcript of the show, so also feel free to refer to the recorded podcasts if you prefer to listen, especially as some content there is not repeated here.
Several people were apparently a bit offended by the conversation Skip & I had the week earlier when we discussed weight loss. There is a new weight loss drug available, & I believe it will help certain people with obesity. The drug is named Q-Nexa, & you can refer to last week's blog for more specific information regarding what it is & how it works. During our conversation we discussed that diet & exercise are still utterly important to achieve longlasting weight loss, & some felt that we were insinuating that a person who is overweight is that way due to his or her own choosing or fault. It is not necessarily a person's fault if he is overweight, but without making appropriate dietary changes & without doing some form of exercise, it is not likely that he will lose weight & keep it off. A few helpful hints will follow, but if you truly struggle with obesity, consider seeing a dietician to help review your eating habits, as you might not know what you are doing wrong, AND consider beginning some sort of exercise regimen. I tell my patients to be sure to eat 3-6 times per day, as people who "graze" tend to be thinner than those who eat 1-2 times per day. Of course, you need to eat small meals, so I sometimes recommend dividing each meal into 2 meals. Thus you would eat 1/2 of your breakfast, then finish the other 1/2 about 2 hours later. You would do the same with lunch & supper. Also, try to include protein in every meal as protein makes you feel full, whereas carbohydrates make you hungry shortly after eating. Remember that fats have more calories per gram so eat less of them... carbs & proteins each have 4 calories per gram, whereas fats have 9 calories per gram! Also, do not eat "empty calories"... these are foods that have calories, but essentially no nutritional value... such as soda, sweet tea, & alcohol. As for exercise, you don't need to run a marathon, you just need to expend more energy than you are right now. It is simple & free to take up a walking program. Start walking slowly, & increase the speed & distance as you get in shape. Try to talk or sing as you walk, as that actually uses more energy, or better yet, carry a 1-2 pound weight in each hand & swing your arms as you go. If you need more structure, consider joining a gym such as You Fit (which is fairly inexpensive & seems to attract REAL people rather than just those who look like they don't really need to go to the gym!). Though I can give all these helpful hints, I know from personal experience that it is not easy to lose weight... I have been to weight loss clinics, & I have had a suction lipectomy to remove fat from my hips & thighs... I have even worked in weight loss clinics. But... I am still overweight & don't like my body! It does seem that I have to work hard to lose 5 pounds, but by the same token I don't gain more than about 5 pounds even when I eat poorly & "forget" to exercise. It is as though my body just likes weighing about 135-145 pounds! So I agree that there is more to obesity than just calories in (what you eat) & calories out (what you exercise off). No one seems to have a grip on that yet however, so for now, your best weight loss success will likely come from a combination of good dietary choices & good exercise habits, both of which should be done for a lifetime, & brief episodic use of medications like Q-Nexa.
There was a brief discussion regarding food labels. I am not a nutritionist, so I am not an expert in regards to this! I do know however that the most misunderstood part of the label is the "serving size." This often leads us to make bad choices & to overeat, so let's talk about it briefly. The serving size is of course what the food producer feels is an appropriate serving, but the misunderstanding comes when we assume that the entire package is ONE serving! For example, a Big Gulp is a 32 ounce soda, but one serving of soda is likely 8 ounces. So you must look at the label & do a little math. If a serving size is 8 ounces & that has 150 calories, then you must realize that if you drink the whole Big Gulp you will get FOUR servings, & thus 4 times the calories... which is 600 calories! Apparently, the Mars company recently agreed that people do not understand serving size & have agreed to stop producing king size candy bars in an attempt to help America with her obesity dilemma! Their candy bars will be sized to an appropriate serving, so people will hopefully eat less & get less calories. If you want more calories you can eat 2 or 3 bars, but you will be more likely to understand the number of calories you are getting in this manner.
A gentleman wrote a note requesting help for his wife who often awakens with severe leg cramps. Though this is a common complaint it is not one for which we have a great answer. I suggest that someone with significant nighttime leg cramps should discuss this with his physician, who in turn will hopefully order blood tests. Generally these tests should include: a Calcium, Magnesium, Potassium, Phosphorus, & Vitamin D level, as deficiencies of these minerals & vitamins can certainly cause cramps. If these are normal, you might also need further tests to include: thyroid studies (TSH & T4), muscle studies (such as a CPK & an LDH), & tests for connective tissue disorders (such as an ANA, Rheumatoid Factor, & Sed rate). I had a patient with severe cramping, & as I could not help her, she sought a Neurologist for another opinion. The above work-up came from him, so I learned some tricks! If any of the labs show a significant abnormality, that should be further evaluated, but as is often the case, my patient had no abnormalities. The Neurologist treated her with a muscle relaxant (such as Flexeril or Skelaxin) at bedtime. I know that the old remedy was Quinine, but many of the over-the-counter products with Quinine have been taken off the market. Not to fear! If you want to try Quinine, look no further than your local liquor store where you can purchase Quinine water, & try several ounces just before bedtime! If you don't like the taste or need to limit your fluids, perhaps you can find a pill with Quinine, such as Hyland's Leg Cramps with Quinine. Lastly, as I am a fan of old remedies, some of my patients tell me that putting a bar of soap in the bed near their feet stops the cramps... to which I say, why not try it???
One point of interest is the fact that you should not just increase your intake of vitamins or minerals without first discussing with your doctor, as some are toxic in excess. In other words, you can actually overdose on certain vitamins & minerals! The potentially toxic vitamins are the ones that are fat-soluable, so they can "build up" in your body. These are Vitamins A, D, E, and K, so if you take them in doses above the recommended daily amount (=RDA), be sure to occasionally check a blood level. Minerals such as potassium & calcium can also lead to problems if taken in excess, & in fact I believe the Veterinarians still use Potassium as the injection for euthanasia, as it causes the heart to stop beating when given in a large amount intravenously!
Mandy asked about why she might have lactose intolerance. Well, first, lactose is the sugar found in dairy products, such as milk & ice cream. Lactase is the enzyme which digests or breaks down the lactose. Babies obviously have lactase, but evolutionarily it is not necessary to have this enzyme once you get teeth... as that is when your mother generally stops breastfeeding you! Though many people have this lactase enzyme all their lives, others lose it... at varying ages... & thus become lactose intolerant. Without the enzyme to breakdown the lactose, this sugar passes through the intestines & ferments, leading to gas, cramps, & diarrhea! Thus lactose intolerance is not really a disease process, though it can really make you feel bad! If you are unfortunate enough to have lost your lactase enzyme, I recommend you try getting some lactase pills from the health food store. You take these pills with the dairy product, thus correcting your deficiency, & thus appropriately digesting the lactose before it ferments! Though this doesn't work for everyone, it does work for many, so give it a try! You might also want to try Lactaid which is a milk that already has the digestive enzyme in it.
Our last topic was in regards to a 51 year old gentleman who has sleep problems. Time did not permit a long conversation nor a long answer, but perhaps we can delve into this deeper in the future! The short answer was that not sleeping well might just be a nuissance OR it can be a significant health issue! Some people have what is called "poor sleep hygiene" which means that they do things which keep them from sleeping well. This might include: watching TV in bed, reading a book in bed, falling asleep on the couch (only to awaken later & have to get yourself to bed after you lock the door, brush your teeth, etc.), & sleeping with pets or partners who make noises which awaken us. My sleep specialist has a rule that the bed is for sleep & sex, but nothing else! When you go to bed, you go to sleep! Do not lay in it awake reading a book or watching TV, as your mind can get confused if you do not give it proper clues as to when it is appropriate to sleep. By the same token, you must have quiet & dark, so try to create this in your bedroom. If your pets, partner, or neighbors are noisy, try earplugs! Certainly a Sleep Doctor can help you further with these techniques, but more importantly he can help diagnose more severe sleep issues such as sleep apnea. Sleep apnea is a common problem, especially in overweight people, & it is associated with high blood pressure & premature death! It is caused by obstruction of the airway, so literally you stop breathing during your sleep. When the brain perceives it desperately needs oxygen, it arouses you & you take a big gasp to open your airway. This results in you awakening briefly, but you re-establish breathing... at least briefly. This cycle repeats through the night, resulting in you having stressed your heart & body with the low oxygen episodes. As a result of your multiple arousals, your body does not get into deep sleep, & in the morning you feel as if you never slept! This results in daytime fatigue & sleepiness. If this sounds like you, I suggest you see your doctor & consider getting a sleep study to see if you indeed have sleep apnea, as it can often be successfully treated with something called CPAP which provides pressure to keep your airway open. Weight loss is often helpful, & in rare cases surgery is necessary. As a last thought, do not use alcohol to help you sleep! It will cause you to "pass out" but it does not cause you to sleep... in other words, you do not go through the proper sleep cycle, so you will not feel well rested!
Here's to our health!
Doctor Gigi
PS Feel free to check out the radio show at 1PM Eastern time on Fridays via www.SkipShow.com or listen to the podcasts via the same site. If you want to be a part of the show, call me live at (727)-441-3000 or toll-free at (866)-TAN-1340.
Several people were apparently a bit offended by the conversation Skip & I had the week earlier when we discussed weight loss. There is a new weight loss drug available, & I believe it will help certain people with obesity. The drug is named Q-Nexa, & you can refer to last week's blog for more specific information regarding what it is & how it works. During our conversation we discussed that diet & exercise are still utterly important to achieve longlasting weight loss, & some felt that we were insinuating that a person who is overweight is that way due to his or her own choosing or fault. It is not necessarily a person's fault if he is overweight, but without making appropriate dietary changes & without doing some form of exercise, it is not likely that he will lose weight & keep it off. A few helpful hints will follow, but if you truly struggle with obesity, consider seeing a dietician to help review your eating habits, as you might not know what you are doing wrong, AND consider beginning some sort of exercise regimen. I tell my patients to be sure to eat 3-6 times per day, as people who "graze" tend to be thinner than those who eat 1-2 times per day. Of course, you need to eat small meals, so I sometimes recommend dividing each meal into 2 meals. Thus you would eat 1/2 of your breakfast, then finish the other 1/2 about 2 hours later. You would do the same with lunch & supper. Also, try to include protein in every meal as protein makes you feel full, whereas carbohydrates make you hungry shortly after eating. Remember that fats have more calories per gram so eat less of them... carbs & proteins each have 4 calories per gram, whereas fats have 9 calories per gram! Also, do not eat "empty calories"... these are foods that have calories, but essentially no nutritional value... such as soda, sweet tea, & alcohol. As for exercise, you don't need to run a marathon, you just need to expend more energy than you are right now. It is simple & free to take up a walking program. Start walking slowly, & increase the speed & distance as you get in shape. Try to talk or sing as you walk, as that actually uses more energy, or better yet, carry a 1-2 pound weight in each hand & swing your arms as you go. If you need more structure, consider joining a gym such as You Fit (which is fairly inexpensive & seems to attract REAL people rather than just those who look like they don't really need to go to the gym!). Though I can give all these helpful hints, I know from personal experience that it is not easy to lose weight... I have been to weight loss clinics, & I have had a suction lipectomy to remove fat from my hips & thighs... I have even worked in weight loss clinics. But... I am still overweight & don't like my body! It does seem that I have to work hard to lose 5 pounds, but by the same token I don't gain more than about 5 pounds even when I eat poorly & "forget" to exercise. It is as though my body just likes weighing about 135-145 pounds! So I agree that there is more to obesity than just calories in (what you eat) & calories out (what you exercise off). No one seems to have a grip on that yet however, so for now, your best weight loss success will likely come from a combination of good dietary choices & good exercise habits, both of which should be done for a lifetime, & brief episodic use of medications like Q-Nexa.
There was a brief discussion regarding food labels. I am not a nutritionist, so I am not an expert in regards to this! I do know however that the most misunderstood part of the label is the "serving size." This often leads us to make bad choices & to overeat, so let's talk about it briefly. The serving size is of course what the food producer feels is an appropriate serving, but the misunderstanding comes when we assume that the entire package is ONE serving! For example, a Big Gulp is a 32 ounce soda, but one serving of soda is likely 8 ounces. So you must look at the label & do a little math. If a serving size is 8 ounces & that has 150 calories, then you must realize that if you drink the whole Big Gulp you will get FOUR servings, & thus 4 times the calories... which is 600 calories! Apparently, the Mars company recently agreed that people do not understand serving size & have agreed to stop producing king size candy bars in an attempt to help America with her obesity dilemma! Their candy bars will be sized to an appropriate serving, so people will hopefully eat less & get less calories. If you want more calories you can eat 2 or 3 bars, but you will be more likely to understand the number of calories you are getting in this manner.
A gentleman wrote a note requesting help for his wife who often awakens with severe leg cramps. Though this is a common complaint it is not one for which we have a great answer. I suggest that someone with significant nighttime leg cramps should discuss this with his physician, who in turn will hopefully order blood tests. Generally these tests should include: a Calcium, Magnesium, Potassium, Phosphorus, & Vitamin D level, as deficiencies of these minerals & vitamins can certainly cause cramps. If these are normal, you might also need further tests to include: thyroid studies (TSH & T4), muscle studies (such as a CPK & an LDH), & tests for connective tissue disorders (such as an ANA, Rheumatoid Factor, & Sed rate). I had a patient with severe cramping, & as I could not help her, she sought a Neurologist for another opinion. The above work-up came from him, so I learned some tricks! If any of the labs show a significant abnormality, that should be further evaluated, but as is often the case, my patient had no abnormalities. The Neurologist treated her with a muscle relaxant (such as Flexeril or Skelaxin) at bedtime. I know that the old remedy was Quinine, but many of the over-the-counter products with Quinine have been taken off the market. Not to fear! If you want to try Quinine, look no further than your local liquor store where you can purchase Quinine water, & try several ounces just before bedtime! If you don't like the taste or need to limit your fluids, perhaps you can find a pill with Quinine, such as Hyland's Leg Cramps with Quinine. Lastly, as I am a fan of old remedies, some of my patients tell me that putting a bar of soap in the bed near their feet stops the cramps... to which I say, why not try it???
One point of interest is the fact that you should not just increase your intake of vitamins or minerals without first discussing with your doctor, as some are toxic in excess. In other words, you can actually overdose on certain vitamins & minerals! The potentially toxic vitamins are the ones that are fat-soluable, so they can "build up" in your body. These are Vitamins A, D, E, and K, so if you take them in doses above the recommended daily amount (=RDA), be sure to occasionally check a blood level. Minerals such as potassium & calcium can also lead to problems if taken in excess, & in fact I believe the Veterinarians still use Potassium as the injection for euthanasia, as it causes the heart to stop beating when given in a large amount intravenously!
Mandy asked about why she might have lactose intolerance. Well, first, lactose is the sugar found in dairy products, such as milk & ice cream. Lactase is the enzyme which digests or breaks down the lactose. Babies obviously have lactase, but evolutionarily it is not necessary to have this enzyme once you get teeth... as that is when your mother generally stops breastfeeding you! Though many people have this lactase enzyme all their lives, others lose it... at varying ages... & thus become lactose intolerant. Without the enzyme to breakdown the lactose, this sugar passes through the intestines & ferments, leading to gas, cramps, & diarrhea! Thus lactose intolerance is not really a disease process, though it can really make you feel bad! If you are unfortunate enough to have lost your lactase enzyme, I recommend you try getting some lactase pills from the health food store. You take these pills with the dairy product, thus correcting your deficiency, & thus appropriately digesting the lactose before it ferments! Though this doesn't work for everyone, it does work for many, so give it a try! You might also want to try Lactaid which is a milk that already has the digestive enzyme in it.
Our last topic was in regards to a 51 year old gentleman who has sleep problems. Time did not permit a long conversation nor a long answer, but perhaps we can delve into this deeper in the future! The short answer was that not sleeping well might just be a nuissance OR it can be a significant health issue! Some people have what is called "poor sleep hygiene" which means that they do things which keep them from sleeping well. This might include: watching TV in bed, reading a book in bed, falling asleep on the couch (only to awaken later & have to get yourself to bed after you lock the door, brush your teeth, etc.), & sleeping with pets or partners who make noises which awaken us. My sleep specialist has a rule that the bed is for sleep & sex, but nothing else! When you go to bed, you go to sleep! Do not lay in it awake reading a book or watching TV, as your mind can get confused if you do not give it proper clues as to when it is appropriate to sleep. By the same token, you must have quiet & dark, so try to create this in your bedroom. If your pets, partner, or neighbors are noisy, try earplugs! Certainly a Sleep Doctor can help you further with these techniques, but more importantly he can help diagnose more severe sleep issues such as sleep apnea. Sleep apnea is a common problem, especially in overweight people, & it is associated with high blood pressure & premature death! It is caused by obstruction of the airway, so literally you stop breathing during your sleep. When the brain perceives it desperately needs oxygen, it arouses you & you take a big gasp to open your airway. This results in you awakening briefly, but you re-establish breathing... at least briefly. This cycle repeats through the night, resulting in you having stressed your heart & body with the low oxygen episodes. As a result of your multiple arousals, your body does not get into deep sleep, & in the morning you feel as if you never slept! This results in daytime fatigue & sleepiness. If this sounds like you, I suggest you see your doctor & consider getting a sleep study to see if you indeed have sleep apnea, as it can often be successfully treated with something called CPAP which provides pressure to keep your airway open. Weight loss is often helpful, & in rare cases surgery is necessary. As a last thought, do not use alcohol to help you sleep! It will cause you to "pass out" but it does not cause you to sleep... in other words, you do not go through the proper sleep cycle, so you will not feel well rested!
Here's to our health!
Doctor Gigi
PS Feel free to check out the radio show at 1PM Eastern time on Fridays via www.SkipShow.com or listen to the podcasts via the same site. If you want to be a part of the show, call me live at (727)-441-3000 or toll-free at (866)-TAN-1340.
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