Pelvic Exams

Women over the age of 21 know what THIS is all about.  You go to the gynecologist or your primary care doctor for birth control or for your annual checkup.  After a zillion questions and the typical heart-lungs-belly exam the doc pulls out those lovely things for you to put your feet into and invites you to “Come on down!”

After scooting your bottom down (your NAKED bottom) until you feel like you’re going to fall right off into your doctor’s lap, the doctor proceeds with the annual two-part indignity of Pap test and pelvic exam.

The Pap test involves inserting a speculum (used to let him or her see your cervix) and taking a sample of cells from the surface of the cervix.  The bimanual exam has the doctor putting one or two fingers inside the vagina and the other hand on the abdomen to assess the size and position of the uterus and ovaries.

What if I told you half of that exam wasn’t necessary?

In March of this year, the United States Preventive Services Task Force issued a summary recommendation stating there is not enough information to recommend for or against the bimanual pelvic exam as a screening test.

I admit I had to stop and think about that one.  I was taught in school to do a pelvic exam every time I do a Pap test, but when I stopped to think I realized that I have never found a true problem in a woman who has no symptoms.

What symptoms might a woman have that indicate a potential problem in their pelvic organs?  Pain, of course.  Heavy or irregular menstrual periods.  Bothersome vaginal discharge.  In those cases, the pelvic exam is a useful part of the diagnostic process.

However, how often do we find problems in patients who have no symptoms at all?  Studies have shown that doctors actually are pretty lousy at telling the difference between a normal exam and an abnormal one.  We tend to find problems that aren’t actually there.

One analysis of three different studies looking at pelvic exams’ accuracy in finding ovarian cancer showed that 96-100% of abnormal pelvic exams actually had no abnormality identified.  The doctor felt something and ordered a test (usually an ultrasound or CT scan).  The test showed no evidence of ovarian cancer.

So if pelvic exams are not terribly accurate in identifying ovarian cancer, are they harmful?  Yeah, actually, they can be.  In studies, up to 60% of women reported physical pain and discomfort with the exam.  Up to 80% of women reported fear, embarrassment and anxiety.  Also, women who have a negative experience (because of pain or fear) are much less likely to return to the doctor for a repeat exam.  Obese women are more likely to report a negative experience and are much less likely to have an accurate exam, because of the difficulty of performing the exam.

There are more serious harms too.  There was a study that showed 1.5% of patients who had a pelvic exam wound up with unnecessary surgery for a concern about ovarian cancer.

The USPSTF states that there is not enough evidence to recommend for or against pelvic exams.  However, the American College of Physicians and the American Academy of Family Physicians have made recommendations that pelvic examinations NOT be performed in women who have no symptoms and have no increased genetic risk of ovarian cancer.

What does that mean for female patients?  You need to see your doctor regularly for screening exams based on your age, which may include a mammogram, Pap test, colonoscopy and blood tests.  However, the doctor performing a pelvic exam shouldn’t be part of the visit unless you’re having symptoms.

QUESTION:  Will you be more likely to get regular physicals if you know you won’t have to have a pelvic exam?

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Lung Cancer Screening

It’s the number-one cancer killer of both men and women.  Almost 160,000 Americans died in 2016 from this cancer, and it accounts for over 25% of all cancer deaths in the USA.

We have no effective chemotherapy treatment for most cases of this cancer.  Once it spreads, it cannot be cured.

The most effective treatment for this cancer is surgery, but the vast majority of cases have no symptoms until the tumor is advanced.

Until recently we had NO way to screen for this cancer.

This is, of course, lung cancer.  One of the most feared and most difficult to treat tumors in humans, it usually spreads to the bone, the liver, the adrenal glands and the brain.  It is strongly associated with smoking and with second-hand smoke exposure, as well as with some occupational exposures like to radiation, asbestos and radon gas.

After years of research and the development of new less-costly and less-harmful technology, we finally have an effective tool for lung cancer screening.

In 2015 Medicare approved the use of low-dose CT scanning for screening for lung cancer in certain patients.  Most private insurers and Medicaid also cover this screening test although you should check whether your carrier offers this test.

Who is at risk for lung cancer and eligible to be screened?

  • Age 55-77, both men and women
  • NO signs or symptoms of lung cancer like a chronic cough, fevers, night sweats, coughing up bloody phlegm, or unexplained weight loss
  • Current smoker or quit smoking within the last 15 years
  • At least 30 pack-years of smoking history (an average of 1 pack per day for 30 years, 1 ½ pack per day for 20 years, or 2 packs per day for 15 years, for example)

It’s not a one-and-done screen though.  Like mammography, low-dose CT for lung cancer screening needs to be performed every year.  Often there are tiny nodules found on screening that may be scars, may be evidence of old infections, or may be very early lung cancers.  These need to be followed over time to make sure they are not changing and that no new spots develop.

One other important thing to realize is that although the screening CT is covered by Medicare at no cost sharing (like mammograms, Pap tests and bone density tests), any follow up done because of an abnormality WILL have an associated cost based on deductibles and copays.

It is also important to know that an abnormal screening scan produces a LOT of anxiety.  It’s very hard to hear that you have a 1/8-inch spot in your upper left lung, which is too small to biopsy or to scan in any other way, so we’re going to leave it alone and repeat the scan in 6 months.  Wait, what?!  What am I going to do for the next 180 days and nights until it’s time to scan again?  Wait, and worry, unfortunately.

If you meet the criteria above and are interested in being screened for lung cancer, make an appointment to talk to your doctor about it.  This should happen at a well visit so if you haven’t had your physical in over a year you should definitely call and schedule it.

Lung cancer kills more Americans than any other cancer.  It is difficult to diagnose early enough to be able to treat it effectively.  Low-dose CT scanning is the best tool for lung cancer screening we’ve ever had.

PS – If you meet the criteria to be screened for lung cancer and you are still smoking, you need to cut down and quit.  Today.  I know that goes without saying, but I just needed to say it anyway.

QUESTION: Do you meet criteria for lung cancer screening?  Have you had a low dose CT scan?

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Gastrointestinal Bleeding

Today started out as an ordinary day.  You’re going about your business as usual when you start to get a little crampy lower stomach pain.  You know that feeling, when you’ve got to find a bathroom?

No biggie, you head to the bathroom and have a seat.  After you’re done and tidied up, you stand up and get a big shock.  The toilet is full of blood!

Two patients this week have come in with similar stories so, in the interest of giving my readers an idea of what to do if something similar happens to them, I figured I’d better write about gastrointestinal bleeding.

Gastrointestinal bleeding is, as the name implies, bleeding that happens anywhere in the GI tract.  The most common places for bleeding to happen are in the stomach and first part of the small intestine (called upper GI bleeding) and the colon (called lower GI bleeding).

Let’s talk about upper GI bleeding first.  This is often caused by an ulcer in the stomach eroding into a blood vessel. There may be pain, but there may not.  The bleeding can be brisk, or it can be a slow seep that has no obvious symptoms but gradually results in iron-deficiency anemia.

Significant bleeding in the stomach can cause the stool to become very dark.  If the bleeding is very brisk the stool can become black and tarry and smell like blood or raw meat.  Generally upper GI bleeding will not cause red blood in the stool.

When fresh blood is digested by stomach acid it looks like coffee grounds.  Because blood is irritating to the inside of the GI tract, gastrointestinal bleeding often causes vomiting and diarrhea.  Another sign of an upper GI bleed is vomiting up a substance that looks like coffee grounds.

What about lower GI bleeding?  Usually that IS bright red.  Many things cause lower GI bleeding, from colon cancer to anal fissures to hemorrhoids to diverticulosis.  It may be just small amounts passed with formed stool, or it may be enough to completely fill the rectum and scare the pants off you when you look into the commode.  There may or may not be pain.

One word about bleeding from the small intestine – it usually does not cause obvious blood in the stool.  Generally small intestine bleeding is found because of iron deficiency and a positive test for blood in the stool.  This diagnosis is difficult to make and thankfully is not common at all.

So what do you do if you think you may be bleeding from your GI tract?  First of all, DON’T PANIC!  In nursing school, medical school and EMT training they teach you in an emergency, first take your own pulse.  It’s a little bit of a joke, but it’s a good time to mention that staying calm is the first order of business.

After you’ve taken your pulse (or a couple of good deep breaths) you should call your doctor.  He or she should be able to at least tell with a couple of questions whether you are safe to wait until you can be seen in the office, or whether you should get checked out right away at the urgent care or emergency room.

In general the evaluation for GI bleeding involves stopping the bleeding, finding and treating the source, and reducing the risk that it will happen again.

If you develop black, tarry stool, vomiting up something that looks like coffee grounds, or bright red blood in the stool (without a known history of something harmless like hemorrhoids) you should call your doctor right away and get it checked out.  The cause could be life-threatening.

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When Fear Blocks Transformation

One of my patients, let’s call her Anne, is massively obese.  She is a very sweet woman with a supportive husband and family.  Her family is well off financially and she is educated.  Why on Earth would she struggle so with her weight?

She has the means to hire the most expensive trainers available.  She could build an entire gym in her own home.  She can buy potions and pills and exercise videos galore.  Why can’t she lose weight?

I’m not sure, not with any real confidence, because we haven’t taken the time to dig into the whys and wherefores.  I’m not a trained counselor, after all, and it’s not something we can really get into in the confines of a 15-minute visit when I also have to address all her medical problems and refill all her medications.

But if I had to venture a guess, I’d say she’s scared.  Terrified, even.  There is something about the PROCESS of weight loss that has her so frightened it is easier for her to stay massively obese than to tackle her weight.  What can we do when fear blocks transformation in your health, your career, your life?

Lately I’ve been doing some reading in the leadership coaching industry in the interest of skilling up my ability to help patients with behavior change.  I AM first and foremost a coach, after all.  I’m not a surgeon to take out appendices or cancerous growths.  My most effective tool is my ability to help patients change their lifestyle to change their health for the better.

One of the most fascinating insights I’ve had in the reading I’ve been doing is the idea that patients resist change not because they don’t want the results but because they’re scared.  They see the goal, they know how to get there, they’ve gotten practical advice and a roadmap that works.  But there is something about the roadmap that scares them to death.

Even though I don’t know what Anne’s fear is, I know there is one.  Something about weight loss triggers her brain’s threat response and makes her completely UNABLE to move beyond that point in her efforts to get healthy.  We can speculate that maybe as a child her parents withheld food as a punishment.  Now anytime she even THINKS she might get hungry that threat response is triggered and she compulsively seeks to eat to reassure herself that she is not that helpless child anymore.

Maybe she has confined herself to the role of a sick person so thoroughly that if she gets healthy she won’t know who she is anymore.  She’s afraid her husband won’t take care of her anymore if she is able to care for herself.  Maybe she’s afraid if she loses weight he’ll want to have sex with her again and there’s a history of sexual abuse in her past buried so deep she can’t bear to remember it.

I don’t want to speculate about my friend Anne.  I would love to have the time to sit down with her and really dig in with her as a willing participant, to figure out what frightens her so.  I KNOW something does, because she tells me she wants to lose weight but we can’t make any headway.  She’s not weak, not weak-willed, and not self-sabotaging.  She’s afraid.

What about you?  What are you doing that you KNOW is hurting your health?  Do you eat the wrong foods when you KNOW which foods will support your body’s health and even know tasty recipes to cook them for yourself and your family.  Do you continue to smoke even though you hate every stupid cigarette you take out of the pack?  Do you find yourself making excuses about exercise even though when you drag yourself to the gym you feel amazing and sleep so much better?

What scares you?  What’s holding you back?  I would love to have you email me at drjen@jenniferwurstmd.com and tell me about it.  I will let you in on a secret – once we address that fear and make a plan to help you feel safe, you will be able to transform your habits, meet your goals and make your life even more amazing than it is now.

I’m a coach, after all.  This is what I do.  I help people transform their health and, by extension their lives.  But I can’t do it alone.  I need you to be brave, be honest and real and raw.  I will not judge you – I make my living dealing with real people and real problems.  Send me an email at drjen@jenniferwurstmd.com and let’s get started!

QUESTION: Would you like to share one of your fears?  I’ll start – I eat too many sweets because they soothe me when I’m stressed (stress = fear).  One of my goals is to find ways to soothe stress that do NOT involve food.  I have good days and bad days with that, like most of us.

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Info For Cancer Survivors

In my practice I care for a large number of cancer survivors.  Breast cancer, colon cancer, bladder and prostate cancer, even appendiceal and esophageal cancer survivors are among my patients.

This week I am attending an adult medicine conference and one of the talks was about caring for cancer survivors.  Today I want to review my big two take-home points from that lecture.

First of all, let’s talk about our definitions.  What is a cancer survivor.  Well, if you have been diagnosed with cancer, from that day for the rest of your life you are a cancer survivor.  That’s a LOT of people.  In fact there were estimated to be almost 15 million people in the US and over 500,000 Ohioans (as of January 2014) living as cancer survivors.

Many people don’t realize that once you are a cancer survivor, one one hand you are very different from a medical standpoint from those who have never experienced cancer.  And on the other hand, you are no different at all.

Let’s review the differences first.  Once you have received treatment for cancer you have specific needs and health risks related to your cancer and its treatment.  If you received chemotherapy, radiation or surgery you may have aftercare needs related to those treatments.  For instance, some chemotherapy agents can damage your nerves or cause other long-term side effects.  Radiation to certain parts of the body can increase the risk of damage to healthy tissue in the radiation field.  Colon cancer patients may wind up with a permanent colostomy which obviously requires care long-term.

Survivors of childhood cancers have special needs that will have to be monitored by their physicians.  Learning difficulties, future fertility concerns, and other considerations will need to be addressed.

Any cancer survivor should have a complete survivorship plan developed by their oncologist within 6 months of finishing treatment.  The patient, the oncologist, AND the primary care physician need to have copies of the survivorship plan.  The patient should clearly understand what they will need to have done in the future, how often, and why.  Any long-term effects of treatment should be explained thoroughly with descriptions of symptoms to watch for.

This was my first take-home point.  Cancer survivors have unique needs that depend on the type of cancer they had and what treatments they received to address it.  This makes every survivor different and their survivorship plan must reflect this.

The second take-home point was actually the direct opposite.  Cancer survivors are no different from anyone else in that they need their routine screening exams performed on-time.

Many cancer survivors (including one in particular that I know very well) are content to use their oncologist as their primary care doctor, even years after their treatment is complete.  Oncologists are NOT primary care doctors.  They will not assess your cardiovascular risk and check your cholesterol.  They won’t discuss contraception and STD screening.  They may or may not check hepatitis C and bone density.

Also, many cancer survivors don’t feel they need to be screened for OTHER cancers.  They believe (incorrectly) that they have used up all their bad luck in having one cancer.  Cancer survivors should be aware that their risk of all other cancers is the same as or higher than those who have never had cancer – it will NEVER be lower.  And in many cases the treatment for their first cancer INCREASES their risk of developing a second cancer (so-called secondary malignancy).

This is my advice for cancer survivors.  By all means focus intensely on surviving your cancer.  Get through your surgery, chemo, radiation, all the treatments prescribed by your oncology team.

However, when your treatment is finished, make sure to sit down with your oncologist and get a comprehensive survivorship plan.  This document (and it will probably be a long one full of words you may not understand) should be explained to you in language familiar to you.  It should contain all the details of the treatments you received, including amounts of radiation and chemo drugs delivered.

Your survivorship plan should also detail follow-up testing you will need, how often, and for how long.  For instance, certain chemo drugs (like Adriamycin and Herceptin which are used in breast cancer) can harm the heart muscle and testing should be done periodically to make sure the heart is functioning well after treatment.  As another example, those who received radiation therapy to the chest for Hodgkin’s lymphoma are at higher risk for breast cancer.

If you have survived cancer, it is even more important that you take good care of your body.  Eat healthy and avoid smoking, using drugs and drinking alcohol to excess.  This means limiting alcohol to an average of two drinks per day for men and one for women.  Get plenty of exercise, drink clean water and avoid toxic exposures like industrial chemicals and heavy metals.  Make sure you are up-to-date on appropriate vaccines.  Get good sleep, manage your stress, and maintain a healthy weight.

God willing, you will have many years of life as a cancer survivor.  Your survivorship plan will spell out the road map for you and your primary care doctor to keep you healthy for many years to come.

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How To Choose A Multivitamin

I get asked all the time “What multivitamin should I take?”  My answer is usually to recommend Shaklee’s multivitamin of course 😉 but sometimes I can’t discuss product brands by name.

This week I got an email from Dr. Steve Chaney, a PhD biochemist and professor emeritus from the University of North Carolina where he taught nutrition to medical and dental students.  If you’re interested in such things, please subscribe to his website at by clicking this link.  And you can scroll down to see his post from 3/28 which is what inspired me to write about this topic this week!

This week’s email was about how to choose a multivitamin and his suggestions were fascinating and so USABLE!  Here are the three takeaways that struck me most from Dr. Chaney’s email.

Before you read any further, go get your multivitamin bottle.  You’ll want to look at the label as you read this article.

Your multivitamin should be COMPLETE

There are 24 nutrients for which the US FDA has set Daily Values (DV).  The DV is the amount which is judged to be able to prevent nutritional deficiency in nearly all healthy individuals.  Notice this is not necessarily OPTIMAL intake, just what is needed to prevent deficiency in healthy people.  Those who have medical problems may need different amounts.  The DVs also vary based on age, gender, pregnancy and lactation status.

Your multivitamin should have all 24 nutrients (23 if it doesn’t contain iron).  Count them to make sure.  If it doesn’t have all 23/24, don’t buy it, it’s not complete.

Let’s look at two labels for comparison.  First is the label for Shaklee’s Vita Lea with Iron.

All 24 nutrients are present and accounted for.  You’ll also note that most of the nutrients are present at 100% DV (daily value) or better.  For some (like magnesium, which can cause diarrhea, and calcium, which can cause constipation) the amounts are lower to avoid side effects.

There are also nutrients that the FDA believes are important for humans but there isn’t enough evidence to set a DV.  These nutrients have a “dagger” symbol next to them.  If you see the five trace minerals at the end of the label above, those have the dagger next to them.

Let’s look at another label for a very popular brand of vitamins sold at every grocery store and pharmacy in America.

Credit: Walgreens.com

This one has only 21 nutrients in it.  No magnesium (and if you know me, you’ll know magnesium is one of my FAVORITE nutrients to prescribe), phosphorus or molybdenum.  Not complete.

Your multivitamin should only include safe ingredients

If your multivitamin’s ingredient list includes artificial colors or sweeteners, don’t buy it.  This includes aspartame, acesulfame, and anything that has a color plus a number (like Red 40).  These ingredients have no business in a nutritional supplement.

I want to say a word about gummy vitamins for a moment.  Look at your gummy vitamin’s nutritional panel.  I’ve included a popular one for reference.

Credit: Walmart.com

Definitely not complete.  Here’s the ingredient list:

Credit: Walmart.com

Sugar (3 grams and 10 calories per serving), artificial colors and artificial flavors.  NOT healthy.

Gummy vitamins are candy pretending to be healthy.  If you can find one that’s complete and has no added sugar or unnecessary calories, artificial flavors, artificial sweeteners or artificial colors, by all means buy it and send me the info so I can put it on my website and issue an official apology.  Until then, if you want candy buy candy, but if you want a high-quality nutritional supplement that will support your overall health, a gummy vitamin is worse than not taking a multivitamin at all.

Don’t fall for marketing hype!

If there is no DV or dagger symbol next to an ingredient in your multivitamin, that ingredient probably does not add anything of value to support your health.  (Notice I’m talking about your multivitamin, not herbal products taken for proven health benefits in addition to your multi.)  Similarly, a lot of multivitamins have marketing buzzwords on the label like “organic,” “natural,” “whole-foods,” etc.  Also be aware that the individual nutrients in a multivitamin are highly purified and contain no DNA or protein so “non-GMO” is meaningless.

Companies also will claim that their products are safer than other companies’ products.  Ask for proof.  How do they know?  How many quality tests do they run on their raw materials and finished products?  How often do they issue recalls?  What is the procedure if a customer has a problem with a product?  Is there a guarantee?

Now that we’ve discussed how to make sure a multivitamin is complete, whether its ingredients are safe, and whether you’ve unwittingly fallen for marketing hype, let’s check in with you, Dear Reader.  How did your multivitamin do?  Leave me a comment and let me know!

PS – If you found your multi isn’t all you thought, please check out Shaklee’s Vita Lea multivitamins or email me at drjen@jenniferwurstmd.com with any questions.

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Supplements For Soft Tissue Injuries

Many of you know I had surgery 2 weeks ago to remove varicose veins in my leg.  The pain, bruising and swelling were of epic proportions but they are subsiding slowly.  As a very active and busy person it has been very difficult for me to exercise patience to allow my body to heal at its own pace.

This week I decided to do some research on supplements to help my leg heal faster.  As expected, I found that a good multivitamin and plenty of protein are essential for healing.  However, I was surprised to find evidence of efficacy of a certain type of supplements for soft tissue injuries.

Proteolytic enzymes are chemically active protein substances that act to break down other proteins.  Those who remember their Biology 101 will remember that enzymes are proteins that make chemical reactions happen faster than they would on their own.

Why are proteolytic enzymes helpful in wound healing and in repairing other types of tissue damage?  Well blood is protein, and in order to get all the blood broken down and cleaned up by macrophages in the tissues you need enzymes to break down the hemoglobin and other blood proteins.

Those familiar with Chip and Joanna Gaines on the show “Fixer Upper” will remember Chip’s joy on Demo Day.  The first part of a major remodel is breaking up and taking out the cabinets, appliances, drywall and other bits and pieces that need to be gotten rid of.  The first step in healing a soft tissue injury is a similar process to Demo Day.  Damaged proteins like collagen and hemoglobin must be cleaned up in order to make way for new healthy proteins to be put in place.

So what’s the evidence that proteolytic enzymes are helpful for soft tissue healing?  I found articles published in the 1960s that showed supplementing with proteolytic enzymes produced remarkable healing of athletic injuries from a wide variety of sports.  There is more recent evidence too.

  1. In 2009 researchers showed that a protease preparation containing fungal enzymes, papain and bromelain made a significant difference in muscle strength recovery after running downhill for 45 minutes.
  2. It was also shown that protease supplementation (containing bromelain, papain, trypsin, chymotrypsin and several other enzymes) improved recovery of leg muscle strength and soreness after running downhill.
  3. A small study showed statistically significant improvement in fatigue and markers of muscle damage and inflammation with supplementation of bromelain in competitive bicycle racers.
  4. A list of surgically relevant herbal preparations listed bromelain as helpful in accelerating wound healing.
  5. A very extensive discussion of the effect of supplements on surgical wound healing mentions bromelain as effective at reducing swelling, pain and healing time.

To summarize, if you have a sports injury or a surgical wound, it would be reasonable and safe to add a proteolytic enzyme supplement to reduce swelling, bruising and time to heal the injury.  Make sure anything you choose contains bromelain because it seems to have the best research data to support its use.  As always, be sure to tell your surgeon what supplements you take or are planning to take that may affect your surgery.

Before you ask, yes, I started taking a supplement containing bromelain (among other enzymes) a few days ago.  And I’m taking some research articles to my follow up appointment with my surgeon for him to review!  I wish I had known about bromelain before my surgery, I might have had less pain and swelling to deal with.

QUESTION: Are you surprised that taking enzymes orally helps healing injuries and surgical wounds?  Would you take them yourself?

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Money And Health

With all the wrangling and fighting in Washington over the federal budget and also over the future of the Affordable Care Act, I’m feeling philosophical today about the connection between money and health.

What is the connection between money and health?  Can money buy health?  Can lack of money keep you from being healthy?  Well, yes and no.  It has been shown pretty convincingly that, in general, poor people are not as healthy as those who are better off financially.  Whether that is due to educational disparities, differences in access to health care, different diet quality, or other factors isn’t really clear.

Does being better off financially equal better health?  No, of course not.  Look at movie stars and celebrities.  Every week it seems there is another celebrity drug overdose or story about a movie star committing suicide in the depths of mental illness.  Wealthy celebrities struggle with obesity just like everyone else does.  Even access to infinite health resources does not guarantee one will be healthy.

What is money anyway?  Why do we need it?  Money is an artificial construct that makes it easier to engage in trade.  It is a symbol that everyone has agreed in advance has a certain value.  It is easier to trade coins or paper money for foodstuffs than to take a goat or bales of wool or stacks of animal furs to the grocery store.

The only thing that will motivate a person to open their wallet or pull out a credit card (another artificial construct, BTW) is the belief that the thing they are buying will make their life better.  Whether it’s underwear, carrots, legal advice, prescription medication, or a Ducati motorcycle, the thing being purchased will make the buyer’s life better in some way.

(BTW the government is selling you something in return for the taxes you pay – the right to stay out of prison.  There is an interesting thought, right?)

OK.  So if you need money to buy the things YOU need for food, shelter, clothing, etc, you have to have something to trade for that money.  The things we possess to trade for money all fall into three broad categories:  goods, time and expertise.

So what brings money into your household?  We spend an awful lot of time doing whatever we do to earn money.  Shouldn’t it be something that gives us pride and pleasure?

Too many people sacrifice their health in the pursuit of money.  There is a sweet spot where your career and your health are balanced.  Your stress is enough to keep you motivated and energized but not so much that you are at risk of getting sick from it.

Money cannot buy health.  You don’t have to have a lot of money to do the things you need to do to be healthy.

  • Eat a balanced diet with plenty of fresh fruits and veggies in season, whole grains, nuts and seeds with limited amounts of meat and dairy.
  • Move your body every day in a way that you enjoy.
  • Get plenty of sleep
  • Drink plenty of fresh, clean water
  • Play and laugh and spend time with people who make you feel good

We all need money, but we DON’T need to be so focused on it that we make ourselves sick in the pursuit of it.  Take a moment today to examine whether your career and health are in balance or whether you need to reevaluate the relationship between money and health in your life.

QUESTION: Do you think you are sacrificing your health in order to earn money?  Why or why not?

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Should You Have A Coronary CT?

There has been a lot of buzz in the news recently about coronary CT, also known as CT Coronary Angiography (CTCA).  This is a noninvasive scan done to check for blockages in the heart’s coronary arteries.

Why would someone get a coronary CT?  There are 3 main reasons.

Chest pain

There are many reasons someone would have chest pain.  Coronary CT can help distinguish true angina from other sources of chest pain like GERD, asthma and anxiety.  Because it is noninvasive and doesn’t require IV medication or running on a treadmill, for some patients a coronary CT can be a good diagnostic option.

Management decisions

When someone has high cholesterol, we manage it based on their risk of having a heart attack in the next 10 years.  Our current model of estimating risk is actually not that great, unfortunately.  Knowing whether or not a person already has blockages in their coronary arteries can clarify heart risk and help decide whether they need medication to bring down their cholesterol.

Knowledge is power!

If a person has a family history of heart disease and is concerned about their personal risk, a coronary CT can help clarify things.  Similar to Lifeline screenings, a coronary CT is often available at low cost and sometimes is offered without a prescription.

Before you get a coronary CT, consider what you will do with the information.  If you find that you have some hardening of the arteries in your heart, are you ready to get serious about diet, exercise and weight control?  Are you ready to start taking a statin drug?  Will you work hard to get your blood pressure under control?

If you get a coronary CT and it is clean, that’s great, and very reassuring.  However, what will you do if it is NOT clean?  Are you ready to do what you need to do to reduce your heart risk?

Before you get your coronary CT, think about what you will do with the results.

QUESTION: Have you thought about getting a coronary CT?

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Hair Loss

Carolyn is a lovely lady who came to my office recently complaining that her hair was falling out.  This is a common problem that primary care doctors see.  Most of the patients are women, and often it is difficult to figure out why hair loss is happening.

If you’re a woman and you’re losing your hair, it can be terrifying!  Many of our standards of beauty in America, right or wrong, center on thick glossy healthy hair.  When we see a woman who has hair loss, we think of chemotherapy and assume she is unhealthy when that may be completely inaccurate.

What are the causes of hair loss?  In general, they can be broken down into 5 main categories.

Autoimmune

This type of hair loss is pretty obvious.  There are well-defined patches of bald skin on the scalp.  Sometimes the skin is perfectly normal, and sometimes there is scarring present.  A doctor should be able to diagnose these causes of hair loss pretty readily by discussing symptoms and doing a physical examination, and discuss treatment.

Trauma

How can you cause trauma to your HAIR?  Easy.  You pull on it.  Women who wear their hair tightly pulled back all the time will lose hair by injuring the follicles.  This is most often seen in African-American girls and women who wear their hair in cornrows and other tight braids.  It is very common to see receding hairlines in these patients as the hair follicles at the edge of the hair field are lost.

We also see hair loss from repeated pulling on the hair, a nervous habit called trichotillomania.  Treatment for anxiety will reduce the urge to pull or twirl the hair and stop the hair loss from happening.

Hormones

By far the most common cause of hair loss in America is male pattern baldness.  Everyone is familiar with the bald-spot-and-receding-hairline pattern in our fathers, grandfathers, uncles and other older male relatives.

Did you know women can get male pattern hair loss too?  It happens after menopause, when the hormone balance in the female body shifts to be more male-predominant.  Women tend to have more of an all-over-the-scalp or general thinning of the hair rather than a receding hairline or bald spot on the crown.

Most people who check with Dr. Google about their hair loss are familiar with underactive thyroid as a cause of hair loss.  It is true that hypothyroidism has hair loss as one of its symptoms.  Thyroid medication can also cause hair loss.

Another hormonal cause of hair loss is the shedding of hair after childbirth.  About 3 months after a baby is born, Mom usually starts losing the extra hair she grew in pregnancy.  Don’t worry, the new mom won’t have to worry about going bald in addition to getting back into her pre-pregnancy clothes.  The hair loss stops after a few weeks and usually her hair is the same as it was before she got pregnant.

Stress

This is an extremely common and extremely frustrating cause of hair loss.  When the body goes through a major stress, physical or mental, it can cause the hair to go into “sleeping” (called telogen) phase.  Surgery, childbirth, or the death of a close family member can trigger it.  The body just doesn’t have the resources to put into growing hair, so it conserves those resources in the most sensible way it can.

About 3 months after the stress has resolved, the hair follicles want to start growing hair again.  Unfortunately the follicle can’t start growing the same hair shaft again.  It has to shed that hair shaft and start over.  All those hair shafts being shed at the same time is what makes a person fear their hair is falling out.  Like the new mom above, the hair won’t ALL fall out, and after a few weeks looking at the hairline will show new, short, fine hairs growing.  This is reassurance that stress was the cause and that the body is back to business as usual as far as hair goes.

Nutrition

Nutritional deficiencies are another common cause of problems with the hair.  Very commonly after bariatric surgery we will see patients complaining of hair loss.  Calorie restriction from ordinary dieting, not just the super-restrictive diet after bariatric surgery, will cause some hair loss too.

Protein, vitamins and minerals are important nutrients for healthy hair growth and if you’re not getting enough your hair will suffer.  Nutrients to pay close attention to as far as hair growth goes include iron, zinc, biotin, omega-3 fats, protein, vitamin D and trace minerals like selenium.

Your doctor can check your iron and vitamin D levels.  Everyone needs an omega-3 supplement because almost nobody gets enough in their diet.  Same with a good-quality multivitamin.

If you’re having trouble with hair loss, see your doctor to make sure there isn’t a potentially serious cause for it like hypothyroidism or iron deficiency.  If no cause turns up, I invite you to consider trying a few months of Vitalizing Plan which contains your comprehensive multivitamin, Vitamin D, fish oil and probiotics to boot.  Everyone who uses Vitalizing Plan tells me their hair and nails are improved from using it.  And since it’s guaranteed, there’s no risk.

What have you got to lose, except more hair?  Give your doctor a call and check for medical causes of hair loss.  If s/he doesn’t turn up a cause, let me know and we’ll talk about nutrition!  You can email me at drjen@jenniferwurstmd.com or call 888-741-9153 to set up a time to talk.

QUESTION: Do you have problems with hair loss?

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