Childhood Excessive Weight Recommendations

When I was training at John Peters Smith Hospital in family practice, I researched a case series on childhood obesity and lower extremity injuries.  At the time, I was really involved in sports medicine, and hypothesized that excessively overweight children injure themselves more. 

While more overweight children had lower extremity injuries, the outcome was not statistically significant.  This surprised me and the reason was probably because larger children are not as active.

In older days, all children did was play outside and exert themselves.  No TV existed, so children were easily distracted by their imaginative play.

Nowadays, we have every excuse in the book to keep our kids indoors.  We’ve got movies, games, air conditioning, and the works.  This plethora of pleasures has decomposed some of our childrens’ health.  It is very important to maintain about 60 minutes of active play time outside, and limit T.V. to 2 hours in a day. 

Another reason well child checks are necessary is that we can evaluate the growth charts and see what the Body Mass Index is based on height and weight. 

Limiting children’s daily intake of sugary sodas or drinks to once a day will help children with healthy caloric intake. 

Our Nutrition specialist, Christine Morgan has a special transitional diet plan from the S.A.D (standard American diet) that will improve children’s, and adults’ health. Food Choices for Transitional Diet:  She says to eliminate all forms of HFCS sugars, (high fructose corn syrup.) 

These sugars are in all soda drinks, and fruit juice drinks, and flavored water drinks.  She also recommends removal of high processed foods such as anything from a package or box, Mac and cheese, hamburger helper, pizzas, and frozen chicken nuggets. 

She recommends replacing all that badness with turbinado sugar, 100% Stevia leaf, 100% fruit spreads, and homemade lemonade or Stevia sweetened herbal green and regular tea. 

Lower processed foods include: old fashioned oatmeal, grapenuts, shredded wheat, high fiber pancakes and waffles, Ezekiel bread, and my favorite low sugar peanut butter!

Christine has a list of great recommended natural foods to try.  I recommend you discussing any personalized diet plans with her.  Her email is:  txnaturaldoc@yahoo.com

I am also posting her transitional diet on my blog.

If you have any questions, email me at runsinthewynd@gmail.com, my twitter is @askjustusmd, and my blog is www.askjustusmd.blogspot.com

Christine Morgan's Transitional Diet

 Food Choices for Transitional Diet

Eliminate:

      Sugar- all forms of HFCS (high fructose corn syrup), this includes ALL sodas (soft drinks), diet drinks, kool-aid, drink mixes, fruit juice drinks, Gatorade, Jell-O, puddings, energy drinks, favored water drinks, white sugar and products made with white sugar, jelly, and jam.

      Highly processed foods- chips, cookies, Mac & cheese, hamburger helper, boxed dinners, pizzas, hotdogs, bologna, frozen chicken nuggets, sweetened boxed cold cereals, pop-tarts, instant flavored oatmeal, frozen pancakes, waffles, white rice, white bread, white flour tortillas, ice cream, candy, Velveeta processed cheese.

      Margarines and spreads, artificial sweeteners, fried food, vegetable oils.

Good Choices:

      Sugar- turbinado sugar (dried sugar cane juice crystals), 100% Stevia extract, organic powdered Stevia leaf, 100% fruit spreads, homemade lemonade, Stevia sweetened herbal, green and regular tea,

      Lower processed foods- old fashioned oatmeal, grapenuts, shredded wheat, high fiber pancakes and waffles, Ezekiel bread, high fiber bread and tortillas, rice pastas, brown rice, turkey breast deli sandwich meat, low sugar peanut butter (Smuckers, 1gram sugar)

      Natural foods- lean beef, salmon, sardines, eggs, turkey, chicken, fresh peanut and almond butters, stir-fry meals (meat and vegetables), salads, non-cream soups, hard cheese, vanilla yogurt (no fruit), fresh and frozen vegetables, fresh fruit (apples, pears, grapes, berries, lemons), canned pineapple (drained and rinsed), prunes as snacks, cooked dried beans, red potatoes only (no Idaho or white), dark lettuces and greens, homemade or low sugar salad dressings

      Butter, organic virgin coconut oil for cooking, olive oil for salads.

      Fluids- WATER (16oz. per day minimum), homemade lemonade, teas, 100% fruit juice diluted 50% with water

      Desserts- homemade cookies made with whole grains and turbinado sugar, dried prunes, 100% fruit spreads on toast, stewed or baked apples or fruit, raw fruit

1.   NO portion limits on Good Choice foods EXCEPT foods with sugar and dessert foods.

2.   Start meals with a salad, soup, or both.

3.   Please no eating after 7:00 PM.

4.   Please drink water before any other liquid in the morning. Slowly increase water consumption.

5.   Plenty of rest (minimum of 8 hours, no noise or TV), fresh air daily, walking or exercise daily.

6.   Results will be seen within 4 weeks.

     

 Christine Morgan CNC

txnaturaldoc@yahoo.com

     

Beware some NSAIDS

One of the uncommon side effects of non-steroidal anti-inflammatories (NSAIDS), is high blood pressure.  These medications like Tylenol, Ibuprofen, and Aleve, all can decrease the flow of blood to the kidney.  The kidney will feel like it's not getting enough blood so it makes the blood pressure increase.  A vicious cycle ensues.  Beware of NSAIDS if you already have high blood pressure.  Talk to your doctor if you have a chronic pain syndrome that is minimally controlled with NSAIDS, and high blood pressure.  I have seen a few cases of high blood pressure resolve when we stopped the NSAID.

Anxiety vs. Clinical Anxiety

Sometimes things make us anxious and we get a little adrenaline and “fight or flight,” which is normal.  It is good to have a little anxiety to rev up your engines if a bear was chasing you.  This kind of anxiety is essentially normal.  However, a lot of diseases fall under clinical anxiety which can impede a person’s very way of life.

Clinical anxiety is when something known or unknown causes us to completely break down, close down, and lock out.  Some of the problems a person might have can be general or very specific.  Specifically, a person might experience phobias, and generally they might experience fear of the unknown.

Other diseases that have evolved out of clinical anxiety are coping mechanisms, such as obsessive compulsive disorder.  When a person has difficulty dealing with whatever anxiety they have, the only way they can cope is by cleaning their hands a lot, or locking the door over and over again.  The reason they do that is because that is the only thing they feel they can control.  Wouldn’t it be sad to have to deal with such an issue? 

You shouldn’t feel ashamed or guilty for having these diseases for they can be treated.  They can be treated for short term or if needed for long term.

Short term treatment includes psychotherapy, or benzodiazepines, and long term treatment includes Buspar, or SSRI antidepressants which have dual effect on depression and anxiety, like Paxil, or Prozac.

It is much safer to deal with clinical anxiety with appropriate therapy than to self treat with alcohol, smoking, or illicit drugs.  Don’t feel stigmatized even if you have fallen so far as to need other means for a way out.  There is nothing to be ashamed of.  We can help.

Please send questions or comments to my email at runsinthewynd@gmail.com, or twitter: @askjustusmd, or blog at: www.askjustusmd@blogspot.com

Evolution of Medicine 1

I am fascinated about our profession as doctors, and as such read about how Allopathic medicine has come about.  I will post some short paragraphs from some of my research and study on the history.

Before medicine and religion there was magic – incantations, spells and prayers that removed disease. Supernatural entities, demons, spirits of dead animals and humans caused disease.  People worshiped gods and goddesses of symptoms.  Febris, the Roman goddess of Fever and Malaria could cause and cure fever. Sitala, a goddess in Hindu culture, caused high fevers, rashes, hotflashes, and pustules, as well as cured them.  The first medicines were used to assuage pain.  Medicine was not standard practice, and very primitive.  As science evolved higher, and practitioners researched more, standard recipes were made to form the first basic medicines. 

Question: Do I need antibiotics for coughing?

Cough is one of the most common complaints in a doctor’s office.  Sore throat is probably the most common. 

Doctors need to know why you have a cough to begin with.  You could have Asthma, or Pneumonia, the common cold, or even some nasal drainage that is going down your throat.

Coughing is a symptom of Bronchitis which is self limiting, and can last up to three weeks.  Color of sputum doesn’t help doctors determine if it is truly viral or bacterial.

If you don’t have fever, or a fast heart rate, and a fast breathing rate, then you probably have just  bronchitis, and not a pneumonia.  Sometimes a cough is the only symptom of older adults with pneumonia. 

Bronchitis most of the time is caused by a virus, and rarely needs to be tested for, unless you are high risk for pneumonia, such as older than 65, history of smoking, asthmatic, HIV positive, etc.

Doctors can treat bronchitis in two ways.  Either with antibiotics or with symptom management.  The standard of care is symptomatic treatment in the younger patient, unless Pertussis is suspected.  Pertussis is a “whooping cough” and should be covered with the Tdap vaccine booster every 10 years.

Doctors can treat your symptoms with either over the counter or prescription strength nasal decongestants, expectorants, corticosteroids, cough suppressants and bronchodilators. 

The AAP, Association of American Pediatrics recommends against cough suppressants in children younger than 6. 

Some complementary medications include Echinacea, honey, and pelargonium.  Pelargonium, i.e., Kalwerbossie, a South African geranium, or folk remedy rabassam have modest benefit for bronchitis.

I tell a lot of patient’s who have over 4 days of symptoms that antibiotics can do no harm, and might lessen length of symptoms. 

A Zithromax Pack, some steroid dose pack, and cough suppressants usually can lessen symptoms faster than over the counter symptom treatment.

Regardless of how doctors treat this, if you feel bad, then you should see your doctor.  That is what we are here for. 

Depression from Pain

I can't begin to imagine what it would be like to be in pain all the time.  How much energy would it take from me.  How would I be able to concentrate?  Would I be able to sleep at night.  What about all the things I want to do, the dreams I wanted to fill?  How would my children deal with a dad that can't play with them?

These questions haunt me as I care for some of my own patients who deal with chronic pain.  Whether it is Fibromyalgia, chronic pain syndrome, arthritis, or otherwise, I don't know how I would feel normal.  In fact, I would be depressed.  I see depressive symptoms in my chronic pain patients, and the treatment of depression is very important.  Keep an open mind, if you have some pain that is keeping you from doing things you enjoy, go see a doctor right away, we may be able to help.

Snoring and Heart Disease

Make sure that you let your doctor know if you or your spouse snores.  The obstruction of airflow through the airways can make the amount of oxygen in the blood decrease.  Over time, this can lead to lower heart function.  The plethora of medical supplies on the market nowadays can assist in improving your sleep, and in turn your heart's health. 

I believe in treating obstructive sleep apnea so much, that if I ever had it, I would want a CPAP, or other device to increase my airflow at night.  No one likes to feel fatigued during the day because of restless sleep and low oxygen in the heart. 

Depression or Just Feeling Down?

For many people, unfortunately a stigma exists against depression.  The joke back in the 90s was "oh you're on Prozac?  Well that explains a lot."  However, what many fail to realize is that the brain is the strongest organ in the body.  It can make you see, feel, smell, and think of things that may or may not be there.  It is so strong, people have literally been destroyed.  What I want to express is that the little chemicals in our brain that make things work can sometimes be out of balance, and what occurs are symptoms that we doctors know as depression. 

Depression can take many forms and can include many different symptoms.  Criteria exists to guide physicians to the diagnosis.  The simplest thing to do is to download a PHQ-9 questionnaire off the internet and fill it out.  It is just a 10 question list and the main question is, "In the past 2 weeks have you had problems with:.......  Then the next 9 questions include issues associated with depression.  It is simple to do.

One shouldn't feel stigmatized against having a disease as serious as depression.  It is not one's own fault that their brain is not regulated properly.  And getting help is the best thing to do.  If symptoms persist longer than 2 weeks, it may be more than just feeling down.  It may be mild to moderate, or even severe depression.

Difficulty falling asleep, or sleeping too much, loss of interest in hobbies, loss or gain of appetite, low energy, feelings of guilt, difficulty with concentrating, feeling down and helpless or hopeless, and thoughts of suicide are common in depression.  Therefore, if your questionnaire shows you may have depression, schedule an appointment with a physician, either a family physician, or psychiatrist.  If you have mild depression, you can discuss with a psychologist.  All mental health professionals only want the best for any patient.

Befriending Patients

I have only been in practice for almost 2 years, but developed meaningful relationships with my patients.  I'm lucky that I have laughed more than cried with my patients.  Actually, I haven't cried at all just yet, but I did when I was a medical student, and as a nurse before that.  I feel though, that I might cry soon for one of my patients.  I've enjoyed our clinic visits, and the one hospitalization he had with me.  His disease is overtaking him quickly, but he is comfortable in hospice. 

Some may think it is taboo to befriend patients, especially in the medical field.  I beg to differ.  Some will say that you lose objectivity, and I beg to differ.  Befriending any patient is paramount to good care.  As the saying goes, people don't care how much you know, until they know how much you care.  My patient, my friend, this one is for you.

A Practice in Empathy

       Not many people really like to go to a doctor.  For some, the failure of their body to heal, or failure of their immune system to overcome, disables to the point of desperation.  Most people go to take away pain, to take away symptoms of disease, or just make small talk and ask questions.  Some people will try every known home remedy or homeopathic treatment before coming to see the doctor.
       I realize that most of the time if one goes through the trouble of calling an office, waiting in a waiting room, and sometimes feeling humiliated by defeat, then the least I can do is be empathetic in each patient's plight.  I try to listen intently when they talk, not interrupt their story, and show sympathy for the symptoms they feel.
      Medicine is one of many journeys people travel in their search for well-being, and I feel grateful that they still trust us.

Question: I have Diabetes and sometimes feel hopeless and fatigued from all the issues involved with it. How can I feel better about myself?

I am sorry to hear about your issues.  Diabetes is a horrible disease, and has many implications on your health. 

Depressive symptoms and diabetic symptoms can go hand in hand.  Diabetics feel fatigued, can’t sleep, have migrating pain syndromes, have no interest in hobbies sometimes, and feel hopeless.  Those are symptoms of depression as well.

A recent journal article from the Archives of General Psychiatry reports that women who suffer from both diabetes and depression are twice as likely to die.  Talk about implications, these two together increases your mortality substantially.  In fact, many diabetics are probably not diagnosed as having depression.  

Diabetes brings people down because it is difficult to care for themselves, difficult to manage the disease.  This can lead to complications.  I always try to get a sense of how a diabetic patient is feeling, how is their energy, their sleep, their interest, feelings of hope, to make sure I’m not missing a depressed diabetic.

It is essential to discuss any symptoms of depression with your doctor.  It is possible to manage the symptoms, therefore increasing your quality of life.

We can effectively treat depression and diabetes together.  Most people have a stigma against depression and they shouldn’t.  It is a real disease with real implications.  It is simply an unbalance of chemicals in your brain, and that balance is a physical manifestation of your emotional state.  We can fix that imbalance; therefore help fix your emotions.

Question: Every winter I get cold or flu like symptoms. Is there something I can do or take to minimize this?

Did you see the commercial on Psoriasis that has these little robots picking up little red specks from a conveyor belt and placing them up on a wall above them thereby making the psoriasis rash worse?

It is interesting to note that while some people think that those little bots are bad guys, they are actually chemicals our immune system releases in times of stress, and disease.  Some people probably think, “Kill the bots!”

The human body has a miraculous way of dealing with illness.  The Immune system stands ready 24 hours a day to fight anything and everything.  It has the power to unleash all these chemicals, but the side effects of the chemicals sometimes make us feel bad. 

Fevers are caused by chemicals released from our immune system to “pasteurize” our blood and kill bad guys.

Symptoms some people experience include sinus drainage, congestion, ear pain and pressure, facial pain, and sore throat.

While these symptoms are annoying, they can be controlled.  There is an over the counter medication for nearly every symptom we have. 

To prevent bad colds during the winter, I recommend 5 OTC products: Probiotics, Garlic, Vitamins A, C, and D, and Echinacea. 

Probiotics such as Lactinex, Acidophilus, Align, and Bifantis all have several million cells per tab and can be taken to prevent and treat diarrhea, gastroenteritis, irritable bowel syndrome, indigestion, and flatulence (what some know as “gas.”)

Garlic comes in tab form OTC, or in natural cloves.  You can take the tab daily or mix it in sugar water with 1 part crushed root with 10 parts water.  Do not take with Coumadin or oral anticoagulants. 

Vitamin A comes in 5,000 IU for men and 4,000 IU for women.  Vitamin A increases resistance to infections.

Vitamin C RDA is 60mg for adults. 500mg to 1000mg are safe daily intake, even though no research over past 20 years shows that those doses do not prevent colds.  However, Vitamin C is essential for healthy neutrophils, a key infection fighter in our immune system.

Vitamin D is our super ubiquitous vitamin we talked about in an earlier article, and 2000 IU daily is recommended for healthy immune systems.  In addition to aiding our immune system to fight colds, it also can reverse certain cancers like myeloid leukemia.

Two tsp of Echinacea in a cup of water three times daily is recommended to reduce the duration of a cold.  You can take an Echinacea tab daily to try to prevent colds.

I recommend this strategy for the winter months.  Of course, if you have symptoms longer than 4 days, any worsening of your colds, or concerns, no improvement with OTCs, or fever greater than 100.4 degrees you must come in to the ER or see your doctor and get appropriate treatment.

Thanks for all your great questions, keep them coming at runsinthewynd@gmail.com

Question: If there was one Vitamin you would recommend, which one is it?

A lot of alternative therapies are flooding the markets and many people have a hard time deciding what is best for their health.

Mainstream medicine as many refer to it as, or Allopathic medicine as we call it is just one of the options people have with their health. 

Studying medicine and the history of medicine has given me much to appreciate when it comes to naturopathies, home remedies, and our own scientific research.

I can easily tell you that Vitamin D is very important, because it is utilized for many different organ functions.  It is a prohormone, so it is important in metabolism of many hormones.  A recent published study reports that nearly 3000 genetic binding sites for Vitamin D relating to various diseases such as Diabetes type 1, Multiple Sclerosis, some cancers and Dementia have been found. 

I am impressed that over 800 studies of Vitamin D’s effect against cancer have been done.  I frequently tell my patients that low Vitamin D is linked to problems with the heart, joints, and the muscles.  You can actually cut your risk of Diabetes, some cancers, and Coronary artery disease by up to 50% by maintaining adequate Vitamin D levels. 

The usual amount of Vitamin D3 in a multivitamin is around 600 International units (IU), but the recommendations are much higher.  You can get some sunlight exposure for about 10-15 minutes if you are light skinned, and 30 minutes if dark skinned to increase your levels.  You need to take around 2000 IU daily to increase blood levels.  Also, be patient when taking this vitamin.  It doesn’t work overnight, in fact it may take up to half a year to get adequate levels again. 

I make it a point to check a simple blood test of Vitamin D OH 25 levels on my patients during annual exams, and sometimes when patients complain of fatigue. 

If you have any questions, please email me at runsinthewynd@gmail.com