Dr Staw's Good Medicine

Weight loss - the old and the new

2012-02-19T11:46:00.000-05:00

We all know the facts: Over two thirds of Americans are overweight. Half of them (one third of Americans) are medically obese, which places them at high risk for the development of premature heart attacks and a variety of other serious medical conditions.

The main cause of obesity is overeating, even more so than lack of physical activity.

The most effective way to lose weight is portion control, and with it comes the control of caloric intake.

But portion and calorie intake control is a tough job. It’s a “full time job,” and it takes willpower and discipline.

So what do you do when the brute force approach doesn’t work for you?

The New York Times Business section of February 16^th had an interesting article on the possible approval by the FDA of a new appetite suppressant, Qnexa (U.S. to Review Diet Treatment Once Rejected).

The use of appetite suppressants for the treatment of obesity has a long history. Medications like phentermine, Tenuate and Xenical have been used for years (we all remember the fen-phen period, of which phentermine emerged as the surviving drug…).

More recently, metformin (used in diabetes) has been used in some cases, and a combination of phentermine and certain antidepressants has been shown to be more effective than phentermine alone.

What’s new about Qnexa is not really new. The proposed drug is a combination of two well known medications now widely used: phentermine, the familiar appetite suppressant, and topiramate (Topamax) which is most commonly used for migraine prophylaxis.

Topamax, like most other drugs has a long list of side effects, one of which is weight loss. So physicians who treat obesity, have now begun using Topamax “off label” for it’s weight loss side effect, in combination with phentermine. The combination appears to be very effective.

Diabetes and memory loss – If I were a mouse…

2012-02-07T19:35:00.000-05:00

In diabetics, blood sugar levels that are persistently high, low, or widely fluctuating are an indication that the diabetes is not under control. Diabetes, especially when uncontrolled, is a known cause of progressive memory loss. Besides making sure that your diabetes is under control, what else can you do to protect against memory loss?

Many of us drink coffee to feel more energetic, help us think more clearly, or work more efficiently. But does regular coffee, or decaffeinated coffee help memory or prevent memory loss?

Studies in specially bred mice, done several years ago, suggested very strongly that coffee enhanced memory. When mice drank the equivalent of five caffeinated cups of coffee a day over several weeks, their memory was far superior to those who drank plain water.

For those who think 5 cups of caffeinated coffee a day is too much, what about decaf?

A more recent study done on the same type of mice, showed similar results.

So what about man?

Several uncontrolled studies in man suggest that caffeine slows age-related memory loss. One study, done in Portugal, showed that people with Alzheimer’s had consumed less coffee than their non-Alzheimer counterparts.

So where do we go from here?

Meet you at Starbuck’s tomorrow morning, and bring your mouse with you.

Think prevention and early detection

2012-01-16T22:08:00.000-05:00

We now answer our phone as “Doctor’s office” rather than “Doctor Staw’s office,” and there’s a reason.

As of Monday, January 16, a new physician in town is sharing office with me. His name is William Sanchez, specializing in family practice. Dr. Sanchez was born in the Dominican Republic, where he also attended medical school. He did his medical training at Columbia Presbyterian in New York City and at the University of Arizona, Tucson, AZ.

While Dr. Sanchez and I will each maintain our separate practices, both of us expect to be working closely together; we firmly believe in the value of early detection and preventive medicine. Office cost sharing will allow both of us to give our patients the type of service which is only available in a “solo practice.”

Our office is now in the midst of implementation of our newly acquired EMR (electronic medical records) system. It takes a little while to get used to it, but I know it will be worth it at the end. More about it in the next blog(s).

Don’t forget to request your renewals by email at renewals@drstaw.com. You can also contact me for non-urgent matters at istaw@drstaw.com.

Stay warm.

Smoking, lung cancer, and early detection

2011-11-26T22:48:00.000-05:00

Smoking is the number one primary cause of premature death in the US (did you know that the obesity-sedentary lifestyle is number two?)

Many pulmonary physicians, including myself, argued for many years that periodic x-rays of the lungs in heavy smokers could save lives. Several years ago a study showed that doing chest CT scans in heavy smokers leads to early detection and possibly a better cure rate. All this was met with harsh criticism from many professional organizations (I wonder why).

But what the pulmonary specialists knew for quite a few years was finally shown to be true in the June 29 edition of the New England Journal of Medicine. The use of low radiation, periodic CT scans of the lungs in heavy smokers led to early cancer detection, and thereby saved many lives. This is not the total answer to lung cancer, but it certainly helps.

So, if you are a heavy smoker and have not discussed the cancer risk issue with your physician, do it now. If your insurance company doesn't cover this screening test, I know several radiology practices that will do it for $300, and it's well worth it.

Suboxone treatment resources

2011-11-13T22:52:00.000-05:00

If, for whatever reason, you have developed an opiate dependency problem, this may be an excellent time for you to quit. Suboxone is gaining popularity as a medical, office-based opioid dependency treatment program.

Fewer than 3% of US physicians are certified to prescribe Suboxone. Most of those certified are psychiatrists. In our area, very few internists, like myself, are Suboxone-certified.

You can find Suboxone-certified physicians at http://www.suboxone.com/, and you can try to match up with one by email at http://www.treatmentmatch.org/local/.

Fot additional information you may want to watch my interview of the weekend of 11/5/2011, Cablevision channel 12.

On a personal note...

2011-10-26T21:05:00.001-04:00

Getting the garden ready for the Fall and Winter. Have you ever seen a Marigold this tall (or a doctor this short)?

Suboxone treatment for opioid dependence

2011-10-19T18:35:00.000-04:00

Opioids are prescribed in the US mainly for pain control. This includes medications like Codeine, Percocet, Vicodin, Oxycodone, Dilaudid, and many other branded and generic drugs. Chronic use of these medications, even when used appropriately, can lead to opioid dependence.

Opioid dependence is characterized by "an individual's inability to stop using the opioid despite the fact that stopping its use would be in his/her best interest." Criteria for the actual diagnosis of opioid dependence have been developed by the World Health Organization, and are widely used by physicians in office practice.

The complications of long term opioid use are numerous and, besides physical dependence and addiction, include liver dysfunction, constipation, nausea, respiratory depression, and many more.

Opioid dependence can lead to opioid abuse, a much more dangerous condition with many medical and legal adverse outcomes.

What do you do when it's time to get off the opioid pain medication, and you can't do it because of drug dependence?

The newest trend is to use Suboxone. Suboxone is a two-component medication which contains buprenorphine (itself an opioid) and naloxone. It works primarily by preventing withdrawal symptoms and controlling the craving for the opioid medication. It allows you to remain active in daily life activities such as work and family functions. The medication is taken daily, and comes in a wafer form which dissolves rapidly under the tongue.

Physicians have to go through specific training to become certified in the administration of Suboxone.

I am now certified to prescribe Suboxone. The advantage of having an Internist manage Suboxone therapy is that general medical issues and opioid dependence issues can now be treated in the same office setting in an integrated manner.

Feel free to share this information with those who may need help. If you need more information, please give us a call.

Prostate cancer testing, my view

2011-10-12T22:08:00.000-04:00

Also appeared in the Westport News, 10/12/2011 - Letter to the editor.

The several-day old report by he U.S. Preventive Services Task Force Healthy men don’t need PSA testing for prostate cancer, sparked enormous controversy in professional and lay circles. I will not go through the back and forth arguments, which are described in detail in major newspapers like the New York Times and the Washington Post, but just give additional food for thought.

There is no question that with PSA testing, many more prostate cancers are diagnosed now and the number will increase as time goes on, and as newer techniques for screening become available.

There is also no question that in many cases, men are treated for prostate cancer when, at least in retrospect, they shouldn’t have been treated. Maybe because they did, or would have, died of other causes, or because the complications were worse than the disease.

It may be true that, overall, PSA testing does not presently lead to increased survival. Some men treated for prostate cancer definitely increase their life span. Others may not, or may even have complications that will shorten their lives.

But, in my opinion, these are not good enough reasons to stop screening men for prostate cancer. Not testing only decreases the amount of information we have, which creates ignorance, not knowledge. And this type of ignorance is not a solution to the question of how to treat prostate cancer, or any other cancer. More than 28,000 men die each year of prostate cancer, and literally ignoring the problem will not solve it.

The issue is that men have the right, and perhaps the obligation, to know if they harbor the cancer. And it is the responsibility of the medical profession to refine its techniques so that Medicine can better identify which patient has a better change to benefit from prostate cancer treatment and who may be hurt by it. As these techniques are refined, prostate cancer survival will increase, just as survival from many other types of cancer is increasing.

I feel that the Task Force report was seriously flawed, and I suspect was motivated by reasons other that good medical decision-making.

On a personal note: my prostate cancer was diagnosed over 5 years ago on the basis of a rise in my PSA, which was still considered normal. On the basis of the post-op pathology report, I know that, had I not had the surgery done at that time, I would have been in big trouble today.

Do you have diabetes? Five thing you must do!

2011-10-10T22:52:00.000-04:00

The five must do lifestyle changes that will help you stay out of trouble if you have diabetes, or if you are at risk for the development of diabetes, are:

· Follow a healthy diet

· Maintain an optimal body weight (Body Mass Index not higher than 25)

· Engage in recommended amounts of physical activity

· Don't smoke (don't even think about it)

· Keep alcohol use to no more than 1 drink a day for women, and 2 drinks a day for men.

According to data released earlier this year by American Diabetes Association, diabetes was the seventh leading cause of death in the US in 2007. Last year it was the sixth. In reality, the number is much, much higher, because diabetes is a major contributor to heart disease and stroke.

The economic burden to individuals and the country as a whole is enormous. Costs attributable to diabetes in 2007 were $116 billion in direct medical costs and $58 billion in disability, work loss and premature mortality. Again, this does not account for the contribution of diabetes to the cost of heart disease and stroke.

Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

All of these numbers are undoubtedly underestimates. Many case of diabetes continue to be undiagnosed.

Need help? We're here

Chronic Pain

2011-10-02T19:44:00.001-04:00

Pain is now the most common reason why patients seek medical care. Data compiled by the CDC shows that in 2007, analgesics, as a group, was the number one prescribed category of medications in the US, approximately 13% of all prescriptions. The number is most likely higher now.

Pain can be either acute or chronic. Acute pain is the one you get with injury, such as a motor vehicle accident, moving furniture, or playing sports. Chronic pain is sometimes harder to define. Some authorities define chronic pain as pain that persists, despite attempts to cure it, for six months. Others call the pain chronic after 3 months. It appears that the best definition for chronic pain is pain that persists for a period longer than is medically expected for it to resolve.

The economic cost of chronic pain is mind boggling. The American Academy of Pain Medicine reports that in 2011, at least 116 million people in the US have "common chronic pain." Low back pain, migraine (or other form of headache) and neck pain are the leading diagnoses. A significant percentage of chronic pain patients (at least 20%) have had to take medical leave from their jobs and 16% had to modify their jobs. You can only imagine what this does to a person caught with this problem when unemployment is so high.

The cost for direct medical care for chronic pain is estimated to be $261-$300 billion a year. The lost of productivity is $297-$336 billion. This is almost $200 a year for each man woman and child in the US, and it's most likely an underestimate.

Treatment of chronic pain depends on the cause, severity, and the overall health of the person affected. To be effective, treatment is frequently multidisciplinary. Depending on the situation, it may involve medications, physical therapy, surgical intervention, biofeedback, hypnosis, management of stress or depression, exercise and reconditioning, acupuncture, chiropractic, weight management…and the list goes on…

So, it's very important to identify the cause of pain and treat it early in the game, before it becomes chronic. When the pain does become chronic, it is most important to control it, so that the patient can return to the mainstream of life, and become functional despite the pain.

Need help? Don't hesitate to call.

Coupons for medications

2011-08-04T20:59:00.001-04:00

We are keeping your out of pocket costs in mind!

Did you know that we have a large collection of money-saving coupons for your brand name prescription medications?

Click here to see the list, and check it periodically. It will be expanded and updated regularly.

If you are already taking coupon-bearing medications, all you have to do is drop by the office and pick up the coupon(s). Otherwise, discuss the possibility of switching to a coupon-bearing medication at your next visit.

In addition, our office has the lists of generic medications that are available at major pharmacies at large discounts (e.g. $10 for a three month supply), and antibiotics dispensed absolutely free of charge. Don't hesitate to ask at your next visit.

Weight and antidepressants – what's the connection?

2011-07-31T20:50:00.001-04:00

Depression in the US is widespread, increasing gradually since WWII. More than 30 million Americans are thought to have depression, with two thirds of them women. Not surprising in the age of an economic crisis.

Many Americans with depression are now taking antidepressant medication, such as Celexa, Prozac, Wellbutrin or Elavil, to name a few.

Obesity in the US is even more widespread, with 70% of adults classified as overweight, and half of them classified as medically obese. The harmful consequences of obesity are well known; no need to repeat them here.

Does the use of antidepressants affect your weight? For many, this is a valid health question. For others, especially women (but not limited to women), it's also a social issue, a body-image issue, and many times a reason for refusing to use medically-necessary antidepressant medication.

Many patients on antidepressants gain weight. Is it a direct effect of the antidepressant, or is it that some patients begin to enjoy life more, and "celebrate" it with more eating.

Others lose weight. Is this a direct effect of the medication, or is it that these patients can now better deal with the realities of life and better control their eating habits and exercise?

While the jury is still out on this question, some answers begin to emerge. A meta-analysis (a statistical analysis of related research) that appeared in October of last year in the respected Journal of Clinical Psychiatry indicates that the antidepressants Amitriptyline (Elavil) and Mirtazapine (Remeron) and Paroxetine (Paxil) are associated with weight gain, while the antidepressants Ffluoxetine (Prozac) and Buproprion (Wellbutrin) are probably associated with weight loss.

The pressure to treat overweight in both depressed and non-depressed patients has become so urgent that some antidepressants are now used "off label" for weight loss, either alone or in combination with prescription appetite suppressants.

So, if you're taking or contemplating the use of an antidepressant, and weight loss or weight gain is an issue for you, don't forget to discuss the specific pros and cons related to your situation, with your doctor.

In our office, we have the ability to make a very reliable estimate of your daily caloric requirements (we do this by measuring your actual oxygen consumption while at rest), and use that as a guide in treatment when a combination of depression and obesity exists.

Chronic cough

2011-05-02T22:11:00.001-04:00

Cough is common, and can linger, during the allergy season. But does cough equal allergy? Most commonly it doesn't.

A cough can be an annoying, embarrassing symptom, or an important clue leading to rapid diagnosis and effective treatment. It is one of the most common reasons to see a lung specialist, accounting for more than one third of new patient visits in our practice. There is an abundance of confusing medical literature available, most of it on the internet; a recent search found more than 300 articles related to chronic cough published so far this year, and that's only the tip of the iceberg.

Coughing itself is remarkably effective. Acute cough is our primary defense mechanisms to protect the airways and lungs from unwanted invaders, such as aspirated food or secretions laden with bacteria or acid from the stomach. Receptors line the major airways to trigger an acute cough, which can create flow rates approaching the speed of sound! This rapid air flow creates shearing forces that move secretions up and out, but unwanted effects, such as rib fractures, sprained chest muscles and even syncope (brief loss of consciousness) can result.

What makes a cough chronic? The accepted time scale is three weeks without an obvious precipitating cause. There are many clues to the cause of a cough which your physician can review with you. Generally a carefully taken health history and physical exam will identify many major concerns, such as asthma or allergy, exposure to inhaled toxins, or medicines known to cause cough. Smoking is of course an irritant; it inhibits normal mucus clearance mechanisms, and most long term smokers have a chronic cough, though some are not bothered by it. The timing, nature and history of the cough are important to review, along with associated respiratory symptoms and findings on physical exam, such as abnormal breath sounds. Chest x-ray and tests of lung function are helpful in the detection of unexpected or subtle abnormalities, such as airflow obstruction indicating asthma or COPD. “Post infectious” cough can follow respiratory infections, either minor or major, and can last for months. A state of airway hyper-responsiveness develops even though the infection itself has resolved. Frequently anti-inflammatory medicines, such as those used for asthma, are given to bring the airway back to normal. Acid reflux is another occult cause for chronic cough, as is allergic post-nasal drainage. Frequently these conditions produce minimal symptoms except for the cough. Surprisingly the majority of well established coughs have more than one cause as their basis. All must be treated, or resolution does not occur.

In most cases, rare or life threatening causes are easily ruled out and common causes, such as asthma, allergic drainage and acid reflux, are diagnosed and treated effectively. Resolution and patient satisfaction depend heavily on a systematic evaluation and adequate length of therapy, thus a good working relationship with your Physician is key.

Diagnosis and treatment of chronic cough is an important part of our office specialty. If chronic cough affects you, give us a call.

Get what's important from your doctor visit

2011-02-12T09:13:00.003-05:00

Part of my article in EzineArticles.

The most important thing you should get out of your appointment with the doctor is an adequate explanation to the problem which prompted your visit.

Write down your questions in the order that you feel is the most important. Write down, or ask your doctor to write down, the answers to your questions, including instructions for the use of prescription and over the counter medications, medical devices, and lifestyle changes. If there isn't enough time to have all of your questions answered, then you will have had the most important ones addressed, and could save the rest for the next visit.

Carry with you, at all times, a legible, up-to-date list of all the medications you take. Include in it all prescribed and non-prescribed medications by all of your physicians. Also include in the list the dose, reason for use, frequency of use, and the date you started taking the medication. Examples might include:

1) Digoxin.25 mg. every evening, for control of heart rhythm, started 6/2009.
2) Buffered aspirin 650 mg. as needed for mild headache, started 2007, Dr. XYZ.

This list will be useful to you during your visit and in case of an emergency. Don't assume that your physician knows all the medications you are taking!

During your visit, try to be as specific about your symptoms as you can. Telling your doctor "I had a fever last night with shaking chills and a temperature of 101" is much more meaningful and leads to a faster diagnosis than saying "I have been feeling sick since last night." Telling the doctor "I have been taking amoxicillin 500 mg. every eight hours since I became sick" is much more meaningful than "I took those yellow horse pills you gave me two years ago for two days."

Remember: In order to derive benefit and satisfaction from your visit to the doctor, both you and your physician must work together. You are the principal source of information about the way you feel. The more detail your doctor has about your condition, the more will he be able to help you, and you will feel better having accomplished what you started out to do. It takes teamwork!

Be an active partner in your own health care. Let's do it together!

Do you have COPD?

2011-02-02T21:03:00.000-05:00

If you develop shortness of breath faster than you should, you cough frequently, and are also a smoker, you may indeed have Chronic Obstructive Pulmonary (Lung) Disease, or COPD. The term COPD refers mainly to chronic bronchitis and pulmonary emphysema. More than 80% of COPD is caused by cigarette smoking, with the remainder caused by genetic factors (alpha 1-antitrypsin deficiency), industrial exposure (e.g., coal mining) and questionably air pollution.

COPD is a progressive disease, responsible for an enormous strain on the national healthcare budget, on the work place, and on one's personal well being. More than 12 million Americans are now known to have COPD, and many more have the "hidden" disease. COPD is the fifth leading cause of mortality in the US, and its economic burden is even higher.

The sooner COPD is diagnosed and treated, the better it is. Lives can be saved, jobs can be spared, and extra medical expenses avoided.

So, if you have shortness of breath, smoker or not, make sure COPD is not a factor. Don't delay, see your doctor, you won't regret it!

Think twice before indulging…

2011-01-30T22:20:00.000-05:00

Are you planning to exercise away the extra calories of your next meal? Think again.

A typical McDonald double cheeseburger has approximately 440 calories. Add large French fries at 500 calories and you're at more than 900 calories (we won't count the soda because I know you chose the zero calorie one…).

If you weigh about 155 lbs (what used to be the typical adult male weight in the US), and you like to walk, you'll burn 76 calories for each mile.

So the meal you just had would cost you an 11.8 mile walk. No problem, it's still less than a half-marathon distance.

Incidentally, if you were to stop by the Cheese Factory for a cheese cake portion, that will only cost you an additional 9 miles.

Of course, you could do the un-American thing, and have a good portion of no-skin chicken and salad (you can even have a little oil and balsamic vinegar dressing) plus fruit, at less than 400 calories for the meal. Still hungry? Have an apple plus another fruit later.

Do the right thing, your body will thank you for it.

Control your calorie intake

2011-01-25T22:13:00.001-05:00

What you see here is just a small sample of what's now available at our Health Extenders practice as part of our newly designed weight loss program. For more information, you may contact us by email. If you live in our area (Fairfield County, CT) and want to have a comprehensive evaluation of your weight loss needs, contact us by phone at (203) 853-1919.

This will help you lose weight and remain thinner

2011-01-17T22:51:00.001-05:00

Many of you have been aware of our weight loss programs at our practice for years. At home, Sandy and I find it helpful to control our breakfast calorie intake by using HMR shakes. We prefer the HMR 70 vanilla mix. Try it if you wish. This is how we use it:

1 packet of HMR 70 vanilla mix
1 glass filled ½ with crushed ice & ½ with water
1 tsp Hershey’s powdered cocoa (sugar-free)
Place HMR packet in bottom of blender.
Then add ice, water and cocoa and blend.

Optional additions:
½ banana or,
½ cup berries
extracts (calorie free)

Add to partially-blended shake and blend again for an additional minute.

Enjoy!

Calories:
HMR 70 110 calories
Banana/berries 50 calories (approx)
Hersheys cocoa 5 calories

Total 165 calories (approx)

You may use 1 ½ to 2 packets of HMR, but remember to count your calories. You may experiment with other fruits and extracts to create a special shake for yourself.

Share your experience with us. Selected recipes will be published with full credits (and 6 free packets of the mix with your next order of HMR shakes).

Weight loss 2011 – How we handle it at our practice

2011-01-03T21:13:00.001-05:00

So you decided to lose weight, but you're not sure you're doing it the right way?

Know that you are not alone. More than two thirds of adult Americans need to lose weight. Of these, more than half are severely overweight (BMI, body mass index, greater than 30; normal is 20-25), and are at significant medical risk. A major reason why Americans don't live as long as they should is obesity.

Here is some of what we do to help:

Evaluate your need for weight loss
Assess reasons why you're having difficulty in losing weight
Make sure there is no medical abnormality responsible for your increased weight
Measure (not guess) your metabolic rate, and calculate your daily calorie requirement
Design a diet-exercise program that meets your specific requirements, taking into account any medical condition thou may have
Assess your ability to do exercise and prescribe an exercise/physical activity program (and you don't have to be an athlete to do it…)
Identify and reduce overeating triggers
Provide calorie-specific meal replacements and snacks
Prescribe medication to control appetite, where applicable

Don't try to lose weight too fast. One-to-two pounds a week is good.
Don't wait, just do it!

New Year's Resolutions... Will You Keep Them?

2010-12-27T20:23:00.000-05:00

As 2011 approaches, many of us will be making New Year’s resolutions. Some of the most popular resolutions will follow the usual tradition: to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, with economic stress and job pressure, many people may choose to "shoot" for a less stressful life.

In reality, 50% of those who start an exercise program drop out within less than 6 months and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of rest, daily stresses resurface. So how do you succeed?

Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For most people, this translates into increasing exercise, and managing stress.

Exercise: For beginners, it's extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic, and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.
Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.

Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.
The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. Many books have been written on the subject, and a copy of a progressive muscle relaxation routine can be obtained from our office (just give us a call or request it on your next visit).

There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.

People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…

I Can't Exercise - Just Do It!

2010-12-05T22:28:00.000-05:00

I am not here to convince you to exercise; you already know the reasons why you should. Yet, more than 60% of Americans under-exercise, and of these, more than 25% are simply sedentary. The remainder of this writing is taken from my previously published EzineArticles and other articles.

Common reasons given for failure to exercise include: I don't have the time...I'm too tired...I don't know what type of exercise to do...I have a medical condition (usually a "bad heart," back pain or knee pain)...I'm too heavy... I become short of breath...I can't afford the gym...It's boring...I'm too old.

And there are more innovative excuses: my uncle lived to 106 and he never exercised (we should all be blessed with such good genes)...It's too cold outdoors in the winter...I'm always away... I do enough at work...

You get the idea.

Almost any form of physical activity is helpful, but a good exercise program should include at least 30 minutes of moderate, aerobic physical exercise most days of the week. Examples of aerobic exercise are brisk walking, jogging, bicycling, swimming and aerobic dance. An effective exercise program should include:

Warm-up, 3 to 5 minutes. A warm-up gradually increases your heart rate and the blood flow to the heart and muscles preparing them for exercise. To warm-up, do the activity you have chosen to do (for example walking or biking), but at a slower pace during the warm-up period.
Aerobic activity, at least 30 minutes (build up gradually from 15 minutes over several weeks). With aerobic exercise you use more oxygen to burn calories for the extra energy you spend. Exercise within your target heart rate zone (target charts are available in gyms, on the net, and at your doctor's office).
Cool-down 3 to 5 minutes. Cooling down allows your heart rate, breathing and blood pressure to return to normal, and allows you to stretch better.
Stretching, 5 to 10 minutes. Stretching will improve your flexibility, decrease muscle soreness and help you relax. It's important to stretch those muscles you were using during exercise. Hold each stretch for 15-20 seconds, but don't stretch to the point of pain.
Strength training, which is a very important component of a good exercise program.

Before you start an exercise program, check with your doctor if you are over 40 or have a history of medical problems. If you truly have special needs, a reasonable exercise program can usually still be designed for you.

Start before it's time for New Year's resolutions

Are you interested in checking your degree of conditioning and your general exercise capacity? We have a unique testing facility where we measure your maximum oxygen capacity (known as vO2max) and tell you how fit you are. The test is done as part of a cardiopulmonary exercise evaluation, under medical supervision. We are the only free standing medical facility in our area performing this type of evaluation.

Watch those new HMO premiums

2010-11-22T22:50:00.000-05:00

Beginning in January 2011, it is expected that most group and individual health insurance premiums will increase significantly. Most health insurers are seeking increases of more than 20%. It remains to be seen how much of it will be approved (I bet most of the requested increases will be approved). The biggest offenders appear to be Anthem Blue Cross and Aetna. In our experience, Anthem is also been shown to reduce benefits more than others.

This may be the right time for you to look at your health insurance plan, and, assuming you are in a position to do so, choose the policy that best fits your needs.

You may want to take a few points into consideration:

1. A high-deductible, lower premium policy, may save you money if you're generally healthy and able to take a limited monetary chance. Most of these policies still pay for yearly preventive care. Our practice does its part of cost control by keeping fees as low as possible for uninsured visits.

2. Our practice is not an Anthem provider (we're in litigation, we've filed suit).

3. We have special programs for the uninsured, which take into account your economic situation, and help you take advantage of cost saving programs outside our practice (e.g., lab tests and imaging studies).

Don't forget that, in the end, much of your future health is up to you. US health care is still reasonable, but the main reason we rank only number 37 in the world in longevity, is our faulty lifestyles.

So, make sure you don't smoke, limit sugars, starches and saturated fats, and please exercise!

Have a great holiday season.

Weight loss 101 - a beginner's primer

2010-11-17T21:50:00.000-05:00

Weight loss should be taken seriously. It's a contract between you and your body. Guidance can come from many sources: your nutritionist, your doctor, or a recognized weight loss organization; but if you don't work at it, you'll be disappointed with your results.

Generally, you'll be given a diet and/or sensible eating guidelines. Our many years of experience have demonstrated beyond any doubt that "sticking to it" pays off handsomely in the end.

Your daily caloric consumption (your metabolic rate) can be estimated by measuring your REE (Resting Metabolic Expenditure), and adjusting this measurement for daily activity. The test is available at our facility.

If you decrease your calorie intake by 500 calories a day, you should lose approximately one pound a week. You'll lose more in the first week because of excess water loss.

If you increase your physical activity you'll lose more, depending on your type of activity. Walking a mile on flat ground burns 100 calories on average. Doing intense activity on a regular basis will also increase your metabolic rate, and further enhance the rate of your weight loss. Do not take on intense physical activity without consulting your physician.

Stick to your assigned daily caloric intake.

Weigh yourself frequently (daily is OK) on a reliable scale, same scale each time, preferably when you first wake up in the morning, before breakfast and before getting dressed. Record your weight on a single sheet (preferably on your computer, use Excel or a similar program if you have it), and bring it with you at your next visit with your health care provider.

Food calories
Fat: 1 gram has 9 calories
Protein: 1 gram has 4 calories
Carbohydrates: 1 gram has 4 calories
Alcohol: 1 gram of alcohol has approximately 7 calories

Fat is "calorie dense," it's packed with calories. Some fat is essential, and it helps keep appetite in check.

Most vegetables are "volume foods" with few calories and a lot of nutritional value; and they help fill your stomach.

Sugars of any kind (watch out for high fructose corn syrup, cane powder, "organic brown sugar" and others) are unhealthy carbohydrates. The same is true for white flour products and starch. Whole wheat products are a much better choice.

Take a close look at food labels, and make sure you look at the line that tells you how much sugar is in each portion; the less the better. There are acceptable sugar substitutes such as blue agave nectar (a liquid) and erythritol (sugar-like crystals).

Organic foods. Organic food is great. It's grown without chemical pesticides, hormones or antibiotics. But organic food may still contain unacceptable amounts of fat and sugar. So, again, don't forget to look at the food labels.

Snacks. It's OK to have snacks, but don't forget to take them into account when you calculate your calorie intake for the day.

Eating out. Eating out is not a sin. It's sometimes hard to keep a calorie count when you eat out. If you feel you over-ate, cut down the next day. Better yet, "bank" your calories by cutting down a little a day earlier.

Don't be embarrassed to ask the waiter to make sure that sauces are not too heavy, or to express other weight concerns you have. Don't rely on "iffy" answers: it's OK to ask to talk to the chef.

Use of special medications. Occasionally, medication may be prescribed to help you lose weight. These are usually meant to decrease you're appetite or the desire for food. Many of our patients have benefitted from the temporary use of appetite suppressants. But these medications are not meant to be a substitute for portion control, and their use has to be prescribed by a physician and monitored periodically.

Good luck in pursuing your weight loss goals.

A visit to Israel and a treatment for psoriasis and dermatitis

2010-11-01T22:11:00.001-04:00

My wife and I returned today from a 12 day trip to Israel (which we have done many times before), and were back at work before noon.

This was a dual purpose trip: visit family, friends and new sites; and re-visit the developers of the new EdenSkin line of products designed to treat common skin conditions such as psoriasis, atopic dermatitis and seborrheic dermatitis.

Some of the exciting sites included the impressive IDF air force outdoor museum in the Negev; the Tel Aviv museum which exhibited the unusual and unique photos of David LaChapelle (born in Fairfield, CT); the Palmach museum in Tel Aviv commemorating the importance of this organization in the creation of the state of Israel, and the Druze village of Dalyiat el Carmel on the slopes of Mount Carmel overlooking the breathtaking Izrael Valley.

And on the medical front, we learned a lot more than what we already knew about the Israeli health delivery system, how effective it is, and how much simpler it is than what we have here. More about it in the future.

We also completed our review of the EdenSkin family of products, developed by a small company in Kfar Saba.

We have been watching the development of QoolSkin for several years. I've been using it successfully in the office for a while. It's herbal, and it contains no steroids, parabens, colors or fragrances. Most importantly, its side effect profile is extremely low, and it works where conventional therapy doesn't. We now keep the product at our office.

Other EdenSkin products include TopicSkin, also an herbal preparation, which I have used for the treatment of allergic dermatitis, and SeboSkin, which I intend to use for the treatment of seborrheic dermatitis.

Looking at the whole picture, this was a great trip, which also carries a potential benefit to our patients.

Avoid those extra winter pounds

2010-10-05T21:09:00.000-04:00

Winter is approaching, and the natural tendency for many of us was to stay indoors. For many of us, lack of activity and overeating follows, and the result is those frustrating extra winter pounds.

Weight gain is not only a medical issue. Sure, there is an increase chance of diabetes, high blood pressure, accelerated heart disease, joint pain, and many other medical conditions. But also important are the social, financial and psychological aspects of overweight. Thin and fit is still the general desire of most people. Some of us would become depressed over gaining weight and the inability to lose it, and others would feel that they lost a promotion opportunity because of it. Very few of us would enjoy buying a new, larger wardrobe, or the inability to fit into our summer vacation clothing.

So what are you going to do about it?

Losing weight is a full time job; you have to be aware of your goal at all times. Some of us can do it without much help. Decrease food portions, decrease fat intake, increase exercise --- the usual steps --- works. For others, professional help is a must.
Professional weight loss focuses on the entire person and his/her needs, and includes:

Establishing realistic goals. The ultimate goal of weight loss has to be a target weight that can be both achieved and maintained. This target weight may not be immediately identifiable, but becomes apparent as you work with your health care provider.

Portion control. Both the portion size and content of the food you consume need to be controlled and monitored. Accurate record keeping, while tedious, is extremely important. Your ability to keep records is a good indicator of how successful you'll be in controlling your weight.

Increase in exercise. Exercise helps burn excess calories, but don't count on exercise alone to reach your target weight. Cardiovascular exercise is best, but stretching and muscle strengthening are very important. Exercise at least four days a week, don't be a weekend hero. Special testing before taking on a rigorous exercise program is advisable, talk to your doctor.

Use of appetite suppressants when appropriate. The days of fen-phen long gone, but other medications are available. Stay away from over-the-counter preparations and "miracle drugs," they can be harmful, and, at best, you'll waste your money.

Use of meal replacement. Low calorie meal replacements have been available in super markets for several years. Others, of much higher quality, are available through some physician offices, including ours (e.g., HMR products). These products help in portion control and record keeping, and may keep you from binging.

Treatment of depression. Depression is frequently a cause of weight gain, and if it exists, it must be addressed.
What about weight loss spas? Many of them are very good, effective while you're there. But when you're back at home, you may still need to consult your health care professional.

When addressed correctly, overweight is manageable. And when you need professional assistance, go with those who will focus on your overall medical needs, not just weight loss. We're here to help!