About Dr. Jen

A family doctor in private practice in North Royalton, OH.

New Goals For Blood Pressure Control

Well it’s happened.  For the last 6 months I’ve been warning my patients that the powers-that-be are going to be tightening up the goals for blood pressure control.  This week the American Heart Association, the American College of Cardiologists and a number of other professional organizations released new blood pressure control guidelines.

Why now?  For years the definition of hypertension has been a blood pressure over 140/90 for patients under 60 years of age, and over 150/90 for patients 60 and over.

There have been a number of new studies published showing that patients with blood pressure over 130/80 are at higher risk for heart attack, stroke and kidney disease due to the wear-and-tear of elevated pressures on the circulatory system. Our hearts and blood vessels and kidneys were not designed to deal with elevated blood pressures for long periods of time.

My cardiology colleagues hate when I compare the circulatory system to a water pump and piping, but the analogy works.  Too much pressure and the pump wears out sooner.  Too much pressure and the pipes can fail.  In the case of the living tissues of the human circulatory system, too much pressure strains the pipes and the chronic injury heals as scarring which shows up as plaque.  Too much pressure and the delicate filters of the kidneys get damaged.

I’ve known for a long time our guidelines were wrong.  Any number of times I’ve had patients with “normal” blood pressure need an echocardiogram (heart ultrasound) for a murmur or some other problem.  When the echo is done the report mentions that the heart muscle is stiff (called diastolic dysfunction).  Why does the heart muscle get stiff?  From chronically working against too-high blood pressure.  I treat my patients with diastolic dysfunction with blood pressure medication, regardless of the numbers I get with the BP meter.  My goal is typically to lower the top number and bottom number both by 10 points.

Why treat patients with diastolic dysfunction with blood pressure medication?  Because whatever the numbers, their heart is telling us that THE PRESSURE IS TOO HIGH.  The heart is working too hard, “lifting weights” like the big muscle-bound guys at the gym, and the heart muscle is too thick and stiff to function properly.

These new guidelines are actually not as aggressive as I expected.  The SPRINT trial, one of the primary drivers of the new guidelines, actually showed that controlling blood pressure below 120/80 saves lives from heart attacks and strokes and prevented the development of kidney disease.

Here is a picture graphic showing the new guidelines:

What are we supposed to do with patients whose blood pressures are considered “elevated” or “high?” We are SUPPOSED to start with lifestyle changes.  “Aggressive” lifestyle changes, in fact.  Yay!  That is right up my alley!  Unfortunately, many doctors are likely to skip the lifestyle change talk and move right to medications.

We cannot medicate away a bad lifestyle.  This is something I teach my students in no uncertain terms.  If a person wants to be healthy you MUST start with a healthy lifestyle.

A healthy lifestyle means avoiding smoking, excessive alcohol and other harmful substances.  It means eating more fresh whole colorful plant foods, whole grains, beans, nuts, seeds and healthy fats and avoiding or limiting animal foods like animal flesh, eggs and dairy.  A healthy lifestyle means drinking fresh clean water instead of soda and juice.  It means getting plenty of sleep, plenty of exercise and plenty of fresh air and time in nature.  A healthy lifestyle means doing what you can to minimize toxic stress and your exposure to negative, toxic people.  Respecting your body, respecting your mind and respecting your spirit are integral to health.

Supplements have their place as well.  I have patients for whom the only blood pressure “medication” needed is a magnesium supplement once or twice daily.  Fish oil can also help to reduce blood pressure especially in doses over 2000 mg daily.  Please reach out to me if you’d like more information on using supplements to help with elevated blood pressure.

If the next time you’re at the doctor you’re told your blood pressure is too high, please make sure to discuss diet, exercise, other lifestyle changes, weight loss and supplements with your doctor.  If your blood pressure is over 150/90 you likely will need medication right away, but don’t give up on the lifestyle changes.  One of my favorite things to do is to take patients OFF of blood pressure meds!  It definitely happens often enough to keep me hoping 🙂

So these new guidelines mean we’re going to be prescribing more medications but also hopefully that we will be pushing harder on people to make healthier lifestyle choices.  Which ultimately will be good for us all.

QUESTION: Do you have high blood pressure?  Are you sure?  Do you think the next time you see your doctor you will be discussing your blood pressure?

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Natural Immune Support

Welcome to cold and flu season :-/  My office schedule has filled up with parents, kids and older people with coughs, sore throats and clogged sinuses.

Every year I have patients that come in two or three times with colds and sinus infections and they ask me what they can do to get better and stay better.  I start by telling them immune support depends on good diet, plenty of rest, and good hand-washing.

However, this is only part of the story.  I can tell YOU that I have some extra ammunition in my medicine cabinet.  Want to know what I and my family depend on for immune support?

As I’ve written before, all health starts with a good nutritional foundation.  Because the vast majority of us (over 95% of us in fact) don’t get all the nutrition we need from our food, a good multivitamin is a smart step.  I wrote about choosing a multivitamin not long ago, click here to read that post.

If you’re taking a good multivitamin already and still find yourself catching all the cooties you run across, Shaklee has supplements that will help with extra immune support. If you’re new to reading my blog, I wrote about why I chose Shaklee for my nutrition partner on this page.

Have you heard of interferon?  It is a group of signaling molecules important in the immune system.  One of the early researchers on interferon, Dr. Yasuhiko Kojima, felt he could use botanical ingredients to create a supplement that would increase interferon naturally and strengthen the immune response.

It took him years of research but he did develop a supplement that did just that.  When looking for a company to bring his development to market, he chose Shaklee.  This product is called NutriFeron.  Research has shown that it provides natural support to the immune system.  Skeptical?  Good!  Here’s information with links to the original research articles.

A lot of people reach for cold remedies when they start with congestion and sore throats.  Not in my house!  When that first scratchy tickle in the back of the throat starts, we begin using Defend and Resist and Vitalized Immunity.  They are very effective in providing what the immune system needs to fight colds and other respiratory infections.

What about kids?  Kids can use both Defend and Resist and Vitalized Immunity as well as adults, but what about basic nutrition support for them?  Shaklee to the rescue!  The chewable multivitamin for children, Incredivites, contains lactoferrin which helps support and strengthen their immune system to keep your little superheroes healthy all year round.

I also wanted to tell you about some specials Shaklee is running through the end of November.  We want to encourage people to have what they need on hand (because 3-5 days to order and ship is too long when you’re starting to get sick).  Until the end of November Shaklee is offering a free bottle of Defend and Resist when you purchase both Vitalized Immunity and NutriFeron.  Click this link to check out the Immunity Power Pack offer.  (I’m jealous because YOU can get this offer, but I can’t.  Not available for Shaklee business leaders.  Boo.)

We didn’t forget the littles, either.  Until the end of November there is special savings available for the ShakleeKids Power Pack which includes Incredivites, Mighty Smart Chews (chewable DHA from fish oil) and Chewable Vita-C.

Staying healthy during the holiday season can be tough.  Between get-togethers (all those hugs and kisses!), shopping (cart handles and doorknobs) and work stress, the immune system gets a pretty good challenge.

Eating healthy, staying hydrated and getting good rest go a long way towards fighting off the illnesses surrounding us this time of year.  Adding a good multivitamin and Nutriferon for immune support is smart.  If your luck runs out and some cootie catches you, Vitalized Immunity and Defend and Resist will help your immune system stand strong.

Curious about which supplements are right for you?  Take five minutes to fill out a HealthPrint personalized health assessment now.  Get started being your healthiest you, during the holiday season and all year round.

QUESTION: Do you tend to catch a lot of colds during the winter?

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Shingrix for Shingles Prevention

Remember a few weeks ago I wrote about THIS problem?

Credit: www.zostavax.ca

About 2 weeks ago, the FDA approved Shingrix, a new vaccine for the prevention of shingles in people aged 50 years and older.  They also took the very unusual step of stating that people should get Shingrix rather than Zostavax, the only other vaccine available to prevent shingles.

Not only did the FDA state a clear preference for Shingrix over Zostavax, they also recommended that people who have already been vaccinated with Zostavax should be RE-vaccinated with Shinrix.

Wait, what?!

To my knowledge, the FDA has never done this, showing such a clear preference for one vaccine over another, to the point of saying that a previous vaccination is essentially invalid. Why would the agency do this?

It is much more effective than Zostavax

In the clinical studies, Shinrix was well over 90% effective in preventing shingles and its most devastating consequence, postherpetic neuralgia, in all age groups.  By contrast, Zostavax is only 18-64% effective, and is least effective in patients over 80 years of age, who are at greatest risk of a shingles outbreak.

The protection lasts longer

The protection given by the Zostavax vaccine has not been evaluated in long-term studies.  I found a reference to one long-term study of Zostavax that is supposed to be completed in 2024.  However, no studies that I could find have followed people who received Zostavax longer than about 2 years. (Any science types out there who can find one, please post it in the comments!)

Shingrix studies, by contrast, were carried on for up to 5 years and showed that the vaccine remains effective for prevention of both shingles and postherpetic neuralgia.  The question remains, though, will the protection be lifelong?  After all, if you vaccinate someone at age 50 they have hopefully MANY more than 5 years to live shingles-free.

No live virus

Shingrix is not a live virus vaccine, therefore there is no restriction on vaccinating people who are immune compromised or live with someone who is immune compromised.

What are the downsides of vaccinating with Shingrix rather than Zostavax?

Two shots, not one

The Shingrix dosing schedule calls for a second, booster dose of vaccine 2-6 months after the first dose.  This may be a problem with Medicare, because there are no Medicare-covered vaccines that call for a second dose within one year.  We will have to see how the coverage determinations shake out at the Medicare level.

Much higher rate of side effects

Shingrix’s package insert reports over 50% of patients who received the vaccine complained of body aches, fatigue and headache afterwards.  88% of people reported pain at the injection site (compared with 14% of people who got a placebo shot).  Recipients also reported fever, shaking chills and GI symptoms in fairly large numbers.

Younger people had more problems than older people, probably because they were making a more robust immune response.

A LOT of vaccine

From a population health standpoint, a 90% effectiveness rate sounds fantastic.  However, from a cost standpoint it might not be so great.  Here’s a crash course in how we determine how many people you have to treat in order to prevent an illness or condition.

For Shingrix, 11.1 people aged 80+ got shingles in 1000 person-years if they did NOT get the vaccine, and 1.0 people if they did.  That’s great, right?  90% effective.  But in order to determine how many people you need to vaccinate to prevent one case of shingles, the math is different.  It’s 1 divided by the difference in ABSOLUTE risk.  1/((11.1-1.0)/1000)

You need to vaccinate 99 people over age 80 in order to prevent one case of shingles over 5 years. That’s a LOT of vaccine, but much better than 435 patients with Zostavax.

The bottom line

Shingrix isn’t even available to order yet for doctors’ offices and pharmacies, and already it’s creating a stir.  The unprecedented endorsement by the FDA favoring Shingrix over Zostavax will likely force Zostavax off the market soon.

Shingrix IS much more effective than Zostavax at preventing both shingles and postherpetic neuralgia.  That higher effectiveness comes at the cost of being a more uncomfortable vaccine to receive, and having two get two shots instead of one.

If the goal is preventing shingles, Shingrix is clearly the way to go.  I will hit the age to be eligible to receive the Shingrix vaccine in a few years.  Will I get it?  Probably, because I’ve already had one bout of shingles and I really don’t want to have it again.

QUESTION: Have you had Zostavax?  Will you get Shingrix?

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Boo! Healthy Halloween Treats For You!

Happy Halloween everybody!  I LOVE Halloween 🙂  Costumes and boisterous kids and, yes, treats.  If you come in to the office on Halloween you’ll see that my office really gets into the spirit.  Nope, I’m not going to tell you what my costume is.  Maybe I’ll post a pic on my Facebook page on Tuesday 🙂

The downside of Halloween is that it starts the snack-food feeding frenzy that doesn’t end until New Year’s Day.  It’s a constant parade of sweets and treats for the next two months.  VERY difficult for those of us who are conscious of our weight and our health.

Fear not!  There are plenty of healthy Halloween treats available!  Here are a few ideas of how to help your kids (and your neighbors) have a happy healthy Halloween!

1.  Dark chocolate:  Dark chocolate is MUCH better for you than milk chocolate.  It has more antioxidants and helps lower cholesterol and blood pressure.

2.  Portion-packs of apple slices, pretzels, raisins, trail mix or nuts.  Make sure to ask if nuts are OK, some children are allergic.

3.  Dried fruit:  Banana chips, freeze-dried strawberries, pineapple, raisins, so many possibilities!  Sweet and MUCH healthier than candy!

4.  Carrot sticks:  Sweet and crunchy, and oh so good for you!  Full of fiber and vitamin A for healthy skin and eyesight.

5.  Popcorn balls:  Also high in fiber, popcorn balls are available at this time of year in factory-sealed packages for trick-or-treaters.

I found an awesome YouTube video from The Vegan View with four different awesome idea for healthy Halloween-themed treats.  These would be great to make with kids.  Check it out!  (And their costumes are so cute!)

Here’s a photo of the most adorable Halloween treats I’ve seen this fall, courtesy of Pinterest!a8947aaa1fb9b9debe8a096ef0561147Make sure you set aside some time to stay active, and eat a healthy meal with the kids before they head out trick-or-treating.  Send the kids out with a SMALL bag and encourage them to take only one piece of candy at each house.  After they get home, consider having them choose their favorites to keep and then have a “candy buy-back” for cash, a gift card, or a special privilege.

Have fun, stay safe, and be healthy!

Question:  Are you planning to take any steps to “limit the damage” to your health this Halloween?  Please share your ideas below!

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Should Everyone Wear Sunglasses (Even Kids)?

A friend of mine mentioned recently that he’s been spending a lot of time at Cedar Point and mentioned he was surprised how few kids wear sunglasses.  All the parents wear sunglasses, especially at the waterpark, but very few of the kids are wearing sunglasses.

Does it matter?  Well, it turns out my friend is right to be concerned.  (And kudos to him, in his pics his absolutely adorable son is always wearing shades!)  According to the Vision Council (an eye care industry group), eye health depends on protecting the eyes from UV radiation.  Many people either are unaware or don’t believe that protecting the eyes from UV radiation from the sun is a critical, year-round concern.

There are 3 types of UV radiation – UVA, UVB and UVC.  UVC is filtered by the earth’s atmosphere and not a concern.  UVB is the type of UV radiation that stimulates vitamin D production in the skin, and is partially filtered by the atmosphere.  This is why those of us in northern Ohio can’t get vitamin D from the sun for the wintry half of the year, the sun is too low in the sky and the rays pass through too much air on the way to us.

The type of UV radiation that is most dangerous to the eye is UVA.  The earth’s atmosphere does NOT filter UVA.  If the sun is in the sky your eyes are being exposed to UVC radiation, no matter what season or time of day it is.  Wearing sunglasses as much as possible is important to protect your eyes when you are outdoors.

Here are 3 common misconceptions about sunglasses and sunglass use.

Kids don’t need sunglasses

Children receive about 3 times as much UV exposure per year as adults.  This is because they generally spend more time outdoors than adults do.  However, only 7.4% of adults report their children always wear sunglasses.

UV radiation damage is cumulative which means it builds up over time.  Damage can lead to aging of the skin, skin cancer, cataracts and damage to the retina.  Beginning in childhood, daily sunglass use will decrease the damage and preserve children’s eye health.

The darker the lens, the better the protection

This is not true.  UVA radiation passes right through lenses no matter what their color.  They must be coated to block UV radiation.  Polarized lenses are even better at blocking the UV rays.

In fact, it could be argued that dark lenses without UV protective coatings are the worst option of all, because they cause the pupils to dilate and allow more UV light through to the retina.

When you go to buy sunglasses check for labels to indicate the protection they give.  Make sure you choose lenses that are labeled as protective against both harmful types of ultraviolet light.

Wearing a hat is good enough

Not true.  While wearing a hat protects somewhat against direct UV exposure, it does nothing to stop REFLECTED UV light.

Credit: visioncouncil.org

So how do we get our kids to keep sunglasses on their face?  Hats are hard enough, right?  First of all, having a child pick out their own sunglasses makes it more likely they will wear them.  Make sure to get good quality glasses that fit the child’s face and don’t pinch or rub.

In addition, polarized lenses are more comfortable from a vision standpoint because they reduce glare and block more light.  Kids are more likely to keep them on because they don’t squint as much and they can see better.

Teenagers typically don’t want to be told what to do.  Make sure they understand they will have less problems with red, irritated bloodshot eyes if they wear sunglasses regularly.  Just like with kids, letting them pick out a couple of pairs of cool sunglasses they like will go a long way towards getting them to wear them regularly.

Kids, teens and adults all need to protect their eyes from harmful ultraviolet radiation.  The fronts of the eyes, the lens and the retina are all susceptible to damage which accumulates over time.  You and your family only get two eyeballs and it’s up to us to protect them!

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How To Take Care Of A Cancer Patient

Most of you know that my husband Russ has been battling multiple myeloma for the last 6 1/2 years.  What you may not know is that although he was in remission without treatment for over 3 years, this summer the cancer unfortunately relapsed.

Of course, as his wife, my focus is doing everything I can to keep him healthy and make this next leg of the journey as successful as possible.  What can I do to help him?  I’d like to share with you some of what I’ve learned about how to take care of a cancer patient.

The sad reality is that we will all, at some point in our lives have a close friend or family member struggle with a life-threatening illness.  Knowing how to help them is a useful skill and can make us caregivers feel less helpless.

Make sure they eat, drink, get fresh air and rest

Whether you feel like a bully or not is irrelevant.  Cancer patients need to eat.  Simple, fresh, nutritious food that is easy to grab and go should be available all the time.  Keep in mind that cancer treatment often changes the sense of taste.  The patient’s favorite foods may not taste good to them, and they may get weird cravings.  Stay flexible.

Sandwiches, soups, fresh fruit and veggies, oatmeal, scrambled eggs and calorie-dense foods like nuts and nut butters are good choices.  Good fats like avocado hide easily in blender smoothies.  Protein smoothies (non-GMO soy is better than when as a protein source) are a good protein source.  Be careful with meat, it’s hard to digest and may make nausea worse.

Staying hydrated is important.  Water is the best way to hydrate but iced tea is good too and adding lemon or lime juice can make plain water less boring.  Don’t rely on soda because neither added sugar nor artificial sweeteners are healthy choices.  Sports hydration drinks are OK if the patient has diarrhea but choose one that doesn’t have artificial sweeteners or colors (Shaklee Hydrate is my choice!).

Sleep is tough.  Many cancer patients don’t sleep well, because of symptoms, treatment effects and stress.  Talk to their doctor if they’re having trouble sleeping, medications can help.

Also don’t underestimate the importance of getting outside.  Nature is healing and too much hibernation is not good.  Russ’s first outing after being in the hospital in 2011 was to the Yankee Peddler Festival.  Granted, he spent a lot of time holding down benches and tree stumps, and we didn’t stay long, but he was in the fresh air and sunshine, and we were together as a family.

Take care of yourself too

As I’ve written before, one of the first orders of business when you are a caregiver is to take care of yourself.  If you are exhausted you won’t be able to take good care of your loved one.  You can’t pour from an empty cup!

Eat and drink as you should.  Get enough rest.  Get outside, with or without your loved one.  Exercise.  Recharge your batteries by doing what you enjoy as often as you can.

Vent OUT, not IN

Not long ago, I read a really good article that was sort of about the etiquette of being around someone struggling with a serious illness.  I can’t find the article right now, but the gist of it is this.

Imagine a bull’s eye target with the patient in the middle.  Everyone they know is arranged in the rings around them.  Those closest to them, physically and emotionally, are in the smallest rings and as you get farther away you find distant family members, casual acquaintances and those they see in passing.

Their spouse and children are on the smallest ring.  Grown children may be a step out, depending on the relationship.

When you interact with others in relation to the cancer patient, remember that you are on the RECEIVING end from those who are farther in than you are.  For instance, when my mom was sick with breast cancer I had my own fears and anxieties.  My sister and I were terrified we were going to lose our mom.  I didn’t unload on her or my dad about that, though.  My husband or my close friends were my resource to deal with my own fears.  I vented OUT, not IN.

This doesn’t mean that you can’t tell a cancer patient that you’re afraid for them.  You don’t have to be relentlessly cheerful and optimistic all the time.  Just be careful not to add stress to their already overwhelming burden.  When dealing with a cancer patient, your goal is to relieve stress, not increase it.  Let them vent out, take pressure off, don’t increase the pressure.  It’s about them right now, not about you.

Cancer patients have a lot to deal with.  They are juggling treatment schedules, financial worries, physical symptoms and side effects, fears and anxieties.  Some may be continuing to work, like my husband.  They have family responsibilities as well.

There is a lot we can do to support a cancer patient in their journey back to wellness.  Support their health, take care of yourself and find your own support system to help you keep your feet under you.

QUESTION: Did I forget anything?  What has helped you in taking care of person struggling with a serious illness?

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Are Multivitamins Dangerous?

I’ve done a TON of physicals this week, and when I see a patient for a well visit, we always talk about diet.  For most (if not all) humans, the best diet is one full of whole fresh unprocessed plant foods, the more colorful the better.  Limiting meats and other animal-based foods is wise if your goal is to decrease your risk of cancer and heart disease.

Even if you eat healthy, it’s hard to get all the nutrients you need from your food.  I always recommend a good quality multivitamin to my patients.  This week a few people have asked me, are multivitamins dangerous?

It’s common to see reports on the news that vitamin use increases the risk of cancer, heart disease, and other problems.  If you follow my blog (or talk to me for a few minutes) you know I believe strongly in good nutrition.  So when people are asking if multivitamins are dangerous, I want to reassure them.

Here on my blog I try not to lean on my own opinion too much.  So I went off to the research database, and found a great article published recently that reviewed recent research about the safety of multivitamin supplements.  You can read the article yourself at this link.

So are multivitamins dangerous?  Here are my 3 take-home points from this article:

  • Nutrition should come from food, but our diet is stupid, so taking a multivitamin is a smart harm-reduction method.

There is no multivitamin or supplement that can overcome a bad diet.  Too much processed food, food full of added sugar and fat, and food with artificial ingredients will damage your health.

With that being said, we live in the real world and there are times when we can’t eat a perfect diet all the time.  Even though we live in a country with fresh healthy food available, often it is grown and stored and transported in such a way that the nutrients degrade.  It’s been reported that our food is much less nutritious than it was 50 years ago.

In this day and age, a multivitamin can be sort of like the seatbelt in your car.  You should eat healthy (like you should drive safely) but your daily multivitamin can be a just-in-case safety measure for those crazy days when you just don’t get all the nutrients you need from your food.

  • Comprehensive multi-nutrient supplements (like a good quality multivitamin) are better and safer than single-nutrient supplement

Some research shows that single-nutrient supplements like calcium and vitamin E are associated with higher risk of some diseases.  I don’t recommend people take single-nutrient supplements.  You’re best off taking a comprehensive nutritional supplement program tailored to your specific needs.

For instance, a woman over 60 would need a good quality multivitamin that doesn’t contain iron.  A younger woman of childbearing age would need more iron, more iodine, and more folic acid in her multivitamin.  Someone with migraines or anxiety may need to add a B complex supplement and extra magnesium.  Someone concerned about heart health may want to add fish oil, coenzyme Q10 and extra magnesium.

People are different, and what works for someone else may not work as well for you.

  • There is no consistent evidence that taking a multivitamin increases the risk of cancer, heart disease or stroke.  There ARE suggestions that taking a multivitamin may reduce the risk of health problems in certain populations.  This is really exciting!

Multivitamins have been studied extensively to see if taking them is associated with lots of different medical problems. The research has been pretty neutral in general, with no association with higher OR lower risk of major medical problems.  This may be because multivitamin preparations vary so widely in quality and in what nutrients are contained in them.

A few consistent trends do seem to be present though.  Multivitamins are not associated with a higher risk of cancer.  Some studies have, in fact, shown a lower risk of cancer in people taking a multivitamin.  Researchers are doing more studies to see if they can show lower cancer risk consistently in those taking multivitamins.

Multivitamins also seem to not increase the risk of cardiovascular disease, age-related eye disease, mental health and cognitive problems in the elderly, or overall mortality.

So what’s the overall point?  Take your multivitamin every day!  Even if you have a really healthy diet, a multivitamin will help fill in any gaps.  After all, these nutrients affect every cell in your body.  Every cell needs them, every day.

Need help choosing a multivitamin?  I recently wrote about how to choose a multivitamin, so click this link and read up!

You probably already know I use and recommend supplements from the Shaklee Corporation.  Want to see what products would be best for you?  Click this link and answer the questions to get your HealthPrint personalized nutrition assessment.

QUESTION: Do you take a multivitamin?  Do you feel it makes a difference in your health?

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Diabetic Amputation Rates Rising

Mary is a lady I have taken care of for several years.  Every time she comes in I check her heart and lungs.  Then, when I go to check for swelling in her legs, we have a good laugh.  See, the first time I saw her, I checked for swelling and only then realized something pretty important.

Mary’s lower left leg is missing.

She is diabetic and developed gangrene in her left leg some time before she started seeing me and had to have her left leg amputated below the knee.  She is a very sweet lady but now has some significant trouble getting around.

Why would Mary need to get her leg amputated?  There are a number of possible reasons.  Diabetics can lose feeling in their feet and if they hurt themselves they may not feel it.  They don’t generally have good circulation and wounds take longer to heal.  Diabetics also have immune systems that don’t work right and they have trouble fighting infections.

Unfortunately Mary is in good company.  The rates of diabetic amputation are risking across the country.  For instance, in California, the rate of diabetic amputation rose 31% between 2010 and 2016.  Some counties like San Diego and Riverside counties had over 60% increases.  Across the United States the rate of diabetic amputation rose 27% between 2010 and 2014.  Before 2009 the rates had been dropping.

Why is this happening?  Why are people losing toes and feet, ankles and legs to diabetic amputation?

There are a number of possible reasons.

  1. More diabetics.  The number of Americans with diabetes is on the rise.  This doesn’t explain it all, though, because even just looking at diabetic patients the rates are rising.
  2. Access to care.  Before the Medicaid expansion that came with the Affordable Care Act many low-income diabetics went without care for their illness.  Also, coverage for podiatric care (which includes care for foot wounds and chronic foot infections) is not consistent across the country and across insurers.  If you can’t afford medication and see the specialists you need, you’re at increased risk for complications like amputation.
  3. Health literacy.  Many diabetics don’t understand why they need to see the doctor regularly.  They don’t know all the bad things that can happen as a result of diabetes.  They don’t know they could lose their vision, have a heart attack, wind up on kidney dialysis, have a diabetic amputation.  Education is key.
  4. Lifestyle factors.  If you’ve ever tried to lose weight you know how hard it is to change your lifestyle.  Eating a healthy, mostly-plant-based fresh-food diet, exercising regularly and drinking water are critically important for diabetics but many patients seem to think as long as they take their pills or their shots that’s all they need to do.  NO medication can make up for a crappy lifestyle!

If you are a diabetic, please make sure to see your doctor regularly.  If your doctor wants you to check your blood sugar and blood pressure, PLEASE do it, and keep a written log.  (It’s really hard for us to scroll through your glucometer’s tiny screen, so please bring us an organized log.  It will save time for more important things!)

Don’t smoke.  Whatever you need to do to quit, do it.

Get.  Serious.  About your diet.  NOT kidding.  What we put in our mouths determines the majority of health for ALL of us, not just diabetics.  Even if you have a low income, you can make healthy choices in your diet.

Walk.  Get outside and walk.  Go to the mall and walk.  It doesn’t matter WHERE you walk, as long as you do it.  Research has shown that walking is an excellent intervention for those who have circulatory problems in their legs.  It actually helps grow new blood vessels around any blockages that are there.

Look at your feet every day.  If you can’t reach them, get a mirror on a stick or have a family member check your feet.  All parts of them, tops and bottoms and between the toes.  Report ANY wounds or cuts or scaly, red areas to your doctor, even if they’re not painful.  Remember, diabetics lose feeling in their feet and it can be subtle so that they don’t realize the sensation is not normal.  Wear sturdy protective shoes to keep from injuring your feet, especially if you know the sensation isn’t normal.  Cute little sandals and flip-flops will NOT protect your feet from injury.

A diabetic amputation is a huge deal.  Amputation affects independence, the ability to walk and drive and get done the things that we need to do every day.  We need to do a better job preventing the need for diabetic amputations. That means being aggressive about diabetes and blood pressure treatment, protecting our feet, staying active and being engaged with our doctor and an active member of the treatment team.

God gave you two legs, two feet and ten toes.  There’s a reason for that, and we need to do everything we can to keep all those parts in good working order!

QUESTION: Do you know anyone who has lost part of their foot or leg to diabetic amputation?

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What Is Physician Burnout?

Dr. Sadd is a colleague of mine that I’ve been worrying about for a while.  He comes to the office and constantly complains about EVERYTHING.  Dr. Sadd snaps at the office staff, makes negative comments about his patients, and has no tolerance at all when things don’t run smoothly.  He doesn’t really have “good days” and never seems to be happy.

Dr. Sadd is burned out.

What is physician burnout?  Burnout doesn’t just happen to doctors but is very prevalent in the medical field.  Because of this, research on burnout is often done on doctors and nurses and other medical professionals.

Physician burnout happens when the emotional and energetic toll of practicing medicine becomes overwhelming.  Burned out doctors and nurses are exhausted.  They are cynical and have a hard time connecting with others.  They doubt they are really making a difference.  Those of us in the health professions generally chose the field BECAUSE we want to make a difference.

If not addressed, burnout can drive doctors and nurses out of medicine.  Worse, burnout can cause depression and lead to suicide.  And physician burnout is very common.  Recent studies suggest that over half of American doctors are suffering from burnout.

What are the causes of physician burnout?  Recent changes in the American medical landscape with increased regulation and government reporting requirements are contributing to burnout.  We aren’t secretaries.  When we have to spend more and more time staring into the computer screen instead of interacting with patients, it adds more stress.

Doctors and nurses often feel they have less and less control over the way they practice medicine.  They often feel as though their training and expertise aren’t valued.   Checklists and paperwork, financial pressures and rules that don’t make sense all contribute.  If we don’t have enough support with the clerical side of things we can feel overwhelmed.

In addition, some doctors don’t have a good work-home integration.  Long work hours are hard on the family.  We neglect activities that we enjoy and put more and more energy into work.  Eventually the tank is empty and we have nothing more to give to our patients.

If you have lost the joy you used to take in your work, you might be burned out. You might be burned out if you are dreading going to work tomorrow,   If you find it really hard to finish tasks at work that used to be easy, or if you find yourself procrastinating, you might be burned out.

Unfortunately, if you are a doctor or nurse and you’re burned out, you might actually be dangerous.  Burnout increases the risk of medical errors.  In addition, patients who see a burned-out doctor are less satisfied with their care and may be more likely to sue if something goes wrong.  Interestingly, burned-out doctors seem to be more prone to car accidents.

What can you do about it if you are a doctor or nurse and you think you might be burned out?  First of all, be honest with yourself about the situation.  Talk with your supervisor and find out what resources are available at work.  Think about whether you’re taking steps to take care of yourself and enjoy your life NOW.  Too many of us focus on the future at the expense of the present!

After this process, it’s time to reconnect with the joy of your career.  Why did you choose a career in medicine in the first place?  What are the biggest stressors?  Are there ways to reduce the stress while maximizing the rewarding parts of your career?

Physician burnout (and nursing burnout) is a big problem in medicine and more and more organizations are recognizing it.  While your organization may offer tools to decrease burnout, it’s first up to you to recognize that you are losing your joy.

After all, the first step to fixing a problem is recognizing it exists in the first place.

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Toxoplasmosis

My family and I got some surprising news about our cat Domino this week.  You may remember I wrote a few weeks ago that she was sick with pneumonia.  The vet treated her with rounds of two different antibiotics and the pneumonia just wasn’t clearing up.

We were wondering if she might have a lung tumor causing the pneumonia not to get better as expected.  Then Dr. Kontur said “Let me do one more test.”

Turns out, the test came back “screaming” positive!

Domino has toxoplasmosis.

Toxoplasmosis is an intestinal infection with a parasite called Toxoplasma gondii that is found in some animals including cats.  Dr. Kontur tells me it usually affects young cats and older cats with asthma (like Domino) and can cause pneumonia.  Treating the infection requires antibiotics and hopefully it will clear up easily.

So why am I writing about toxoplasmosis today?  Because Toxoplasma can infect humans too.  Toxoplasmosis can be transmitted from animal feces, soil or sand contaminated with animal feces, and by eating raw or undercooked meat or seafood.

Most people who get toxoplasmosis from their cats or any other source have no symptoms at all.  In addition, those who do get sick generally just get flulike symptoms (headache, fever, body aches and fatigue).  Healthy people are at little or no risk of long-term harm from toxoplasmosis.

Who IS at risk?  Pregnant women and those whose immune systems are not normal are most at risk.  People with HIV infection, inherited immune deficiencies, or receiving chemotherapy for organ transplant, cancer or autoimmune diseases are at risk.

Pregnancy is definitely not much of a concern for me, my childbearing days are done.  However, I do have a cancer patient in my house.  As many of you know, my husband was diagnosed over 6 years ago with multiple myeloma.  As a result, we are very conscious of infection risk where he is concerned.

If you or someone you know is at risk for toxoplasmosis, there are a few things you should keep in mind.

  • Clean out your cat’s litter box every day.  It takes 1-5 days for Toxoplasma organisms to become contagious after passing in the cat’s stool.
  • If possible, have someone who is NOT pregnant and is NOT immune compromised clean the litter box.
  • Fully cook meats and seafoods before eating them.
  • Wash your hands thoroughly with soap and hot water after gardening and after cleaning a cat litter box.
  • If your kids have an outdoor sandbox, keep it securely covered to keep feral cats and other animals out of it.

For healthy people toxoplasmosis is not generally a serious health problem.  However, it can cause pregnant women to miscarry their babies and can cause infection in the unborn baby.  In additon, people with immune suppression can develop breathing problems, neurologic problems like seizures, and can affect the eyes and vision as well.

We are so blessed that Dr. Kontur discovered Domino’s toxoplasmosis infection!  Here’s hoping her infection clears up quickly and easily (although she HATES being force-fed pills).  And clearing up Domino’s infection will help protect Russ from any possibility of infection in the future.

If you’re looking for a new vet for your four-legged family member, please give Dr. Kontur a call at Summit Animal Hospital in Northfield.  She rocks!

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