07 Oct

A Cardiologist’s Exclusive Guide to 5 Favorite Vitamins and Supplements

The demands of the modern world take a heavy toll on our body.

Lack of sleep, stress as well as a diet filled with processed foods wreak havoc on our internal machinery. Our body may suffer not only from lack of vitamins and minerals, but also coenzymes which are metabolic buddies needed to produce energy, promote bodily functions and cell growth and prevent aches and pains from which we often suffer.

Food is an excellent source of vitamins and minerals. But those rich in particular nutrients are not always our favorites. And we tend not to eat enough of them to get the results our body needs for a healthy lifestyle.

Coenzyme Q10 (CoQ10): The Energizer Vitamin

A good example is Coenzyme Q10 (CoQ10). Our body normally produces a small amount of CoQ10 but our lifestyle and certain medications may decrease our natural supply. CoQ10 is abundant in organ meats, which we may not normally include in our diet. It is also found in beef, mackerel, and sardines.

How often are you willing to eat liver and sardines?

When Coq10 is lacking, we may feel a lack of energy as well as muscle aches and pains.

And if we are on statins for cholesterol, beta blockers for blood pressure, diuretics such as furosemide, antibiotics or hormones, these deficiencies are often more pronounced and supplementation is essential.

Vitamin CoQ10 or its biologically active form, Ubiquinol, can easily be found in the vitamin section of the pharmacy or supermarket.

Top Five Favorite Vitamins and Supplements

A top vitamin on my list of favorites is Vitamin K2 which helps prevent chronic disease and maintain your cardiovascular health, strengthen your bones, promote cognitive health and even improve your skin. By the way, there is actually a Vitamin K1, which we learned about by accident. For years, people who took coumadin (warfarin) were advised to limit their vitamin K intake as it potentially counteracts the anticoagulant properties of warfarin. Unbeknownst to researchers, Vitamin K comes in two varieties. Vitamin K1 counteracts the effects of warfarin. But Vitamin K2 pulls calcium out of arteries and puts it back in your bones and has nothing to do with coagulation. So we were advising patients to avoid foods like green leafy vegetables, dark chicken meat and egg yolks which are excellent sources of Vitamin K2.

Magnesium is another underrated mineral which has been known to prevent cramps in your legs, calm your nerves and lower your blood pressure. Avocados, dark chocolate, nuts, seeds, tofu, legumes and bananas are tasty sources of magnesium. But you may not be getting enough of it even with a healthy diet. A simple blood test can determine if you need more or less of this simple nutrient.

As a cardiologist, I am also a fan of the more well-known supplement Omega-3 fatty acids which lowers triglycerides and helps with sugar breakdown. Don’t let the word fat in the name be a deterrent since this is one fat you absolutely want to include in your diet. Found in fish such as mackerel, herring, oysters, sardines, salmon as well as nuts, flaxseeds and cod liver oil, omega-3 fatty acids may curb stiffness and joint pain and is important for visual and neurological development in babies and dry eyes in adults. When possible, try to get omega-3 fatty acids from foods rather than supplements. But if fish is not your favorite, then a supplement may be a consideration. A word of caution: make sure you buy this supplement from a reliable source as some brands may not be free of heavy metal impurities.

Equally well known is Vitamin D3 which we believe is essential for calcium balance and strong bones. Less well known but equally as important is the role Vitamin D plays in reducing cardio-vascular disease as well as stroke and peripheral vascular disease. Vitamin D sources include sun exposure and your diet. Cheese, egg yolks, sardines, fortified orange juice, milk and yogurt as well as canned tuna are excellent sources of Vitamin D. But getting enough Vitamin D through your diet alone is challenging. Most adults should have their levels checked with their physician before starting any supplement.

Let’s end with Vitamin B complex, nutritional supplements which have all eight B vitamins which are essential in producing energy and lower levels of inflammatory markers.

Good new. B vitamins are found in many foods like meat, dairy, eggs and seafood.

If you are eating well, you are probably covered except during pregnancy where your body demands more B12 and folate to support fetal development. Some medications do interfere with the absorption of Vitamin B and some of us with certain medical conditions are susceptible to nutrient deficiencies.

When it comes to your health, there is no one size fits all. Multivitamins may seem like a quick and easy answer. But research shows that men who take a daily multivitamin have an increased risk of developing prostate cancer. While causality has not been established, I personally am not a fan of the shotgun approach. Take the time to talk to your physician and create a targeted therapeutic plan to balance the heavy toll life takes on our body.

Together we can balance all our individual health needs and wants and create a comprehensive strategy to a perfect “Vitamin You.”

Types of Headaches
02 Aug

Not Tonight Dear: Common Types, Causes and Treatment of Headaches

America’s got headaches.

It’s a well-documented fact. Just look at the statistics.

It is estimated half of the adult population suffers from run of the mill headaches at least once a year. According to a population-based US government survey, 1 out of 6 Americans and 1 out of 5 women suffer from severe headaches and migraines. This statistic has not changed for the past 20 years.

Interestingly, headaches are more prevalent in younger adults than in seniors than and twice as high in women as in men.

Who knew there were so many different types of headaches?

According to The International Classification of Headache Disorders (ICHD) there are more than 150 different types of headaches which are divided into two main categories: primary and secondary.

Primary Headaches

Migraines and tension headaches are considered primary headaches since they are conditions in themselves. Tension headaches are fairly common and usually resolve fairly quickly with the passage of time and over-the-counter pain killers.

A migraine is a more severe kind of headache that occurs when there is vascular instability. Patients with migraines report having an aura before suffering this malady, which means they may see flashing light, experience nausea or sensitivity to bright light. The pain or symptoms can last anywhere from a few hours to a few days.

Cluster headaches are recurrent, severe headaches which are six times more likely to develop in men than women. Often characterized by a burning pain behind the eye, they often occur without warning and usually take place at the same time of day and are induced by stress.

Other primary headaches include exertional headaches brought on by strenuous exercise and hypnic headaches which is also known as an “alarm headaches” since it wakes you up in the middle of the night.

Secondary Headaches

As for secondary headaches, those are related to a head injury, caffeine withdrawal, medication overuse, sinus, menstrual and hangover headaches.

Causes

There are many factors which can trigger a headache or a migraine. External factors such as weather conditions, persistent loud noises or music, fragrances or carbon monoxide poisoning are possible contributors. Stress, sleep apnea, alcohol, vision problems or eye strain and dehydration are also known contributing factors.

The Food Factor

Food or lack of it can be a trigger for a headache or migraine.

Food triggers are often specific to individuals. What triggers a migraine in one person may not do the same to others.  In my experience, foods containing Monosodium glutamate (MSG) or nitrates since they are vaso-active substances are very common triggers. Other foods which commonly cause migraines include caffeine, spicy foods, aged cheese and even chocolate.

I have a patient who had consistent headaches after seeing a movie in a movie theatre. The trigger: movie-theater popcorn, a bummer since that was her favorite part of the movie experience.

Treatment Options

The most common treatment for a headache is over-the-counter medications such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) and aspirin. For migraines or any severe repetitive headache, it is best to schedule an appointment with a neurologist or migraine specialist. There are a variety of prescription medications to both treat and prevent migraines including sumatriptan (Imitrex) and zolmitriptan (Zomig). Some of my patients have found success with Botox, stress reduction, yoga and massage.

So next time your wife says, “Not tonight dear, I have a headache,” you can take comfort in the fact you are not alone. It’s part of being an American.

02 Jul

3 Reasons Binge Watching is Bad for Your Health

You wake up in the middle of the night and cannot go back to sleep. Tossing and turning is making you anxious. So you turn on the TV and catch up on the latest Netflix series.

Here’s another typical scenario. You have FOMO (Fear Of Missing Out) because everyone at your office was watching Game of Thrones and you never did. Now you are trying to figure out what all the hoopla was about by watching four episodes a night.

Just FYI, it’s going to take you a while. There are eight seasons.

Binge watching occasionally? No problem. Like everything else in life, moderation is key. But regular binge watching is a poor lifestyle choice with at least three major health consequences.

Consequence #1: A sedentary lifestyle is deleterious to your overall health.

Multi-episodic TV watching means you are sitting for long periods of time. And being sedentary is a significant public health issue.

According to the Center for Disease Control (CDC), “Only 21% of adults are meeting the physical activity guidelines of 150 minutes of moderate-intensity physical activity each week and less than five percent perform 30 minutes of physical activity per day.”

Recent research confirms how a sedentary life can lead to obesity, type 2 diabetes, stroke, cardiovascular and metabolic disease and even an increased risk of death.

If that is not enough to get you to turn off the TV and leap out of your recliner, couch potatoes have a high incidence of depression and other mental health disorders.

Consequence #2:Your TV emits blue light which may negatively impact your eye health and sleep cycle.

Binge watching can lead to poor sleep quality, increased fatigue, eye strain and insomnia. Blame it on the blue light. According to Hollywood Ophthalmologist Inna Ozerov MD, “Blue light is part of the visible light spectrum, with wavelengths of about 415 nm to 495 nm. Blue light can be divided into two bands: blue-violet light (415-455 nm) and blue-turquoise light (465-495 nm).  The largest source of blue light is the sunlight but computer monitors, cell phones, tablets, TV screens all emit blue light.  Recent studies have found that Blue-violet light may cause harm to the delicate cells that make up the retina and may be implicated in the development of age-related macular degeneration or AMD.”

It can also delay the release of melatonin, the hormone which regulates sleep and reset your circadian rhythm. The result is sleep deprivation which can lead to fatigue, depression, memory issues and even heart problems.

Consequence #3: Binge watching can lead to binge eating.

Binge watching and binge eating often go hand in hand. From personal experience, binge watching is often associated with poor snack choices.A reasonable portion of anything on an occasional basis is not a cause for concern. However, most of us are not preparing stacks of celery sticks to munch on as we get cozy comfy on the couch. And while air-popped popcorn with no added sugar or salt is low in calories and high in fiber, oil-popped, flavored popcorn can be a slippery slope. Mindless snacking, even on so called “healthy choices” can lead to obesity and the related medical consequences.

In the mood to mindlessly binge watch or have a chunk of time on your hands? Break it up. Watch an episode and then throw in a load of laundry, grab your mat and do some sit-ups or run an errand. If the binge takes place at night, limit yourself to one episode before disconnecting and trying to fall asleep.

Finally, if you must binge watch, invite others to join you and make it a social occasion. Just don’t forget to serve the celery sticks.

13 Jun

How to Lose Your Veins in Ten Days

You’re so “vein,” I bet you think this blog is about you… and it is.

For many, varicose veins are an issue of cosmetics. Most are not aware these prominent sinewy (a favorite word of mine) vessels can cause pain, swelling and ultimately skin breakdown and ulceration. Many may experience leg heaviness and tightness.

And by the way, it is not just women. Men are equally as affected.

The Cause of Varicose Veins:

So how does one end up with this vascular problem? For one, blame your genes. You are more likely to develop varicose veins if your parents had them…and we are not just talking about mom. Another risk factor is trauma which destroys the native valves which live in your veins which are responsible for moving blood back to your heart. When they malfunction, blood moves in the wrong direction, causing the veins to dilate and become snakelike.

Obesity is another cause. Excess weight caused by the pressure of your belly pushes blood flow backwards and blows out those necessary valves.

The Old Guard Treatment for Varicose Veins:

Conservative measures such as compression stockings have been the mainstay of treatment for decades. Although these elastic hosiery may take care of the symptoms of varicose veins, improve circulation, prevent them from getting worse and even hide them, their constricting existence during the hot months makes them an unwelcome and annoying presence.

There is a supplement which may help improve your venous tone, horse chestnut extract, while use may be helpful, it is not curative. In days of yore, surgical options such as vein stripping were used to remove them. The treatment, albeit effective, was quite barbaric as it required a number of incisions along the length of the vein and after it was tied off, the vein would be removed segment by segment, pulling it out of the leg. Recovery was brutal.

The New Guard Treatment for Varicose Veins:

More recently advances in catheter technology have allowed doctors to laser, burn out or glue these veins shut. Such procedures are less invasive, less painful, and allow for a quicker recovery time. One or two veins at a time in 30-45 minutes session and most people go back to their normal activities thereafter. Most patients do fine long term so if you are plagued by varicose veins, see a specialized health care provider trained to identify and treat these conditions which are diagnosed by a non-invasive ultrasound.

“My legs have always been unsightly and having babies made the veins even more pronounced. I hesitated to do the surgery but I after my last baby, I opted for this newer treatment and I am thrilled. I even started wearing shorts.”

Christina R, Age 35, Davie Florida

To schedule a vein consultation, please call 954-980-0361. Your legs will thank you!

20 May

Is Using A CPAP Machine On Shabbos Permissible?

In recent years an increased number of people have been diagnosed with sleep apnea. Indeed, experts estimate that three to nine percent of the general population suffers from its most common form, Obstructive Sleep Apnea (OSA).

A person with OSA stops breathing periodically during sleep, which causes deep (and loud) snoring and deprives the brain of oxygen. Untreated sleep apnea puts a person at greater risk of high blood pressure, stroke, heart failure, diabetes, obesity, and depression. It may also severely impact one’s executive function and ability to stay awake during daily activities such as driving.

Dr. Adam Splaver, a clinical cardiologist in Miami, FL, describes the risks of sleep apnea as follows: “When you have obstructive sleep apnea, you are becoming hypoxic for extended periods of time. This causes rise in blood pressure [and] irritates the electrical system of the heart, causing atrial fibrillation and starving your other vital organs of life-nourishing oxygen, including your brain. Patients can wake up foggy with a headache and, in some circumstances, cause irreparable damage if a stroke or heart attacks occur.”

Numerous factors determine whether a person will get OSA, including age, neck size, the shape of one’s septum, allergies, sinus problems, obesity, and family history. Men get it more than women.

Those who suffer from sleep apnea are often encouraged to change their behavior or life-style; take medication to clear the nasal passages; or even have surgery. The “gold standard” treatment, however, is sleeping with a CPAP machine.

A CPAP (continuous positive airway pressure) machine is a ventilator device attached to a mask worn over the nose which provides mild air pressure to keep one’s airways open. Some machines have a humidifier as well, used to lessen nasal congestion, dryness, and rainout. The continuous flow of air prevents the throat and nasal passages from closing and allows a person to sleep without risk of repeatedly waking up during the night.

Potential Halachic Problems

Doctors insist that OSA patients should use their CPAP every night, including Shabbos and Yom Tov.

Rabbi Dr. Mordechai Halperin, chief officer of medical ethics for the Israeli Ministry of Health and director of the Falk Schlesinger Institute for Medical-Halachic Research in Jerusalem, told this author that a person who needs a CPAP should be treated like one whose life may be in danger if he doesn’t follow medical instructions. Therefore, he argues, using a CPAP is allowed on Shabbos.

If one can, one should turn the machine on before Shabbos or set a Shabbos timer for it to turn on when it’s needed. The problem is that some models only start working once a person places the mask on his face. Furthermore, breathing into a CPAP machine causes a screen to display numbers, and some machines record details on an installed chip. Finally, the machine increases and decreases air pressure in response to the person’s breathing.

To address all these potential halachic problems, we need to first, briefly, summarize the laws of electrically-operated machines and ill individuals on Shabbos.

Cholim on Shabbos

In general, one is permitted to perform any melacha normally forbidden on Shabbos to save of the life of a person whose life is in danger (i.e., a choleh she’yesh bo sakanah). We violate Shabbos for such an individual even if we’re not sure that his life is truly in danger and even if it’s possible that treatment can be delayed until after Shabbos (Mishnah Berurah 328:16). The Rema (Orach Chayim 328:12) rules that, if possible, one should try to perform the prohibited melacha in an unconventional manner (i.e., with a shinui).

If the person is sick but his life is not in danger (choleh she’ein bo sakanah), we may ask a non-Jew to perform a biblically-prohibited act or do a rabbinically-prohibited act ourselves in an unconventional manner (Rema, ibid. 17).

Some Acharonim (see Chayei Adam 69:12) rule that if one is unable to perform the necessary task in an unconventional manner, one can do so in a conventional manner. In addition, some Acharonim, including the Baal HaTanya (Shulchan Aruch HaRav 328:19; see also R. Shlomo Zalman Auerbach, cited by Shemiras Shabbos KeHilchasa, 3rd edition, 33:3 footnote 18) permit performing even a biblical prohibition in an unconventional manner to aid a choleh she’ein bo sakanah.

Finally, Acharonim explain that these principles apply also when trying to prevent future illness (see below).

Electricity on Shabbos

Acharonim have debated the halachic status of using electricity on Shabbos for over 100 years. The most significant debate relates to turning on and off an electric machine. The Chazon Ish (Orach Chayim 50:9) insists that completing a circuit constitutes the biblically forbidden melacha of boneh (building), and R. Asher Weiss (Minchas Asher 1:32) offers other reasons why using certain electric appliances may violate a biblical prohibition.

Most poskim, however, rule that using electricity is only rabbinically prohibited (see, for example, R. Shlomo Zalman Auerbach, Minchas Shlomo 74, 84).

What about increasing or decreasing a machine’s electric current once it’s already on? R. Shlomo Zalman Auerbach (Shmiras Shabbos Kehilchasa 1:23 n. 137) rules that “shinuy zerem” – i.e., changing the degree of electric current – is permitted. Thus, Shemiras Shabbos KeHilchasa (4:28) permits increasing or decreasing the volume of a hearing aid, for example.

Using a CPAP on Shabbos

Obviously a person who is dangerously ill may – indeed, must – violate Shabbos. But someone suffering from OSA may only be at risk of being seriously ill months or even years from now if he doesn’t use a CPAP. Can such a person violate Shabbos?

Most poskim (see R. Asher Weiss, Minchas Asher 1:30) maintain that breathing into a CPAP is fine as long as the machine is turned on before Shabbos or via a Shabbos timer. It’s true that breathing into it also alters the digital display, and data is often recorded onto a chip, but there are numerous reasons to be lenient on this question.

First, the patient does not intend to, and is not particularly interested in (lo neicha lei), affecting the display and the information recorded, which are, in any event, rabbinic prohibitions. (While most agree that turning on an incandescent light, which heats a metal filament until it glows, is biblically prohibited [see Rambam, Hilchos Shabbos 2:1], turning on a fluorescent or neon light, which do not use heat, is generally regarded as a rabbinic prohibition.)

Second, R. Asher Weiss (ibid.) argues that none of the normal reasons to prohibit electricity apply in this case. (He also permits prisoners to wear ankle bracelets, which record their movements on Shabbos.)

May a CPAP be activated on Shabbos? Rabbi Dr. Avraham Sofer Abraham (Nishmas Avraham, Orach Chayim 328) asserts that a person who may face medical harm in the future is considered to be a choleh she’yesh bo sakana and therefore rules that the patient should, if necessary, “turn on the machine in an unusual way, such as with the back of his hand, and when he rises he should leave the machine on until after Shabbos.”

The Star K (Kashrus Currents, winter 2010) records that R. Heineman also permits using a CPAP on Shabbos, although based on a slightly different reasoning. R. Heinemann insists that a person with a condition that is cumulatively life-threatening is in no less danger than a choleh she’ein bo sakanah, and therefore a person with sleep apnea can activate a CPAP with a shinui.

As for machines that are activated by breathing into them (and for which it is difficult to find an appropriate shinui), R. Heineman invokes the Chayei Adam (cited above) and rules that one may violate a rabbinic prohibition in a normal manner when doing so with a shinui is not possible.

R. Yitzchak Rubin (from Har Nof) and R. Yitzchak Ziberstein, posek of Maayanei HaYeshua Hospital in Bene Berak (Heichala v. 4, 5774) debated using CPAPs on Shabbos. R. Rubin writes that it is difficult to offer a general ruling and concludes that one should consult one’s doctor and posek. R. Zilberstein, however, views OSA as a condition that is safek pikuach nefesh and therefore rules that a patient suffering from it may turn on a CPAP in an unconventional manner. If his doctor tells him the machine must be activated normally, he can turn it on in a normal manner, writes R. Zilberstein.

As mentioned earlier, some machines use a humidifier. Heating water to a temperature above yad soledes bo violates the biblical prohibition of bishul (cooking) and, therefore, the CPAP’s temperature setting should be lowered before Shabbos so that the water won’t be heated above yad soledes (110 degrees Fahrenheit according to R. Moshe Feinstein – see Igros Moshe, Orach Chayim 4:74).

In conclusion, while it is preferable to turn on a CPAP before Shabbos, or set a timer to turn it on when needed, many poskim maintain that one may turn it on in an unusual manner on Shabbos and, if necessary, even place the CPAP mask over one’s face, which turns on the machine. Those seeking practical guidance should discuss this matter with a doctor and halachic authority.

Read more: https://www.jewishpress.com/judaism/halacha-hashkafa/is-using-a-cpap-machine-on-shabbos-permissible/2019/05/20/

12 Apr

Will an Aspirin a Day Keep the Doctor Away?

For many years it was common to advise seniors to take a daily dose of aspirin to prevent a heart attack, stroke, and other cardiovascular complications.

It seemed to be working. Not any more. As more data has accumulated, the old adage, Take two and call me in the morning,” has come into question.

Based on the latest research, the American College of Cardiology and the American Heart Association is advising against daily aspirin use for prevention because, “It may actually cause more harm than good.”

For decades, we prescribed aspirin to preclude clot formation, a forerunner to a heart attack or stroke, and based on the then “current studies,” we thought a low dose of aspirin was a perfect preventative measure. But as time passed and more data was accumulated, it became noteworthy that more people were having bleeding complications. It seems we were creating more health havoc through a simple prevention tactic. While the benefits of this wonder drug were pushed, many suffered the consequences of having thin blood, internal bleeding, strokes and other manifestations of blood loss.

The daily dose of aspirin is no longer recommended for older adults who don’t have a high risk or existing heart disease. Instead, the focus is on promoting a healthy life style and reducing those lifestyle factors which can be modified such as smoking, diet and exercise.

It has also proven beneficial for any individual of any age who has already had a heart attack, stroke, or vascular intervention like stents or angioplasty. The benefits far outweigh the risks.

Though currently out of vogue, the history of aspirin is still fascinating. Aspirin comes from the bark of the willow tree and has been known for centuries for its healing properties. Records dating as far back as 3000 BC corroborate the medicinal properties of the willow as a pain reliever used by ancient civilizations like the Sumerians and Egyptians. The Greeks administered it in tea form to help relieve the pain of childbirth in the year 300.

Fast forward to 1828 when a pharmacy professor in Germany extracted the active ingredient, salicin, from the willow tree. In a clinical trial in the late 1800s, salicin was found to reduce fever and joint inflammation in patients with rheumatism. About the same time German Pharmaceutical Company Bayer figured out how to purify the salicylic acid with acetic acid, aka vinegar. They patented ‘acetylsalicylic acid’ as ‘aspirin’, a brand name which became generic like Kleenex, Xerox and Scotch tape.

This brings us back to modern times where aspirin is still one of the most researched drugs in the world, with more than 700 clinical trials conducted each year. 

Back to the new guidelines for aspirin. Here’s a word of advice: People who were taking the aspirin proactively should not stop it cold turkey but speak to their medical professional.

Case in Point: I have a patient in his 50s who read the news and stopped taking the aspirin despite his history of stents and angioplasty. Several weeks later he was rushed to the emergency room with a heart attack as a clot had formed in one of his coronary arteries. He lived to tell his story and be a warning to all considering taking their health into their own hands.

But for anyone who has had a heart attack, stroke or any cardiovascular-related disease, the standard dose of aspirin taken proactively can be a lifesaver.

And you don’t need to wait until the morning to call me.

18 Mar

50 Ways to Leave Your Doctor (Ok Only Four)

One day, I ran into a patient, a long term patient whom I had been treating since he turned 40. He was now on his mid-50s and I realized I had not seen him in the office for ages.
While perception is reality, I chose to verify my instincts and checked the computer system. It turns out he had not been to the office for more than a year and there were electronic records from other physicians in his file.

The patient had obviously switched practices, but I was left wondering why?

Relationships are complicated and the one you have with your physician is no exception.

And despite rumors to the contrary, doctors are humans. We also have feelings.

Often patients fail to realize the connection we make with our patients, particularly those who have been under our care for extended periods of time. Sometimes we treat multi-generations of family members only to find one day they are no longer coming to our office for medical care.

As a patient, you have the right to leave a medical practice and find another. Your level of comfort with the physician and his staff as well as confidence in the quality of medical care is crucial.

And sometimes you may choose to leave for no reason at all. My goal is not to force you to stay but rather to share some professional ways to give your physician, “The Pink Slip.”

Here are my guidelines for professional “uncoupling”:

  • Bring it up! If something is amiss, let the physician know. While not every situation can be remediated, awareness is helpful.
  • Communicate. If you are unhappy and would like to switch practices, have a face-to- face conversation. Your feedback can only help our practice.
  • Tell a staff member. If you are unhappy or plan on switching practices and are uncomfortable sharing information with the physician, tell the office manager, medical assistant, nurse practitioner, physician’s assistant or front desk person and ask the individual to share the info with the doctor.
  • Send a letter or note directly to the doctor with the reason for your request. There is no need for a dramatic breakup. Just express your concerns in a calm and businesslike manner. Most docs find the info helpful, even if they find it hard to hear.

As physicians, there are some things are in our power to change. Others are not. If numerous patients are unhappy with a staff member, I prefer to know about it. Often I am unaware of the front desk dynamics because I am in the back office providing care. If poor bedside manner is problematic, it’s beneficial for me to know. If you simply moved away from the practice, allow me to wish you luck in your new location.

But some expectations are unrealistic. I cannot put you on an anti-biotic without seeing you or prescribe narcotics over the phone. I also cannot always control the wait time. It’s hard to estimate how many minutes to allocate to each patient. Things come up. But if the wait time is excessive, I would like to know.
In the process of saying goodbye, ask for a copy of your medical records. And have the physician renew your prescriptions so you don’t run out before the switch. Those two steps will ensure a smooth transition.

Trust me. I am a doctor.

01 Jan

Blown Away by the Common Cold?

Piffle! It’s only a sniffle!

No I did not make that one up.

Piffle! It’s only a sniffle! is the name of a famous children’s play. So famous in fact that Sex in the City Actress Kim Cattrall claims playing the role of a cold germ was a formative experience in her acting career.

But a cold is no child’s play.

It can start as a tickle in your nose, a scratchy throat, a subtle cough, a bothersome headache or a feeling of utter exhaustion.

Little invaders called viruses affect your mucosa, which are the linings of your airways. This process alerts your immune system that something is about to go down, big time and your immune system starts mounting an attack on these unwanted pests. In this process, chemicals are being secreted which help recruit or flag down and activate the various parts of the immune system. These substances are what cause your runny nose, cough and the all too pervasive snot and phlegm.

There are no official stages for a cold. Each cold is individual and follows its own path. Some last for hours, others for days or even weeks.

There is some evidence that topical zinc, like branded ZICAM® which coats your nasal or oral mucosa, may reduce the severity and duration of the symptoms. Other remedies that have anecdotal evidence for either masking symptoms or reducing the severity include elderberries, aged garlic, high doses of Vitamin C and D and good old-fashioned chicken soup.

But nothing beats rest, fluid, TLC and time.

It’s hard to totally prevent catching colds. Eating well, exercising and getting enough sleep are crucial components of building immunity. Washing hands is key, particularly after shaking hands with someone. And equally as important, refrain from touching your eyes and your face.

Sharing is not caring when it comes to colds so it’s best to be courteous when you are sick and refrain from shaking hands and spreading the love. Stay at home for a day or two. It does your body good and keeps the virus from spreading.

Because cold are from hundreds of different viruses, a cold vaccine is not on the horizon. So for the time being, grin and bear it…and cough it out.

It will eventually go away.

01 Oct

Is there hope for Dead Butt Syndrome?

Is there hope for Dead Butt Syndrome? Five Pro Tips to Revive Your Gluteus Medius

Let me start by saying that Dead Butt Syndrome is real. It even has a formal medical term, Gluteal Amnesia.

But before I go into the details let me share with you a little anatomy.

There are three gluteus muscles. Most of us are familiar with the gluteus maximus which is located in our buttocks and is responsible for the movement of our thigh and him.

What is Gluteal Amnesia?

Gluteal Amnesia, also referred to colloquially as dead butt syndrome, refers to a condition where the tendons of the gluteus medius (another one of the three muscles) becomes inflamed. The result is pain in your lower back, hip or knee.

This condition occurs in distance runners where the repetitive nature of their exercise can lead to tightness in the hip flexors, even more so in those who do not add weight training to their running routine.

There is also the belief that as we have evolved from a labor-intensive to a corporate sedentary lifestyle, many people are developing gluteal amnesia because we park out butts in our chairs all day. This leads to tight hip flexors and weak glute muscles. Poor posture contributes to the lack of glute activation. As a result, activities normally performed by the gluteus medius are now being performed by the hamstrings and lower back muscles. When your glute muscle loses strengths, it causes an imbalance leaving the other muscle groups to compensate. Pain is your body trying to compensate for the imbalance.

The good news is this condition is reversible but only by “working your butt off (pun intended.)

Here are five exercises recommended byJustinSeedman, a South Florida ACE Certified Personal Trainer, Health Coach, and founder of JustinFit, a concierge in-home personal training company, to revive and reverse dead butt syndrome:

  1. The Squat is a foundational exercise incorporated in many fitness programs targeting the lower body including the glutes.
    How to perform the perfect squat:

    • Stand with your feet shoulder-width apart.
    • Sit back and down like you’re sitting into an imaginary chair. Allow your lower back to arch slightly as you descend.
    • Lower your level until your thighs are as parallel to the floor if possible.
    • Keep your knees over your ankles.
    • Press your weight back into your heels.
    • Push through your heels to bring yourself back to the starting position.

    Perform 2-3 sets of 10 reps

    Tip: Use your couch. Don’t sit on the sofa but use it as a target as to how low to go. Hold a kettlebell or dumbbell to increase the difficulty of this exercise.

  2. Lunges are another first exercise for targeting the glutes. The lunge compliments the squat in a fitness program they are especially popular because they are easy on the back. Contrary to the squat the lunge allows a person to keep their back straight and chest lifted, placing less strain on the back.
    • Stand tall with feet hip-width apart.
    • Take a long step forward with the left leg landing with the heel first one the floor.
    • Lower body until left thigh is parallel to the floor and left shin is vertical.
    • Don’t allow your left knee to go past the left toe.
    • Press into the left heel to drive back up to starting position.
    • Repeat on the other side.
    • Perform two sets of 10-15 reps, alternative legs for an extra challenge.

    Tip: For anyone facing difficulty balancing hold on to a stationary object when performing the lunge. Hold a kettlebell or dumbbells to increase the difficulty of this exercise.

  3. Take your lunge to the next level with Step-Ups. This exercise combines the movement of the lunge with stepping upward on to a bench. This is another move that effectively targets the lower body especially the glutes, quadriceps, and hamstrings.
    • Begin with right foot on a bench.
    • Press through your right heel as you step up onto the bench.
    • Step up onto the bench with your left foot.
    • Return to the starting position by stepping down with the right foot, then the left, so both feet are on the floor.

    Perform 2-3 sets of 10-15 reps, alternative legs for an extra challenge. Hold a kettlebell or dumbbells to increase the difficulty of this exercise.

    Tip: This exercise can be performed using a sturdy chair if you don’t have a bench.

  4. The Hip Press is one the most beneficial exercise improving mobility and strength in hips and glutes.
    • Begin by laying on your back with your knees bend and heels and feet flat on the ground.
    • Keep your hands palms down, with your arms flat.
    • Press through your palms and heels, engaging your glutes, and lift your hips upwards.
    • Hold for 1-3 deep breathes.
    • Slowly lower back toward the ground.
    • Perform 2-3 sets of 10-15 reps

    Tip: At the peak of the movement there should be a straight line from your knees to your shoulders.

  5.  Lateral Band Walks are widely considered by personal trainers to one of the best booty exercises. To perform this exercise, you’ll need a set of Minibands. They can easily be purchased from the sporting goods section of Target or on Amazon.
    • Place a resistance band slightly below your knees.
    • Begin standing with feet hip width.
    • Squat approximately halfway down.
    • Step sideways with your right foot onto your heel rather than your toes.
    • Keep tension in the band as you bring your left leg slowly toward your right, returning to the starting position.
    • Perform 1-2 Sets of 20-30 reps

    Tip: Place bands over clothing to avoid irritation for the band

The best way to avoid developing this syndrome?

If you are a runner, add weight training to your routine. And if a sedentary lifestyle is the culprit, take breaks, walk around and stretch. Vary your work routine by alternating between sitting and standing to perform your office related tasks.

The effort may seem like a pain in the butt but the results may be maximus.

01 Sep

My Wife is Hot. The Room Is Cold:  Whose Perception is Reality?

My Wife is Hot. The Room Is Cold:  Whose Perception is Reality?

 Men are from Mars. Woman are from Venus. When it comes to body temperature, perception is actually reality.

There are generally three factors that affect your perception. The first is your tolerance. Moving to Florida affects your ability to handle the cold while moving to Alaska will affect your ability to handle heat.

The second is body fat which provides insulation. The more body fat, the greater your insulation. Brown Fat is also responsible for regulating your body temperature.Your body burns brown fat to make heat. This is why there is a theory that if you expose yourself to cold temperatures, you will increase your weight loss.

The third is your body’s ability to conserve and regulate core temperature.The hypothalamus in your brain helps regulate your body temperature by triggering changes to the sweat glands and muscles. The body can then increase or decrease the amount of heat lost.

Body temperature is also regulated by our arterial and vascular systems by causing vasoconstriction or vasodilatation. Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. When you dilate your vessels, you allow more blood to go to your arms and legs, which will cool you down. When you vasoconstrict, you maintain the core temperature because you have less blood exposed to the external environment. Sweat also helps cool you down and radiate heat. Your innate ability to control your vascular ability and your sweating will control your ability to cool down or stay warm.

Those factors coupled with hormones and metabolism will give everyone their individual experience. Excessive thyroid hormones, testosterone, epinephrine, norepinephrine and dopamine will raise your body temperature. Lack of estrogen will also make you feel hotter.

Which is why your wife is hot.

Researchers have also found that women may have up to 9x more complaints of cold hands and feet. But that is probably due to hormonal imbalance, metabolism and body fat.

That explains why your wife is cold.

Here are a few tried and true tips to help align Venus with Mars:

    • Make sure to stay hydrated since hydration plays a role in heat maintenance. If you are better hydrated you can better control your body temperature.
    • Have your hormones, Iron and Vitamin B12 levels checked by your cardiologist. Deficiencies in Iron and B12 will make you feel cold.
    • Dress according to your body temperature. If you tend to be cold, layer up. If you tend to be hot, wear breathable fabrics.
    • Always cold? Put on more weight, keep active and try adding turmeric and curcumin to your diet to raise body temperature

When all else fails, turn down the air and pile on the blankets. It’s a small price to pay for aligning the planets.