Is it a cold? Is it the flu? Is it an allergy? And do I stay at home?

"Season of mists and mellow fruitfulness..." and in my office it is the season for giving FluMist (nasal spray) or Flu Shots to the majority of my patients. It used to be a must-have preventive vaccine for those most at risk, like asthmatics, diabetics, people over 65 and young children. Now most people want to be vaccinated so they can feel more protected when they go about their normal work and travel plans during the fall and winter seasons.

Another good reason to be vaccinated is to stop the spread of the influenza virus to those around you and in the community. This year's vaccine covers three strains of the virus out there, including the H1N1. Some people with low immunity can develop infections from the flu or pneumonia so it is very important that we all responsibly take action to protect them and ourselves. Suppose you do find yourself with a runny nose, sneezing, nasal itching, watery eyes and you do not know what to do. You may actually be suffering from nasal allergy symptoms and require an allergy medicine, (tablet or inhaler).

Or you may be running a slight temperature and you are sneezing, coughing and feeling generally run down.

You need to make decisions:
Do I go to work?
Do I go to the doctor?

Normally, I would say that if you are unable to perform your duties well because of your health condition and if you are sneezing and coughing, then it is best to stay at home as you can be contagious. Germs circulate rapidly.

If after two to three days of resting, drinking plenty of liquids, eating chicken soup, breathing in fresh air, maybe taking over-the-counter flu medications to relieve the symptoms you are still feeling the same then you should go to your doctor to check if you have an infection that can be treated by antibiotics.

The best way to prevent flu is always to remember to :
1) Wash your hands regularly
2) Exercise and keep active
3) Eat nutritious meals with plenty of fruit and vegetables
4) Drink plenty of fluids (but try to avoid sodas and sugary drinks)
5) Get good sleep and rest

and don't forget your flu shot.
If in any doubt, call or email your doctor's office for personal advice.

How a Family Doctor Diagnoses Depression

According to a new survey from the Centers for Disease Control and Prevention, one in 10 Americans over age 12 are now taking antidepressants which is a fourfold increase in the prevalence of antidepressant use since the late 1980s.

When a female patient, a mother of two, came to my office for her regular check up this past summer, she didn't seem her usual self. At 48 years old, she looked tired and complained of difficulty sleeping. When I questioned her further I learned that she was not enjoying all the things she used to in the past. She couldn't understand why she was feeling overwhelmed, irritable and anxious. She was not surprised when I told her it was depression but she was reluctant to take medication. I explained that it could help her cope more easily and she agreed to try it out and come back for follow-up. Now she comes to see me once every few weeks to check in and manage her symptoms and discuss any issues she may have. She says the medication has helped her tremendously and she has started to notice the difference.

Most patients don't come in saying, 'I'm depressed". They come in with all kinds of different symptoms like headaches, anxiety, trouble sleeping, for instance, but after a deeper consultation they will reveal their depression.

Most family doctors are best placed to take on the role of therapist with their patients if they take the time to ask the right questions and notice the signs. Some patients are resistant to seeing mental health professionals as they are either in denial or simply can't afford the time or the money.

Many psychiatrists agree that screening for and treating depression in the doctor's office is a necessary expansion of a family doctors' duties. Dr. Gary Small, a psychiatrist and director of the UCLA Center on Aging says "Part of what we do as psychiatrists is teach doctors how to diagnose and treat depression so that a lot of depression can be handled in primary care."

The report, published Wednesday, draws on a survey of over 12,000 Americans over the age of 12. It showed that women were the largest consumers of antidepressants: 23 percent of all women ages 40 to 59 reported taking antidepressants. This does not necessarily mean that women are more depressed than men but that they are more open to seeking help and therapy from their doctors.

Of course, no patient should be treated with medication alone for depression. Follow-up is key so we can talk about adjusting the dosage or stopping the medication as needed. If I see a deeper need for psychotherapy I have an excellent network of professionals I refer to and work together with.

Although the survey captures how many patients are on antidepressants, it does not necessarily represent the true number of patients being treated for depression. Some antidepressants are prescribed for anxiety, neurological pain, fibromyalgia, sleep problems, and menopausal hot flashes.

There is certainly less stigma today attached to seeking help for depression. Talking to your family doctor about your symptoms, your stresses and anxieties will help them decide if an antidepressant will help you cope more effectively and to prescribe the right treatment for you.

Vitamins - to supplement or suppress?

Many of my patients have been asking my opinion on the recent news on the risks of taking vitamin supplements. Studies have shown that there is a slight increase in mortality risk from taking vitamin supplements and an increased prostate cancer risk in men who took Vitamin E. So should we be taking mulit-vitamins at all?

I had already been advising my patients to stop their vitamin supplements four to five years ago unless absolutely necessary. For me this would be in the case of patients who have a Vitamin B or D deficiency, pregnant patients who need folate and pre-natal multi-vitamins or those with cognitive impairment (pre-dementia) when I would recommend a Vitamin B complex.

The issue of vitamin E was raised a few years ago after studies indicated an increase in cerebral hemorrhage hence I do not recommend it. Now the study on prostate cancer further confirms the risks associated with this vitamin.

Iron supplements are out of the question unless there is a clear deficiency and a need for replacement.

Calcium is recommended in small doses due to possible association with kidney stones and the controversy around women and calcium deposition in the heart.

As a nation with a more than adequate supply of nutritional food at our disposal, there is little need to take supplements. And yet the latest surveys show that one third of Americans take vitamins and nearly half of people over 50 take multi-vitamins, spending nearly $10 billion on vitamins last year.

I would rather give the money spent on monthly vitamins to the millions of malnourished human beings in Africa and other underprivileged areas of the world.

Osteoporosis in Men

We are used to thinking that osteoporosis only affects women as a general rule. Well, this is definitely not the case. This disease can occur in men too. We are going to take a look at some of the principal causes and how to diagnose it and then most importantly how to prevent it. But before this, let’s define exactly what is this disease called osteoporosis.

It is the fragmentation of bone tissue, usually due to the natural aging process, and it does occur in men with much more frequency than we are led to believe. Another myth we have to demystify is that osteoporosis is caused only by aging. In fact, it can be brought on by various other risk factors, like cigarette smoking, lack of exercise and sedentary lifestyles, and a high usage of steroids drugs. In the case of steroids, it is more common in people who take cortisones over a long period of time like asthmatics and patients who have sarcoidosis, a disease that causes abnormal accumulations of inflamed cells – granulomas- (in many organs of the body) and other chronic diseases.

Another cause of osteoporosis in men is hypogonadism, which is a deficiency of testosterone, the masculine hormone par excellence. Also, malnutrition, obesity, and alcoholism are potential risk factors for osteoporosis.

The most visible signs and symptoms of osteoporosis, other than a susceptibility to fractures, are a curved posture, pain in the back regions and a slight shrinking in height (you may already have noticed how some elderly people appear somewhat shorter, both men and women.) It may also be that in the initial stages of osteoporosis there are no symptoms whatsoever.

To diagnose osteoporosis, your doctor will examine you and ask questions about your symptoms and sometimes request a bone-density test to measure the status of your bones. The results are immediate and the test does not need any preparation on your part.
To prevent osteoporosis, you could try to do the following:

a) stop smoking

b) limit your alcohol consumption (2 glasses per day maximum for men, one a day for women)

c) Exercise regularly

d) Take vitamin D supplements (ask your doctor for the right dose for you)

e) Expose your body to sun for 10 to 15 minutes at least 2 to 3 times per week. This will activate the vitamin D which in turn will activate the metabolism of your calcium levels to reinforce your bones.

f) Eat calcium-enriched foods, like dairy products, vegetables and greens, sardines, salmon, tofu and almonds.

There are medicines and treatment for osteoporosis which can help you to avoid serious fractures. These medicines and procedures can already help to prevent osteoporosis occurring in those who are taking regular steroids for other diseases.

In the case of men, check your testosterone levels at your next doctors’ appointment because it is now known that a deficiency of this male hormone, or hypogonadism, is a leading cause for osteoporosis in men.

The Importance of Seeking a Second Medical Opinion

I remember many cases of patients coming to see me from far and wide, from Queens or from Goiania, from Staten Island or from Brussels because they had particular medical concerns. They could not make decisions on what best to do faced with incomprehensible diagnosis and with costly and uncertain treatment options. The Internet is a huge source of clinical information but understanding and managing all the information we read on the web is not an easy task. It is not even easy for us doctors to interpret the avalanche of information that assails us day and night. We have to meticulously research the data to ensure that it is accurate and reflects studies that are unbiased or not sponsored by a particular drug company for their own marketing gain. This sometimes means reading between the lines or undertaking further research and sometimes even relying on your own personal and tried and tested experience.

So we can imagine what it must be like for the patient! No doubt, it is a good idea to seek a second opinion when the diagnosis is a complicated one. And especially if there is surgery involved. This should not offend the surgeon or doctor involved at all. If it does then that is their problem not yours. It is about your health not theirs. Don't feel embarrassed to ask for your medical file to obtain a second opinion from another doctor. There is no problem with this. On the contrary, you will feel relieved and reassured to know that the doctors are all in agreement with the diagnosis and treatment options.

I saw a patient once who came to see me with his medical file bulging with notes and test results from exams done in Rio and Sao Paulo. He had been diagnosed with prostate cancer that had metastisized, meaning it had already started to spread over his body. His urologist in Rio had referred him to Sao Paulo where he had been taking injections of female hormones to combat the spread of the cancer. He came to see me in New York where I reviewed his bone scan. I saw that it showed no signs of cancer at all. It was a simple case of osteoporosis. The patient stopped taking the hormones and was so relieved and thanked me wholeheartedly. Even today I still remember with great affection seeing his face light up when I told him he could return home and celebrate his "cure".