TIME TO LIMIT THE PILLS

TIME TO LIMIT THE PILLS?

Here is something you should all try to do or change in this New Year, if possible, and with the help of your Family Doctor: Count the amount of pills, vitamins, herbs and supplements you take regularly and your resolution should be to REDUCE this amount. 

You can start by avoiding online offers or buying through pharmacies things that are not really necessary for your quality of life. More often than not they can be harmful. Instead, bring all you take (or list) to your doctor and discuss each one. A lot of the supplements and vitamins we take is due to marketing hype geared to the vulnerable. 

Your doctor can tell you if you have any deficiency that can be helped with these, if not you can create an overload in your body. For example:

• Too much calcium can produce kidney stones 
• Prolonged use of Omeprazole and similar over the counter anti-reflux medications, such as Nexium and others, can cause a deficiency in Vitamin B and reduce calcium absorption (risk of hip fracture). It can also cause a serious digestive infection with a bacteria called Clostridium difficile which can be devastating and become chronic   If you must take these medicines, your doctor will check your Vitamin B levels at least on a yearly schedule.
• Inappropriate use of statins such as atorvastatin, (Lipitor) can precipitate pre-diabetic state not to mention liver dysfunction and muscle aches. There are now new parameters to calculate cardiovascular risks, rather than just basing it on the level of LDL cholesterol as before. 
• Many patients ask for antibiotics and most are not necessary. Viral infections do not need to be dealt with by antibiotics and most respiratory infections are caused by viruses. The treatment in these cases are rest and hydration and perhaps antipyretics (acetaminophen) for fever. C.difficile is notoriously present after a course of certain antibiotics, I usually recommend a probiotic if I prescribe an antibiotic to replenish the natural gut flora.

So go and talk to your doctor and bring down your numbers......of pills.

"Let food be thy medicine and medicine be thy food". Hippocrates

Depression Survey

Over a four week period at the beginning of this year, we conducted a survey in our office with the help of one of our top students, Duncan Cheng, from NY Medical College. A Depression Questionnaire, composed by Duncan, (see below) was given to 70 patients over a period of 4 weeks while they were waiting to see their doctors. The intention of the survey was to evaluate if patients coming in with somatic complaints had underlying psychological concerns that manifested physically.

The results showed that 6 out of the 70 patients surveyed, or more than 8%, met the criteria for positive depressive symptoms.

From these results we can conclude that when patients come to the doctor’s office, some of them do have hidden psychosomatic agendas. We encourage incorporating questions about mental health in every patient encounter as it could be life-saving to address psychological issues in patients. It also shows that patients should feel more comfortable expressing their feelings openly with their doctors, in addition to their physical symptoms.

More research still needs to be done to further support these findings.

Manhattan Family Practice
Patient Mental Health Questionnaire

Initials:_____ Age:_____ Race/Ethnicity:____________________

Sex: ___M ___F

Were you born in New York? ___Yes ___No

If no, what year or age did you come to New York? __________

1. Do you feel happy most of the time? ___Yes ___No

2. Are you content with your life? ___Yes ___No

3. Do you enjoy things the way you used to? ___Yes ___No

4. Are you usually calm? ___Yes ___No

5. Do you have trouble sleeping? ___Yes ___No

6. Do you often feel helpless? ___Yes ___No

7. Do you often feel tired? ___Yes ___No

8. Is your appetite as good as it used to be? ___Yes ___No

9. Is your concentration as good as it used to be? ___Yes ___No

10. Do you ever have thoughts about killing yourself? ___Yes ___No

Homeopatia (Brazilian Portuguese)

Muita gente fala sobre homeopatia no Brasil e na Europa e agora esta resurgindo esta modalidade terapeutica aqui nos EUA. A homeopatia ja era conhecida ha mais de 2 mil anos desde os tempos do Pai da Medicina, Hipocrates e ja estava em uso nos Estados Unidos ha uns dois séculos atras. Caiu de moda com os avanços cientificos ja que a homeopatia nao se submete ao rigor cientifico da pesquisa para criar e administrar remédios homeopaticos.

No Brasil, na França, Bélgica e tantos outros paises, a homeopatia é uma das modalidades da medicina e muitos médicos a praticam seja em carater exclusivo ou de forma complementar à madicina tradicional como eu mesmo exerço. Ou seja, quando o paciente precisa de um medicamento homeopatico, nao hesito em lhe prescrever, especialmente se se trata de alergias, asma, medos noturnos, traumas, depressao, anxiedade, prevençao do resfriado ou da gripe e tantos outras enfermidades.

A familia real Britanica tem o seu médico particular homeopata e se trata no hospital homeopatico de Londres. Os remédios homeopaticos sao reembolsados pela saude publica em varios paises e provavelmente sera o caso aqui nos Estados Unidos. O problema é que os remédios homeopaticos sao bem baratos e a industria farmaceutica Americana colide com a homeopatia pois a veem como uma rival mais em conta e menos perigosa que os remédios alopaticos, da medicina tradicional. Entende-se que a industria farmaceutica gasta bilhoes de dolares em pesquisa cientifica obrigatoria antes de lançar qualquer produto medicamentoso no mercado e ela quer se resarcir destes investimentos. E como vimos acima, a industria homeopatica nao tem esta obrigaçao.

A homeopatia como o nome indica, estuda as patologias que se curam com substancias encontradas na natureza e que por similitude podem ocasionar os mesmos sinais e sintomas mas em diluiçoes infinitesimais, causam a cura destes mesmos sintomas.

Um exemplo classico é o arsenico que se ingerido in natura, pode causar sufocaçao por constriçao dos bronquios e que se se diluir este mesmo arsenico, este podera causar uma dilataçao dos bronquios. Portanto a mesma substancia que pode matar em dose encontrada na naturea, pode salvar a pessoa se ingerida em forma super diluida. Neste caso usa se o Arsenicum Album no asmatico. Nao tente diluir o arsenico em casa. Isso se faz em fabrica especializada com maquinas muito especiais. Visitei as fabricas em Lyon na França e fiquei impressionado com a técnica, a higiene e asepsia rigorosa com que eles manuseiam seus produtos até a transformaçao em pequenas bolinhas homeopaticas. Tambem produzem cremes como o Arnicare para traumas, o Calendula para queimaduras e mordidas de mosquitos, colirios para inflamaçoes oculares, comprimidos para o stress e assim por diante.

Um dos produtos mais populares é o Oscillococcinum tambem chamado Oscillo, que vem num tubinho cheio de bolinhas minusculas e que se tomam ao primeiro sinal que voce vai ter uma gripe. Isso esta provado que reduz a duraçao da gripe assim como a sua severidade. Uma das vantagens da homeopatia é que pode se administrar a bebes, crianças, adultos, gravidas, idosos e nao tem contra-indicaçao, nao interage com outros remédios, e o custo é bem mais acessivel que os remédios convencionais.

Vale lembrar que a homeopatia trata os sintomas. Se o paciente tem pneumonia bacteriana com tosse e febre, ele precisara de um antibiotico e podera utilizar remédios homeopaticos para a tosse e a febre. Nao podera se curar sem o antibiotico, remédio da medicina classica.
Se tiver um cancer com sintomas de nausea, precisara de cirurgia, quimioterapia e ou radioterapia mas podera tomar remédio homeopatico para a nausea. Nao se trata a doença com homeopatia. Sinais e sintomas sim.

Gosto muito de usar homeopatia quando possivel especialmente para pessoas alergicas a remédios, problemas psicosomaticas, asma, alergias, ansiedade, depressao, pacientes que ja tomam uma grande quantidade de remédios convencionais e que precisam de alguma coisa para dormir ou para a fadiga e o cansaço.

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.