Obesity – a hormonal disorder

Obesity, or having a BMI greater than 30, is becoming a more common health problem over the last few decades with about 40% of adults now dealing with this.  It is also a health problem that is stigmatized and the patient is frequently blamed for.  Everyone knows that if they just ate less and moved more they wouldn’t have this problem. Right? People are stereotyped as lazy and not watching what they eat.  Research shows that there are other things that contribute to patients having problems controlling their weight, besides eating too much. In fact it is common for obese people to eat fewer calories than their thinner friends, Dr. Jason Fung is a kidney doctor who believes that obesity is primarily a hormonal disorder, and not a caloric disorder.

Dr. Fung is the author of several books that have been talked about recently – including the “Obesity Code” and “the Complete Guide to Fasting” and most recently “the Diabetes Code”.  He has a program called Intensive Dietary Management which is available online to provide further support to people who are interested.

Insulin Resistance and increased insulin levels are what Dr. Fung believes has contributed to our obesity epidemic and what makes it harder for people to lose weight the longer they have been obese.

Hormones are molecules that move throughout the body and deliver messages to the target cell.  One of the main hormones involved in obesity is insulin.  Insulin is made in the pancreas and helps the body use energy and store excess energy for a time when it can be used – and thus causes weight gain.  If you decrease the amount of insulin you are exposed to, you can decrease the weight,

How can you decrease insulin levels?

Insulin levels are decreased by

  1. eating foods that don’t raise insulin as much – carbohydrates raising the insulin levels more than proteins or fats.
  2. decreasing levels of the hormone cortisol that increases in response to stress and
  3. decreasing insulin resistance 
  4. decreasing how often you eat. 

How can you treat obesity and reverse diabetes?

So to reverse this epidemic it may help to:

  1. reduce added sugar consumption.  Read labels.
  2. eat whole unprocessed foods.
  3. avoid refined grains like white flour to decrease insulin spikes.
  4. increase consumption of natural fats – healthy fats like avocados, walnuts, virgin olive oil, fatty fish – helps with feeling full by stimulating the fullness hormones peptide yy and cholecystokinin – and fats don’t raise insulin levels as much.
  5. improve stress control and sleep hygiene to decrease the stress hormone cortisol from stimulating insulin.  Try Tai Chi, yoga, meditation, massage and regular exercise to help with this.
  6. increase physical activity to improve insulin sensitivity of tissues.
  7. limit the bodies exposure to insulin by decreasing the frequency of meals. Insulin is released each time we eat so decreasing how frequently we eat decreases how often we are exposed. If cells aren’t as frequently exposed to insulin, then they will be come more sensitive to its effects and less will be produced. And decreased insulin helps with weight loss. 
  8. don’t drink diet soda or artificially sweetened things that increase insulin release even though they don’t contain calories.
  9. increase fiber – to help with digestion and decrease production of the hunger hormone ghrelin.

Dr. Fung recommends people consult with their physician to see if intermittent fasting is appropriate for them and to do lab work in order to monitor their treatment progress.  There are different protocols that people follow when fasting and it can be used with many different diets – although many people chose to pair it with a Keto diet to decrease exposure to foods that increase insulin levels. 

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Healthcare 3.0 or ZDogg discusses Direct Primary Care

ZDogg, well known by those in the medical field for his musical parodies, has talked about something called Healthcare 3.0. He calls Healthcare 1.0 to be the old time family medicine, without clinical guidelines, and a paternalistic relationship between doctor and patients. Healthcare 2.0 is how many offices are functioning now – owned by corporations, driven by quality numbers and productivity goals, they may lose the relationship with the patients they aim to serve. Medicine becomes more of an assembly line, neither the doctor nor the patient are in charge and their healing relationship is disrupted.

Healthcare 3.0 is a combination of Healthcare 1.0 and 2.0.  Healthcare 3.0 provides personalized care that recognizes the needs/wants of the individual patient in the context of the greater whole. It is a partnership between the physician and patient that recognizes the mind-body connection and helps the patient work towards goals that are important to them. The video he created “Healthcare 3.0” was to inspire those in the medical field to dare to try something different that may allow us to create a better future for our patients – as well as ourselves as practitioners. It is the type of care that many of us wanted to be able to provide when we went to med school. 

ZDogg had a practice called Turntable Health from 2013 to 2017 that was his attempt to create a Healthcare 3.0 environment – while they ultimately closed due to multiple factors – large overhead and depending on venture capital funding being two  major ones, they improved medical care, touched many patients lives and inspired many physicians to work towards creating their own version of Healthcare 3.0 – Direct Primary Care being one of these versions. Click here to see an article about his practice.

One of the things that Turntable did was allow patients to have access to many services that would improve their health – nutrition, yoga, health coaching were just a few of the things they could access. I would have loved to join Turntable if it had been located in the Cincinnati/NKY area. I have no venture capital and am trying to keep my overhead low, but I am trying to figure out a way to incorporate nutrition and mental health care into my DPC practice over the next year – as these are two areas that a lot people would benefit from having better access to.  Stay tuned for further updates as I work through this thought process. If you have thoughts on ways for me to do this, or know people who may be interested in working with me –  contact me via email CVillacisMD@HealthConnectionsDPC.com.

ZDogg recently did an interview with Dr. John Bender who has a DPC practice in Colorado, and is on the board of the American Academy of Family Physicians.    Click HERE to see the interview.

Colorado is the other state, that along with Kentucky, doesn’t allow patients with Medicaid to pay for direct primary care memberships with their own money. Yes, you read that correctly.  If you have Medicaid through the states of CO or KY, you can spend your money on things that damage your health, but not healthcare. KY is having problems paying for their Medicaid expansion – but won’t allow for patients to pay for things they want to improve their health. Direct Primary Care provides better access and longer appointments for patients and this helps decrease ER visits and improve health outcomes.  All of this would help patients, and provide the state considerable potential savings. I went to Frankfort last week with 2 other DPC doctors from KY to try to change this. I find it ironic that the coverage that is supposed to help patients obtain medical care, is preventing their ability to obtain medical care on their own. Hopefully as we go forward with this conversation, we will be able provide care in a way that doesn’t discriminate against people based on their insurance status. 

Everyone I know who has opened a Direct Primary Care practice has done it because they want to provide better health care than they are able to do within the current system.  We are moving towards Healthcare 3.0 – come join us!

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Diabetes – Diabetic Neuropathy and Tips for Healthy Feet

What is Diabetic Peripheral Neuropathy?

Diabetic Peripheral Neuropathy (DPN) is nerve damage that is caused by high blood sugar and triglycerides. It is unfortunately very common and up to half of all people with diabetes may struggle with diabetic peripheral neuropathy. DPN can cause people to have both pain and numbness and lead to severe problems like ulcers, bone infections, and even amputations. It can also cause problems with balance, problems walking, decrease muscle tone and lead to structural changes in feet. People may not always be aware that they can’t feel their feet enough to protect them – and this is why it is essential to have a diabetic foot exam at least once a year.

Pain

People with DPN have a burning, tingling, pins and needles sort of pain that is often worse at night or after being on their feet a lot. It is usually symmetrical and progresses from the toes up the legs over time. After a while, it can also affect the hands.

Numbness

If you can’t feel your feet, then it is harder to protect them. People with diabetes have problems sensing pressure, pain, and temperature at times. This can lead to foot sores developing. These sores can develop by stepping on something, friction or other causes. Once established they are then often hard to heal and have a higher risk of infection if the person’s blood sugar isn’t controlled. If the person is a smoker or has peripheral vascular disease, it can be especially hard to heal.

Sometimes people can have so much numbness that they may not be able to feel if they have a broken bone in their foot. This can lead to them walking on it and developing a problem called a Charcot foot – which could need surgery or even lead to amputation.

Unusually shaped feet may not fit right in shoes, which leads to an increased risk of ulcers and adverse outcomes. DPN can lead to other structural changes feet which can make it more common to get ulcers. Once people have one ulcer, they are more likely to get another one. If these sores aren’t tended adequately they can get infected, this infection can spread to the bone and lead to amputation. Treatment may involve removing dead/infected skin, staying off feet, using a special brace to care for it. Frequently patients will be under the care of a podiatrist or a wound care clinic to help care for foot sores. If your PCP refers you to one these specialists – please go!

Treatments:

While DPN can be very painful, there are treatments which your doctor may recommend for this nerve pain. Antidepressants – like amitriptyline or duloxetine, anticonvulsants – like gabapentin or pregabalin are effective and reducing pain and increasing function for people dealing with DPN. Physical therapy can help with strength and balance, and bed cradles can be used to keep blankets off feet during the night.

Tips for healthy feet:

  1.  Inspect your feet daily – use a mirror or ask someone to help if you can’t see. Check your whole foot – big toes, little toes, the ball of the foot, sides of foot, heel… 
  2. Bathe feet in lukewarm water every day
  3. Moisturize feet – but not between toes. Extra moisture can lead to infection. Feet can become drier because the nerves that control the oil/moisture in your feet aren’t working right anymore.
  4. Cut nails carefully – straight across, file edges if needed.
  5.  DON’T cut corns/calluses yourself – talk with your family doctor or podiatrist about it. If not appropriately treated these can turn into sores.
  6. Wear clean, dry socks – maybe diabetic socks.
  7. Wear socks and shoes all the time. Don’t walk barefoot
  8. Protect feet from hot and cold – wear shoes on the sand/sidewalk, test water with fingers before getting in the tub, no hot water bottles or heating pads to your feet.
  9. Look and feel in shoes before putting your feet in. You could walk all day with a pebble in your shoe and injure your foot without knowing it.
  10. Consider special shoes or orthotics – Buy them later in the day when feet are larger and break them in slowly.
  11. Stop smoking – smoking damages blood vessels and makes it harder to heal and dramatically increases your chance of amputation.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

So you didn’t sign up for ObamaCare, what now?

Direct Primary Care meets primary care needs – how to pay for other needs outside of insurance…

Did you decide that you could’t afford to continue with your health insurance and are looking for another way to help pay for catastrophic health issues?  Unfortunately, you are not alone. While Direct Primary Care is an excellent way to get your primary care needs met – it doesn’t provide help with paying for catastrophic health problems where you may need to be hospitalized or have surgery.  Many people will opt for a high deductible plan and pair it with DPC – but even those plans prices have risen out of many people’s reach.  Joining a health cost-sharing plan is a solution that can help pay for serious medical issues.

What are Cost Sharing Health Plans?


Cost Sharing Health Plans may be either faith-based or not faith-based.  Some of the faith-based ones (also called Health Sharing Ministries) have been around for many years, and people who had them were exempt from paying the penalty for not having ACA compliant health insurance. Newer plans, like Sedera, were not grandfathered in and do not exempt people from paying the penalty – although this is a moot point now for individuals.  Some plans, like Sedera, can be provided by employers to help care for their employees and can be paired with another insurance product – called a MEC plan (minimal essential coverage plan) as well as direct primary care.

Limitations/ Considerations on Cost Sharing Health Plans

Since these plans are not insurance, they are not required to cover all the same things that ACA plans do.  Pre-existing conditions may not be included – or only partially covered for several years,  people with specific health problems may not be accepted, mental health coverage is unfortunately poor, and some of the plans require participants to sign a statement of faith.  However, for many people the price difference, as well as a different philosophy, make it a desirable alternative.  There are different levels of coverage available.  A membership for a family with $1,000,000 coverage is generally under $500/mo with most of these plans – instead of well over $1600/mo with the plans that are found on the marketplace. There are programs with less coverage, but I would be hesitant to suggest people consider them. 

Another DPC physician I know put together a chart that lists some of the major Cost Sharing plans and wrote a recent blog post.  Click HERE to link to his chart/blog.  PLEASE read the plan specific sites well and ask questions before signing up – they are not right for everyone – but for many people is a great way to get help when you need it.  These plans are based on principle’s of individual responsibility and helping others who are in need.  These are member to member payments – either directly or indirectly – to help each other – instead of paying a large corporation whose motives may or may not be aligned with the patients’.  Also, as I said earlier – this is not insurance – but a great alternative to investigate.

Health Sharing Plans and DPC

Some Health Sharing Plans may partially reimburse or discount monthly sharing amounts for people participating in a direct primary care practice.  Sedera is only available for individuals at this time who are affiliated with a direct primary care practice.  That is why there is an enrollment link on my sign-up page – not that I am endorsing them over any other plan.  They are simply the only group that has reached out to the Direct Primary Care community to make it easier for patients to enroll and and include it in their monthly bill from DPC Practices. You can sign up after you join, and it is definitely not required. 

If you are a patient of mine and are interested in learning more about health sharing plans and whether or not they would possibly meet your needs, please contact me to talk about this further.  

***Note *** This post, like all my other posts, is for general information only and is not to be taken as direct advice.  Please consult your personal physician, insurance agent, or financial advisor for more information.  

 

What is Addiction?

As a family physician who also practices addiction medicine, it is common for me to find that patients are confused about the difference between physical dependence on a substance, and addiction. Any substance that causes withdrawal symptoms when discontinued has created a physical dependence. Withdrawal symptoms can be caused by many classes of medications and drugs – from alcohol, opiates, and benzodiazepines to some blood pressure medications, sleeping pills, and cold medicines. Withdrawal symptoms may or may not be accompanied by other features that are characteristic of addiction. If you have a surgery and take opiate medications regularly for two months and suddenly stop – you will probably have withdrawal symptoms. Having withdrawal doesn’t mean that you have become addicted to opiates – it merely means that your body has adjusted to having these medications on board and need to come off of them more gradually to avoid feeling sick. If you are taken off opiates because you are no longer in pain, and aren’t having withdrawal symptoms and just want more pain pills because you like the way they make you feel (not because you are still hurting) and you are craving them – that is more characteristic of addiction – now called substance use disorder, or SUD.

Types of Substance Use Disorder

Substance Use Disorder is a new way of looking at and diagnosing addiction that came with the DSM-V, the most recent diagnostic tool put out by the American Psychiatric Association in 2013. These criteria are based on several decades of research. The category of SUD is broken further into different categories based on type of substance used, and how severely the substance has impacted the individual’s life. The following are the different categories:

  1. Alcohol Use Disorder
  2. Tobacco Use Disorder
  3. Cannabis Use Disorder
  4. Stimulant Use Disorder (ex. meth, cocaine, Adderall)
  5. Hallucinogen Use Disorder (ex. LSD, Mushrooms, PCP)
  6. Opioid Use Disorder (ex. Percocet, heroin, fentanyl)
  7. Sedative Use Disorder (ex. Xanax, sleeping pills)
  8. Inhalent Use Disorder
  9. Caffeine Use Disorder

Criteria for Substance Use Disorder

Substance use disorder covers a wide range of symptoms and it focuses on problems that people may have as a result of taking a substance. There are 11 different basic criteria that make up a diagnosis of Substance Use Disorder, and they can be lumped into different groups – impaired control, social impairment, risky use, and pharmacological indicators.

Impaired Control 

People can have impaired control can show up in a number of different ways – 

  1. Taking a substance in larger amounts or for longer than you meant to
  2. Wanting to cut down or stop using a substance but not being able to
  3. Having cravings for the substance
  4. Spending a lot of time getting, using or recovering from using the substance

Social Impairment

As SUD worsens it can effect more different aspects of people’s lives – 

  1. Struggling to meet your responsibilities at home, school or work due to substances
  2. Giving up activities due to substance use – social or work-related
  3. Continuing to use despite causing relationship problems

Risky Use

Continued use despite the harm that it can cause to your person – 

  1. Continuing to use despite knowing you have a physical or mental health problem that could have been created by or made worse by the substance – like cirrhosis and continuing to drink
  2. Using the substance in a way that could put you in danger – such as using drugs while driving 

Pharmacological Indicators

These can develop as part of regular use, but may or may not be indicators of SUD – 

  1. Tolerance – needing more of a substance to get the desired effect
  2. Withdrawal Symptoms – which are relieved by taking the substance.

The Severity of Substance Use Disorder

If an individual has 1 of these 11 above symptoms – ex. just the withdrawal symptoms – it does not indicate that they have a substance use disorder – just that they have become physically dependent on that substance.

  • If a person has 2 or 3 of the above symptoms then that may indicate a mild substance use disorder,
  • 4-5 symptoms indicate a moderate substance use disorder, 
  • 6 or more indicate a severe substance use disorder.

I have had some patients who thought that because they were still functioning well at their job, and their family wasn’t aware, and they were still participating in their same activities – they didn’t have a substance use disorder. It is true that person likely doesn’t have severe substance use disorder. However, if they are now having health problems that are related to their substance use, have tried to stop and haven’t been able to, then they probably have at least a mild substance use disorder. If you think about the person who has been diagnosed with COPD and told by their physician that they need to stop smoking – and find that they are unable to quit – that person probably has at least mild tobacco use disorder.

Treatment for Substance Use Disorders

The first thing that people need to realize is that they are not alone. There are millions of people in the US who deal with substance use disorders every year – and many of them recover from it. The earlier a person is in their substance use disorder, the easier it is for them to make changes. However, it is never too late. The thought that a person has to hit bottom before they make a behavior change is not true. The goal of getting someone into treatment is to keep them from hitting that bottom and allowing them to get back what they have lost due to the substance use disorder, and minimizing future damage. 

I recommend that people talk openly with their physicians about their substance use so that they can learn about how it may be affecting their health and what is the best way to get healthier. Also, there are some substances, such as benzodiazepines and alcohol, that when stopped abruptly can be dangerous to one’s health – leading to withdrawal symptoms such as anxiety, agitation, hallucinations, and seizures. These problems can often be avoided by appropriate treatment. Talking with your physician also gives the doctor a chance to be aware of any things that they may need to do differently when treating you – so that they don’t hurt you by accident. I have seen multiple cases of someone with an opioid use disorder that is in remission, end up relapsing due to being prescribed opiates for an injury “just in case they need them.”

I base recommendations for substance treatment on the severity of the disorder, home environment, patient preference, prior treatment experiences, and several other factors. Frequently, I recommend a combination of counseling and medications. It is important to address any underlying issues that may have led the person to develop the substance use disorder in the first place, as well as the substance use itself. If someone started using opiates in response to psychological distress, treating the substance use disorder without also addressing the mental health issue is going to be less effective. Some people find that participating in groups such as AA, NA, Celebrate Recovery or Smart Recovery provide them with support as well as skills on their path to recovery. Other people may participate in group sessions that meet several times a week for several hours at a time or may have individual sessions on a weekly or monthly basis with a counselor trained in addiction.

There are a lot of different paths to recovery and sometimes it takes a while to find what is right for you!  Just because you have tried to quit in the past and started using again, doesn’t mean you can’t stop in the future. The most important thing is to learn from your past attempts, forgive yourself for not being perfect, and reach out for help again. 

If you have a friend or family member who you think may be struggling with a substance use disorder, or if you think you may have a substance use disorder yourself – please consider talking with your/their physician. There is help available, but the first step is realizing there may be a problem and asking for help.

For more information on substance use disorders, please check out www.samhsa.gov or www.drugabuse.gov or talk with your personal physician.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Happy Thanksgiving!

One thing I sometimes recommend to people is that they make a gratitude list to remind themselves of all the good things that they have going on in their lives.  There are several things that I am particularly aware of being grateful for this year.  Probably the top 2 things are my family and the strength I have found in the Direct Primary Care community.

Most Primary Care physicians today are employed by groups or hospital systems.  As a former employee, I can attest that this is a difficult spot to be these days.  While as an employee I did have the relative security of having an income, I lacked much control over the process of how I cared for patients. Even though I became involved in leadership teams, I was a piece in a much larger system and did not have the authority to make many decisions.  It was frustrating to have ideas about how I could better care for my patients and create a better environment to practice in, and not be allowed to implement any of my ideas for a multitude of reasons.  I found out about Direct Primary Care while reading a practice management magazine – and a light bulb went off. I had a choice.  Patients had a choice.  There was a better way to do things. 

As an independent DPC physician, I am responsible to make sure my office runs the way I want it to as well as providing excellent patient care.  I am a small business owner – something I received precious little training on in residency – which was 16 years ago… I have had so much to learn in this area and I am truly thankful for those who have helped me along the way.  From DPC physicians who opened their practice for me to visit them, to people who coached me on how to write a business plan and sagely advised me to make it for 3 years and not 1; from SCORE mentors advising me on commercial real estate to other members of the Chamber and BNI who have given me suggestions on marketing and bookkeeping.  I am part of a tribe of over 1000 physicians nationwide who are going down parallel paths in opening independent businesses and the support we give each other through Facebook groups, and conferences has been amazing.  I am blessed to have my family who has listened to my ideas, gone to conferences with me, and helps me keep things in perspective as I go through the rollercoaster of being a new business owner.

I am thankful that my mom has completed chemotherapy this month and that my sister and I are living in the same metro area for the first time in 30 years.  I am thankful that my daughter is still able to enjoy her dance and that my son will be graduating from college this summer.  I am thankful that my husband is able to remind me of where I have been and where I am trying to go and WHY I am going there when I get bogged down with daily challenges. And I am thankful for the unquestioning love that our furry friends give us on a daily basis. 

I am privileged to be able to share people’s journey towards better physical and mental health.  Patients open their lives to me and we are able to talk about their goals, dreams and hopes – and how they can try to achieve them.  They share their pain and grief – and I am allowed to counsel them, or just be present with them in the moment. Being a doctor is not a matter of just writing a prescription or a referral – it is much more than this – it is a calling where one human is able to care for another to try to restore and/or maintain health – by drawing on their previous experiences, research and knowledge and melding that with what the other person wants and needs. 

It has been a crazy year and I have much to be thankful for and I am looking forward to what the next year brings.  It’s quite a journey!  Thank you for coming on it with me!

 

How to Measure Your Blood Pressure

Blood pressure measured in my office can be different from blood pressure people may have when they are at home or at work.  In order to figure out how much of a problem someone’s blood pressure is we frequently need them to monitor it on their own.  Below are some common situations where I recommend people check their blood pressure.

1)    If the diagnosis is unclear.  Patients sometimes blame an elevated blood pressure reading on “white coat syndrome” – in other words it is just up because they are in my office but it is really ok the rest of the time.  While sometimes this is true, I really hope that coming to see me isn’t the most stressful part of their life.  If their blood pressure is up when they see me,  I frequently wonder what it is when they get home at the end of a long day!

2)   Sometimes people have concerns like headaches – which can be related to blood pressure – or a number of other health issues.  If they have a headache and check their blood pressure we can see if these problems are related or not.

3) When someone has a diagnosis of hypertension – they can see how their blood pressure is between visits and how it is influenced by different things in their life like stress, smoking, weight loss/gain and also how their blood pressure is in between doctor visits .  Hypertension is a chronic health problem – and like all chronic health problems – people tend to do better when they are actively involved with their own care.  If someone monitors their blood pressure and is seeing that it isn’t where we want it to be then they can let me know and we can figure out what the next steps are instead of waiting for their next scheduled visit.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Be Careful – It’s HOT outside! Heat Exhaustion 101

Heat Exhaustion is a heat related illness that  can happen after being exposed to hot temperatures for a long time.  People who are overweight, have diabetes or hypertension, are under 4  or over 65 years old, or are taking certain medicines (like diuretics, beta blockers, antipsychotics or antihistamines) are more likely to have problems in this situation but anyone who is working or exercising outside is at increased risk.  Heat exhaustion is more common when the heat index is up – if the temperature is over 90 degrees and it’s humid.

Some  signs of Heat Exhaustion are:

  • Profuse sweating
  • Rapid heart rate
  • Dark-colored urine
  • Dizziness
  • Fatigue
  • Headache
  • Muscle or abdominal cramps
  • Nausea, vomiting, or diarrhea
  • Pale skin
  • Rapid heartbeat

Treatment is – you guessed it – GET OUT OF THE HEAT – preferably into an air conditioned area and rest.   It is also a good idea to drink cool fluids (without alcohol or caffeine), remove any extra clothing, take a cool shower, apply cool towels, use a fan to circulate cool air to speed cooling.  If you aren’t feeling better within 15 minutes it would be a good idea to go to the ER for help as heat exhaustion can progress if not treated.  If someone is confused, passes out or isn’t able to drink cool fluids they should go ahead and go to the ER for treatment without delay.  Untreated heat exhaustion can progress to heat stroke with body temperatures going over 104 degrees and lead to the brain, kidneys, heart and muscles and even death.

Preferable still is to avoid heat exhaustion – wear loose fitting, light weight clothing, drink a lot of fluids, avoid exertion in the middle of the day, limit exercising or working in the heat until your body gets more used to it, avoid alcohol use, and if you start to get muscle cramps and feeling overheated STOP what you are doing and get in a cool area and drink fluids so it doesn’t progress.

After having an episode of heat exhaustion you will be more sensitive to heat over the next week or so, so avoid exercising or working outside in the heat during this time.

Read more information from the CDC about heat illnesses by clicking here.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

Dealing with Depression

A lot of people have been talking about depression this week in the wake of Kate Spade’s suicide.  Her husband  said she was trying to get help – but she was still suffering.  I don’t know what kind of treatment she was undergoing, but I was saddened to see her to join the list of people who we have lost to depression over the years.  Please know that recovery is possible –  although while you are depressed, you may feel that it isn’t.

Depression isn’t something you can just “snap out of” but there are things that you can do to help yourself.  Since one of the symptoms of depression is decreased energy, it can be overwhelming just thinking about making a change – so start with one and go from there.

Self-care tips for depression

  • Look after your body and your brain
    • participate in physical activity for 30 minutes a day – go for a walk outside if you are able
    • eat healthier meals – avoid foods high in sugar/carbs that can contribute to mood and energy swings
    • avoid alcohol and recreational drugs – alcohol can actually cause depression, people coming off of meth/stimulants can frequently feel depressed
    • sleep in your bed – not in front of the t.v.
  • Find a sense of meaning
    • volunteer
    • talk to your spiritual leader or someone from your worship community
    • journal,  make a gratitude list
  • Decrease your stress
    • postpone any major decisions you can until after you aren’t depressed
    • keep with your daily routine – small things like getting up and making the bed and taking a shower can help – and you may feel worse if you don’t do them
    • allow yourself to leave work at the end of the day and take your weekends/holidays
    • do yoga, meditate, pray
    • do something creative – draw, play music, write poetry, short stories – to get your emotions out – you don’t have to show anyone what you have done
    • spend time with your pet
  • Connect with the community you already have – stronger connections can help you get well faster
    • participate in activities you are invited to even if you don’t feel like it
    • do an activity with a friend you haven’t connected with recently – go get a coffee, go for a walk or swim
    • schedule things in advance instead of waiting to see what you feel like doing – if you are depressed, you may not feel like doing anything

Treatment for Depression

If you have been dealing with symptoms of depression for more than 2 weeks and things aren’t getting better or if your symptoms are severe, talking to your doctor can help get you connected with the help that you need.  You can go for counseling, take medications  (or both) to get relief while you continue the self-help tips I have listed above.  If your depression gets worse and you are thinking about hurting yourself – please reach out and call the Suicide Lifeline 1-800-273-8255.

Depression  can make you feel isolated  – in part due to symptoms of the disease, as well as the social stigma that may go along with it.   You may find community from joining a small group at your place of worship, or through something like Meetup.  If you want to connect with others who are dealing with mental health problems, there are organizations that help with that too.  Groups like NAMI are designed to help people  (and their families) find a community that understands what they are dealing with.  In the Greater Cincinnati area, there is both a Northern Kentucky and a Southwest Ohio NAMI group.  Another agency in Northern Kentucky that provides peer and family support is Mental Health America.

I don’t recommend that you take much time off of work and stay at home if you are depressed.  I have found that the isolation that people feel staying at home and the lack of routine that comes with taking time off, can actually make people worse instead of better.  If your depression is severe – but not bad enough to be in the hospital, participating in a structured program like partial hospitalization or intensive outpatient treatment  can help.   Depression is a medical condition and you can qualify to take time off for treatment if you are covered under FMLA.

The most important thing to remember is that there is hope.  Depression is treatable.  And, you are not alone.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

 

New Colon Cancer Screening Recommendations

Colon cancer screening has been recommended to start at age 50 for many years.  The most common choices for screening are colonoscopy every 10 years, stool DNA tests every 3 years, testing  the stool for blood yearly.  Specific recommendations are made based on an individuals risk assessment which includes their past medical history as well as their family history.  Recommendations look at the likelihood and benefit of finding a colon cancer and try to balance that with the risk and cost of the test. There are several agencies that make recommendations on how to screen for cancer – the U.S. Preventative Services Task Force, American Cancer Society, and American Academy of Family Physicians are the 3 that I usually take into consideration.

The American Cancer Society came out last week with the recommendation that screening for colon cancer start at age 45 instead of 50. This was based on the fact that people are developing colon cancer at an earlier age than they used to.  Screening recommendations vary over time – for example: the flexible sigmoidoscopy used to be a recommended option to be done every 5 years – but this isn’t done as much now since it only allows the doctor to see the left half of the colon, and there has been an increase of cancers on the right side of the colon over time.

It is not uncommon for screening bodies to disagree – for example recommendations for screening for breast cancer and prostate cancer vary across these agencies. There is also  a difference in how strong recommendations are.  The American Cancer Society rates this new recommendation as “qualified” or less strong than their recommendation for screening for those 50-75 yo.  The U.S. Preventative Services Task Force, American Academy of Family Physicians and American College of Gastroenterology currently still recommend starting screening at age 50 for someone who is not at increased risk.  The new recommendations by the American Cancer Society were made after looking at data that showed a trend of cancer developing earlier than it used to.  Click here to get a link to the study. 

It is one thing for an agency to make a recommendation, it is another thing for a patient to get it paid for.  At this time it would be unlikely for insurance companies to pay for a screening colonoscopy in a 45 year-old without other risk factors.  It is also important to remember that these recommendations are about screening tests – which implies that the person doesn’t have any symptoms – no rectal bleeding, abdominal pain, stool changes, etc. that are concerning.  If a person has any symptoms, then it would not be a screening test, but rather a diagnostic test and none of the above recommendations would apply.

While screening 45 year-olds for colon cancer may not be routinely covered at this time, there are behavioral changes people can make to decrease their risk.  Colon cancer is associated with cigarette smoking; excess body weight; a lack of physical activity; and an unhealthy diet, including a lot alcohol and red or processed meat, and lacking fruits/vegetables, dietary fiber  and calcium.  Making these healthy changes can decrease risk of colon cancer and as well as many other cancers and chronic diseases.  If someone believes that they need screening for colon cancer earlier than 50 years-old, it would be a good idea to speak with their doctor.

There are a large number of people in their 50’s who haven’t gotten colon cancer screening yet.  Hopefully by seeing that there is a shift towards recommending screening at an even younger age, people from 50-75 years- old will be more likely to go ahead and get screened and get the benefit of early detection or prevention of colon cancer.

 

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

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