Medical Handbook 2016 by AIM Media Indiana

Medical Handbook 2016

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Contents Blood pressure guidelines. . . . . . . . . . . . . . . . . . . . . . 2 Dealing with depression . . . . . . . . . . . . . . . . . . . . . . . 8 Heart attack symptoms for women. . . . . . . . . . . . . . 10 New thoughts on peanut allergies . . . . . . . . . . . . . . 12 What to do if you have prediabetes . . . . . . . . . . . . . 14 What you need to know about tuberculosis. . . . . . . 15 Why dirt is good for kids . . . . . . . . . . . . . . . . . . . . . . 18 Treatment for burns. . . . . . . . . . . . . . . . . . . . . . . . . . 19

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Prevent eye injuries. . . . . . . . . . . . . . . . . . . . . . . . . . 20 Slashing soda can improve your health. . . . . . . . . . 24 Cut down on medication errors. . . . . . . . . . . . . . . . . 22 The benefits of eating lunch. . . . . . . . . . . . . . . . . . . 25 Developing a good doctor-patient dialogue. . . . . . . 26

Not just a design, an approach to living.

Washing hands helps prevent spread of disease. . 29 Tips to put some more joy into your life. . . . . . . . . . 30 Healthy posture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

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2016 MEDICAL HANDBOOK

Be hypervigilant about hypertension Guidelines still vary for ideal blood pressure

By Jennifer Willhite

ew guidelines for the diagnosis and treatment of hypertension are again on the horizon. Hypertension, commonly known as high blood pressure, is called the silent killer for a reason, says Dr. Melinda Hunnicutt, cardiologist with Southern Indiana Heart and Vascular in Columbus. “Most people do not have symptoms,” she says. “The most common sign of high blood pressure is headaches, and a less common sign is a pounding feeling in the chest. Nose bleeds are even less common, but may happen when blood pressure is very high.” According to the National Institutes of Health, hypertension affects one in three Americans. It is the leading contributing factor for serious, and potentially fatal, neu-

rological and cardiovascular disease. The most common dangers associated with hypertension include stroke, heart attack and heart failure, Hunnicutt says. In 2014, the eighth Joint National Committee released its evidence-based recommendations for diagnosing and treating hypertension. As a result of the committee’s findings, established guidelines for the diagnosis and treatment of hypertension were revised to state that ideal blood pressure for people 65 and older is 150/90 and 140/90 for adults under 65. Now, not even two years out, those guidelines may soon change yet again. In a 2015 research study called the Systolic Blood Pressure Intervention Trial (SPRINT), funded by the

“The bottom line is we are all different, but watching risk factors is important.” — Dr. Melinda Hunnicutt, cardiologist

2016 MEDICAL HANDBOOK

National Institutes of Health, it was determined that individuals who kept their blood pressure around 120/90 and below were at less risk for developing hypertension. So, otherwise healthy adults who keep their blood pressure low greatly lessen their risk for hypertension and its associated complications as they age, Hunnicutt says. The study was designed to answer the question, “Will lower blood pressure reduce the risk of heart and kidney diseases, stroke or age-related declines in memory and thinking?” More than 9,000 people participated in the nearly eight-year study.

New guidelines? Last summer the SPRINT study offered its findings. It showed that the lower you keep your blood pressure, the better off you are. Good news, right? Well, not so fast. Despite the study’s findings, the established 2014 guidelines are still what physicians follow. “They haven’t yet changed the guidelines,” Hunnicutt says. “But we’re seeing some improvement, so maybe we should be more aggressive.” She believes the 2015 study will be influential in the long run due to the size of the study. Prior to the SPRINT study, the medical community was having difficulty finding documentation demonstrating why people do better when their blood pressure is better controlled, and this study offered just that. However, there are some issues with putting the findings into practice. “The problem I see in practice for certain patients is, one, they’re on multiple medications,” she says. “And, two, some people have variable blood pressures where some days it’s high and some days it’s low.” Hunnicutt admits balancing the new findings and established guide-

lines can be perplexing not only for the patient, but physicians as well. It is confusing to us as physicians what the best thing to do is,” she says. “But the study is telling us a more aggressive treatment is important.”

Lifestyle changes Making simple lifestyle changes can often be enough to lessen your risk for hypertension and bring down your blood pressure numbers, Hunnicutt

says. Exercise, watching your diet, losing weight if you are obese and quitting smoking are great places to start. Another approach used to lower high blood pressure is to limit a patient’s sodium intake. Hunnicutt admits this can be very tricky. You have to be mindful about how much sodium is in each item you drink or eat. Consider this, a simple hamburger with cheese and condiments can quickly approach 1,000 mg of sodium once you

“The problem I see in practice for certain patients is, one, they’re on multiple medications. And, two, some people have variable blood pressures where some days it’s high and some days it’s low.” — Dr. Melinda Hunnicutt, cardiologist

2016 MEDICAL HANDBOOK

count the salt in the bun, meat, cheese and ketchup and/or mustard. That may not sound like much, but if you are limited to 1,500 mg of sodium per day, you have already consumed the vast majority of your daily allowance with one item. Believe it or not, reducing your sodium intake can lower your blood pressure in a matter of hours. Hunnicutt says it is not uncommon to see a difference in a person’s blood pressure literally overnight when he cuts his sodium intake, if just for a day. Seeing a lowering of blood pressure from exercise and weight loss alone can take a few weeks to a few months, she says. But progress is still progress even if it is slow. Most people believe once they are put on a blood pressure medication, they will always be on that medication, and that isn’t always true. However, telling patients they need medication to help bring down potentially dangerous blood

pressures certainly gets their attention, Hunnicutt says. “Depending on where the blood pressure is, I may get someone started on medication right away,” Hunnicutt says. “Then as the blood pressure comes down in the next few months, we can stop it.” It is important to manage your blood pressure and keep it close to, if not below, the suggested guidelines. Ignoring high blood pressure won’t necessarily cause obvious symptoms, but the risk for long-term damage to your body is very real. Despite the findings of medical studies and established guidelines, it is important to remember everyone is different, so the approach for lowering blood pressure is not one size fits all. “All of us are different, so we could say everyone needs to be under 120 every time,” Hunnicutt says. “The bottom line is we are all different, but watching risk factors is important.”

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2016 MEDICAL HANDBOOK

People can’t just snap out of depression

By Mayo Clinic News Network

r. Filza Hussain, behavioral health physician at Mayo Clinic Health System, offers some thoughts on depression and society’s views of it: “Our relationship with the word ‘depression’ is paradoxical. On the one hand, we so freely admit that we are depressed because our team lost the Super Bowl or because the store doesn’t carry a desired outfit in our size. Yet when it comes to talking about clinical depression, the stigma attached with the word becomes omnipotent. Rather than admitting to feelings of sadness, loss of interest in usual activities, guilt, decreased energy, difficulty with attention and concentration, and sleep difficulties, we clam up, put a bright smile on our face and pretend everything is OK. “Why do many people with depression put up a facade and act as if everything is fine? People say it’s because they’re afraid of the judgment that comes with acknowledging they have a mental health disorder. Even if it’s depression, some patients may say, “I don’t want anyone

2016 MEDICAL HANDBOOK

to know I’m nuts,” or “I don’t want anyone to lock me up.” It’s become so acceptable in our culture to say ‘be positive,’ ‘snap out of it,’ or ‘it’s all in your head’ without thinking what these statements really mean. Do you expect someone to snap out of their diabetes? Or has being positive ever changed one’s thyroid function? Perhaps that pain in your chest radiating to your arm is all in your head, after all. “Depression is a real illness. There is an organ involved (the brain), as well as receptors and hormones (i.e., neurotransmitters). There is a lot we don’t understand about this illness, which unfortunately adds to its aura of mystery. But there are treatments that work. Although you can certainly make positive changes in your life that will improve symptoms, you can’t just snap out of it. It’s not a fault or something you did or didn’t do. “So, let’s work towards removing the stigma and mystery of depression. Please speak with your physician and ask for more information.”

2016 MEDICAL HANDBOOK

Understanding heart disease in women

eart disease is the No. 1 killer of women. While both men and women are affected by heart disease, the warning signs and symptoms can be quite different. Dr. Amy Pollak , a cardiologist at Mayo Clinic on the Florida campus, says one in three women die each year of heart disease and stroke, and 80 percent of cardiac events can be prevented. She says living a heart-

2016 MEDICAL HANDBOOK

By Mayo Clinic News Network

healthy lifestyle and making simple changes can be the cure.

Heart attack symptoms for women The most common heart attack symptom in women is some type of pain, pressure or discomfort in the chest. But itâ&#x20AC;&#x2122;s not always severe or even the most prominent symptom, particularly in women. And, sometimes, women may have a heart attack without chest pains. Women are more likely than men to have

heart attack symptoms unrelated to chest pain, such as: l Neck, jaw, shoulder, upper back or abdominal discomfort. l Shortness of breath. l Right arm pain. l Nausea or vomiting. l Sweating. l Lightheadedness or dizziness. l Unusual fatigue. If you have questions, see your health care provider for more information.

2016 MEDICAL HANDBOOK

Traditional thinking on peanut allergies may be shifting

By Jenna Chandler The Orange County Register

t might seem unorthodox, but feeding peanuts to infants at risk of an allergic reaction could actually safeguard them. Mounting evidence suggests that gradually introducing bits of peanut protein, such as peanut butter diluted with hot water, to high-risk babies as young as 4 months old might help them develop immunity. (Whole peanuts, however, are a choking hazard and should not be fed to babies and toddlers.) The latest research, published this month in the New England Journal of Medicine, found most children who consume peanuts at an early age will remain allergy-free, even if they stop eating peanuts by age 6. Now, the National Institutes of Health is proposing new guidelines recommending some children be fed peanutcontaining foods — about 6 to 7 grams over three or more feedings — as early as age 4 to 6 months. The recommendation applies to children who are at high-risk because they already have severe eczema, egg allergy or both. “In my gut it’s counterintuitive,” said Louise Larsen, of Westminster, Calif.

2016 MEDICAL HANDBOOK

Larsen strained to ensure her daughter, now 19, never ate or touched the legumes again after a peanut butter and jelly sandwich sent her into anaphylactic shock, a lifethreatening allergic reaction, at 15 months old. But, Larsen added, “I do believe in science.” Food allergies appear to be increasingly common. They now affect about 1.4 percent of U.S. children, according to a 2010 study by food allergists with Mount Sinai School of Medicine in New York. That figure is up from less than 0.5 percent in 1999. There are a handful of theories for the rise — such as the one that says children are not being exposed to as many germs so their immune systems have changed — but no definitive explanation. For some, eating cross-contaminated food or even consuming traces of peanuts, which can lurk undetected on countertops and on people’s hands, can be life-threatening. The consequences aren’t always so severe; sometimes exposure results in hives or a tingling sensation. Parents were once advised to delay introduction of peanuts into their children’s diets to avoid a dangerous reaction. But, for some, that thinking has shifted.

“If you delay too long, you have a higher risk of developing a peanut allergy,” said Dr. David Fleischer, an allergy specialist at Children’s Hospital Colorado who helped write the NIH guidelines. However, the recommendations, which aren’t yet final, say those at highest risk should first get a skin prick test exposing them to a small amount of the allergen. Depending on how allergic the child is, the feeding might be best supervised or avoided. The proposed guidelines draw upon the results of a clinical trial in the U.K., published last spring in the New England Journal of Medicine. Known as the LEAP trial, it involved 640 infants with severe eczema, egg allergy or both. They were divided into two groups, one with families avoiding peanuts and another with children fed peanut butter weekly for five years. Nearly 14 percent of those who avoided peanuts became allergic, compared to 2 percent of those who didn’t. Research published in the journal this month built upon the LEAP study. This time, every participant avoided eating peanuts for one year. After that 12-month hiatus, 4.8 percent of participants who had been exposed to peanuts as infants developed allergies compared to 18.6 percent from the original avoidance group of infants, researchers said. Pediatricians who specialize in allergies say the findings are promising.

“This study is something we’ve been waiting a long time for,” said Dr. Wan-Yin Chan of CHOC Children’s Hospital. The evidence validates how Chan approached peanuts with her own two girls, now ages 3 and 6, who had mild to moderate eczema as babies. She fed them peanut butter before they each turned 1. It was controversial at the time, Chan said, so she never recommended it to her patients. But she will soon, now that increasing evidence and new guidelines suggest it’s not only safe but beneficial, she said. “We have had a threefold increase in prevalence of peanut allergies in (20) years. I think people will be happy to have a solution,” she said. It’s a solution that many parents are reacting to with trepidation, said Larsen. In 2008, she formed an online community for parents of children with food allergies. Through Facebook, the group, Parents of Kids With a Severe Peanut Allergy, has 8,000-plus members. “The majority of people feel that this sounds good in theory, and we know that for some people this has worked,” Larsen said. “But for many of us, our children would never have survived being introduced to peanuts, because their first introduction to peanuts was severe anaphylaxis. We hope that these new guidelines heavily stress the importance of early testing to weed out babies that might have an anaphylactic reaction,” she added.

2016 MEDICAL HANDBOOK

What is prediabetes?

ccording to the American Diabetes Association, an estimated 86 million Americans age 20 and older have prediabetes. “If you’ve been diagnosed with prediabetes, it means your blood sugar levels are not high enough to be classified as Type 2 diabetes but are high enough to indicate a need for change,” says Anne Bauch, registered dietitian at Mayo Clinic Health System. A normal fasting blood sugar level is below 100, whereas a level of someone with prediabetes is between 100 and 126. Once levels have surpassed 126, it is classified as Type 2 diabetes, which indicates that your body resists insulin or doesn’t produce enough of it to maintain normal blood sugar levels. “When you have prediabetes, sugar begins to build up in the blood stream rather than fuel your cells. This is when insulin resistance occurs, which is believed to be the No. 1 cause of prediabetes,” adds Bauch.

2016 MEDICAL HANDBOOK

By Mayo Clinic News Network

A healthy weight allows insulin to work more efficiently and to keep blood sugars within a normal range. A healthy diet and regular exercise are the best ways to bring your blood sugar levels back to normal. What are the risk factors for developing prediabetes? l Body mass index (BMI) greater than 27. l Family history of diabetes. l Sedentary lifestyle. l Age 45 or older. l Carrying weight in your abdomen. l Previous diagnosis of gestational diabetes (developed while pregnant). When should I be tested? If you’re 45 or older, you should have your fasting blood sugar checked every year during your physical. If you’ve had gestational diabetes, it is important to have your blood sugar checked each year, as there is a 60 percent chance of developing Type 2 diabetes. Are there any symptoms?

Often, people do not know they have prediabetes because they do not experience any symptoms. However, Type 2 diabetes symptoms may include: l Fatigue. l Blurred vision. l Frequent urination. l Increased thirst. What’s my next step? “After diagnosis, a referral to a diabetes educator can be initiated to begin a carbohydrate control meal plan along with an exercise routine. Diabetes educators teach lifestyle skills to manage prediabetes and Type 2 diabetes. We help patients with meal planning, exercise, medication management and monitoring blood sugars,” says Bauch. Talk to your health care provider if you have any questions or concerns about diabetes or if you develop any Type 2 diabetes symptoms.

Tuberculosis: what you need to know

By Mayo Clinic News Network

ew cases of tuberculosis in the southern region of the United States have raised questions about this deadly disease. It’s caused by bacteria that spread from person to person through microscopic droplets released into the air. The Centers for Disease Control and Prevention says there are almost 2 million TB-related deaths worldwide each year, and the disease was once the leading cause of death in the United States. “Only people who are in close contact with people infected with tuberculosis are at risk of becoming infected with TB,” says Dr. Stacey Rizza, Mayo Clinic Center for Tuberculosis associate executive director. “It is prevented by identifying people who have tuberculosis infection, isolating them from others until they are no longer infectious,

and treating them for either active or latent tuberculosis.” Although tuberculosis is contagious, it’s not easy to catch. You’re much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who’ve had appropriate drug treatment for at least two weeks are no longer contagious. There are two types of TB conditions: l Active TB disease: This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later. l Latent TB infection: Those with this condition do not feel sick, do not have symptoms and cannot spread TB germs to others. But if their TB germs become active, they can develop TB disease.

Signs and symptoms of active TB include: l Coughing that lasts three or more weeks. l Coughing up blood. l Chest pain, or pain with breathing or coughing. l Unintentional weight loss. l Fatigue. l Fever. l Night sweats. l Chills. l Loss of appetite. Rizza says more than 10,000 new cases were reported in the U.S. in 2011, and globally, TB is a leading cause of death from infectious disease. “We need to be aware of TB and treat and diagnose it quickly so we can rid our country of this disease,” she says.

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The benefits of dirt for children

By Alison Bowen Chicago Tribune

ids should be spending less time staring at screens and more time getting grubby in the dirt. So says Dr. Maya Shetreat-Klein, author of “The Dirt Cure: Growing Healthy Kids With Food Straight From Soil.” In the book, she writes about the importance of exposing children to microbes in nature, whether it’s eating fresh food from healthy soil in the garden or playing outside. “It’s beneficial on so many levels,” she said. For example, children who spend three hours daily outdoors in natural light are more likely to have perfect vision. More time in nature also correlates to better test performance.

2016 MEDICAL HANDBOOK

In Japan, they enjoy what’s called forest bathing, which is “essentially immersing yourself in the beauty of the forest.” “It boosts mood, people feel happier, it enhances focus,” she said. “They sleep better.” So the next time you’re outside, take a deep breath. We can inhale microbes too. “It’s not like you have to do it one way,” she said. “That’s kind of the beauty of it.” Shetreat-Klein became increasingly concerned about this topic because children were getting more screen time and fewer school minutes for physical education. But, of course, getting outside doesn’t just apply to kids. She herself tries to get outside at least an hour each day. “All of the things that we’re talking about benefit adults tremendously as well,” she said.

Ouch! I’ve burned my hand. Now what?

By Mayo Clinic News Network

here are many myths about how to treat a minor burn. Do I pop the blister? Do I use hot or cold water on it? Do I cover with bandages? One of the most important things to do is to act fast and follow these tips for minor burn treatment: l Use cool (a little colder than room temperature) running water for 10 to 15 minutes or until the pain eases. A cool, clean, damp towel works, too. l Swelling may occur, so remove tight items, such as rings or clothing, from the burned area. l Do not break the blister if it bigger than your little fingernail. If the blister does break, clean it with mild soap and water. Apply antibiotic ointment, and then cover it with a bandage or gauze. l Applying moisturizer, aloe vera gel or other pain relief gels may provide temporary relief. Don’t slather on butter, as butter retains heat and it could be contaminated with bacteria. l Some over-the-counter pain relievers also may be beneficial. Ibuprofen, naproxen sodium or acetaminophen can help ease the pain.

l It’s also important to ensure that you have had a tetanus shot within the last 10 years, as you can get tetanus through an open wound in the skin. You should see your health care provider: l If the symptoms begin to get worse and larger blisters develop. Large blisters are best removed, as they rarely will remain intact on their own. l If the burn covers a large area of the body or infection-like signs begin to show, such as oozing from the wound, increased pain, redness and swelling. Call 911 for emergency medical help for major burns.

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Keep prevention of eye injuries clearly in sight

By Mayo Clinic News Network

r. Joseph Dolan, ophthalmologist with Mayo Clinic Health System in Eau Claire, Wis., shares his thoughts about eye injuries: We often donâ&#x20AC;&#x2122;t think about eye injuries when doing daily activities, but as almost half of all eye injuries each year happen at home, we probably should. Here are examples of common household activities that can cause an eye injury, according to experts from the American Academy of Ophthalmology: l Household chemicals or bleach: Getting unexpectedly sprayed or splashed in the eye can cause anything

2016 MEDICAL HANDBOOK

from minor irritation to a chemical burn. If this happens, immediately flush the eye by putting your head under a steady stream of room temperature tap water for 15 minutes. Contact your eye doctor or urgent care facility to determine what is recommended as a next step, based on the chemical. l Hot grease or oil splatter: As with household chemicals, the most important thing to do is irrigate the eye and contact your eye doctor as soon as possible. l Drilling or hammering: An activity as simple as hanging a picture can cause a nail or screw to become a

projectile or cause fragments to fly off and cause an eye injury. Seek immediate medical help if you are hit in the eye with any foreign object. l Lawn and garden care: Always wear protective eyewear when mowing the grass, trimming hedges, cutting wood or using power tools. Whether you use a riding or push mower, stop the engine when any one approaches. The mower can cause rocks and other objects on the lawn to fly toward someone and cause injury. l Securing items to racks: Use caution with any objects that have the potential to snap, like bungee cords or rubber bands. Also keep eye protection in mind when participating in sports. People think mostly of sprains and strains as sports-related problems, but eye injuries account for an estimated 100,000 physician visits each year in the United States for school-age children. Parents should that ensure children protect their eyes when participating in

baseball, basketball, hockey, indoor racket sports and cycling, to name a few. Also, darts, paint-ball guns and BB guns may seem like toys, but they can cause serious injuries, including vision loss and blindness. Be sure to have a discussion with your youngsters about how to use these items carefully and follow all safety instructions, including protective eyewear. Here are tips I give my patients when it comes to preserving their eyesight: l Use protective eyewear while doing projects at home, when working outside and during sports activities. l When spending time outdoors, wear sunglasses that provide 97 to 100 percent UV protection. l Make sure you and your family get regular eye checkups and screenings. l If you have a chronic disease like diabetes, follow through on any physician recommendations related to eye care health.

We often don’t think about eye injuries when doing daily activities, but as almost half of all eye injuries each year happen at home, we probably should.

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2016 MEDICAL HANDBOOK

Medication errors: tips to keep you safe

By Mayo Clinic News Network

edication errors are common. The Centers for Disease Control and Prevention estimates that 82 percent of adults are on at least one medication and 29 percent take five or more. With numbers such as those, itâ&#x20AC;&#x2122;s no wonder mistakes happen. The CDC also says adverse drug events, which are instances where medication errors cause harm, are responsible for about 700,000 emergency department visits a year. Some typical medication errors include: l Taking over-the-counter products that contain acetaminophen when youâ&#x20AC;&#x2122;re already taking a prescription pain medicine that contains acetaminophen, possibly exceeding the recommended dose and increasing the risk of liver damage. l Taking prescription medications that go by different names but include the same ingredients, increasing the risk of overdose.

2016 MEDICAL HANDBOOK

Mixing up eye drops with ear drops. Chewing nonchewables. l Cutting up pills that should be taken whole. l Using the wrong spoon to measure dosage. l Missing or doubling up on doses. Why do medication errors happen? Mayo Clinic experts say some of the most common reasons are poor communication between health care providers, poor communication between providers and their patients, many medications having sound-alike names or abbreviations, and many medications looking similar. The following tips can help keep you and your family safe. l Ask questions: Find out when and how to take the medication and if there are potential side effects. l Review medication list with your health care provider. l Keep an up-to-date list of all your medications, including nonprescription and herbal products. l l

l Store medications in their original labeled containers. l Keep medications organized by using a pillbox or pill dispenser. l Save information sheets that come with your medications. l Use the same pharmacy for all of your prescriptions. l Don’t give your prescription medication to someone else and don’t take someone else’s. A process called medication reconciliation will also help prevent medication errors. Medication reconciliation is when you compare your current or updated list of medications, both prescription and over-the counter, to what you have been taking. This should be done every time a medication changes or you interact with a new health care provider.

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2016 MEDICAL HANDBOOK

Plenty of reasons to cut soda By Alison Bowen Chicago Tribune

hen Dr. Susan Maples sees patients at her dental practice, she tells them to slash the soda. And she’s not alone. The government’s guidelines, produced jointly from the Department of Health and Human Services and Department of Agriculture, were released in January. Among the key recommendations? Consume less than 10 percent of calories per day from added sugars. The Mayo Clinic describes these as sugars and syrups added to foods during processing. The top culprits are desserts, sodas and sports drinks, where they boost flavor but add more calories with scant nutritional value. And according to a study just published in the medical journal The Lancet, reducing sugars added to sugar-sweetened drinks by 40 percent during a five-year period could prevent 1.5 million cases of people becoming overweight and obese. Researchers note this could also avoid about 300,000 cases of obesity-related type 2 diabetes. All which explains why cutting out liquid sugar is one of Maples’ passion projects. A dentist in Holt, Mich., she feels passionately about how oral health affects the entire body. “To drink a soda or a glass of juice as an occasional treat is one thing, but the way we habitually drink it is downright dangerous,” she said, noting that obesity from chronic sugar is linked to heart disease, cancer and diabetes. So consider cutting them out altogether, she said. And that might include your morning juice. Think juices, soda, energy drinks, sports drinks, sweet tea, lemonade. These, she said, “turn on the insulin pump like crazy.” Not to mention the effect on teeth. “Remember that teeth are the only part of the ectoderm — the body’s outer covering — that will not heal once it is flawed,” she said.

2016 MEDICAL HANDBOOK

Skipping lunch? Your doctor wants you to think again By Allie Shah Star Tribune (Minneapolis)

he lunch break at work is becoming a relic of the past, a trend some doctors warn is making us unhealthy. Just one in five Americans steps away from the desk to eat lunch, studies show. Working straight through the day without a break can lead to higher levels of stress, mental fatigue, physical exhaustion and eventually burnout. “It’s really important that people keep in perspective the big picture — that they will really burn out,” said Dr. John Murphy, a family physician with Mayo Clinic Health System. “That lunch break is critically important.” Midday breaks don’t have to be spent sitting and eating. Getting on a treadmill for a half

hour, taking a few minutes to connect with family on social media or socializing in person with coworkers can offer a mental break from tasks, Murphy said. “Stress reduction is so important to overall health,” he said. Other studies have revealed that connecting with co-workers on a social level is energizing. Taking a few smaller breaks during the day instead of one long break at noon also can protect the body and mind from the unhealthy effects of prolonged hours of sitting in front of a computer. As for Murphy, he aims to take a break every day and usually spends it by taking a short walk. He makes time for one other “healthy” activity on his break, he said, checking for the latest news on his beloved football teams.

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Physicians, patients need to work on healthy dialogue By Elaine Rogers The News-Sentinel (Fort Wayne)

o, there’s that daily Facebook newsfeed and its bombardment of provocative promises about the curative powers of everything from pet ownership to meditation. Meanwhile, five minutes spent tuned in to what Dr. Oz is talking about is sure to add another superfood, spice or yoga stretch to your ever-expanding arsenal of nutraceuticals and hoping-they’re-healthy habits. It’s easy to see why most of us get confused about what we ought to be eating, taking or doing to optimize our health — and to know when or if to bring our family doctors in on the conversation.

Help yourself According to studies from the National Institutes of Health, a third of Americans seek help for their health outside their doctor’s office, although most do so as a complement to conventional care, not as a replacement for it. And the U.S. National Center for Health Statistics reports that 18 percent of Americans use herbal supple-

2016 MEDICAL HANDBOOK

ments, more than double that of the next-most-popular complementary medicines — chiropractic and osteopathic manipulation (8.5 percent) and yoga (8.4 percent). In addition, the National Center for Complementary and Integrative Health says that 92 percent of Americans believe massage therapy is an effective treatment for reducing pain, while 74 percent agree it should be considered a form of health care. “People are highly motivated now to try to stay healthy by taking vitamins, herbs and nutraceuticals or by seeking out complementary and alternative medical treatments,” says Dr. Darrin D’Agostino, chairman of the department of internal medicine at the University of North Texas Health Science Center at Fort Worth. “That’s a good thing. But they also need to be taught to tell their doctors what vitamins they’re taking,” D’Agostino says. “It’s important, because it’s very easy to have drug interactions when those conversations aren’t taking place.” Theresa Hocker, executive director of the Alzheimer’s Association North Central Texas chapter,

says, “It can make them desperate to try anything. … There is no cure for this disease, so we really encourage people that whatever new things they take or treatments they pursue, that they make sure their doctors know about it. You just never know what might interact with what.”

Prescribing wellness D’Agostino is among a growing branch of physicians practicing what is called integrative medicine, acknowledging the merits of healing traditions like acupuncture, massage therapy, yoga and nutrition — termed complementary and alternate medicine (CAM) in medical circles — and actively incorporating them into their patients’ treatment plans. He and others say that integrative medicine and the concept of “treating the whole person rather than just the symptoms of illness” are becoming more mainstream, and even conventional physicians are increasingly more likely

to discuss the nutraceuticals and wellness therapies patients have already prescribed for themselves, or to make suggestions about CAM treatments they might pursue. “I believe there is a benefit with integrating complementary and alternative medical treatments such as nutrition, exercise, yoga, massage, etc., into traditional/conventional medical practices,” says Dr. Lea Krekow, an oncologist at Texas Breast Specialists-Bedford and Texas Oncology’s Bedford and Grapevine locations. “Wellness is more than just the absence of disease.” Dr. Trisha Smith, an internist with Baylor Family Medicine at Highland Village, explains that integrative medicine is about combining the best of both worlds. “Traditional medicine, unfortunately, does focus on treating disease, and most alternative medical systems focus on tapping into the innate healing powers of the human body,” she says. “More and more we are

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2016 MEDICAL HANDBOOK

seeing a trend in traditional medicine towards prevention and wellness.”

Personal touch Integrative medical practitioners may keep registered dietitians on their staffs to provide nutritional counseling, or they might recommend alternative therapeutic approaches like massage therapy or acupuncture as complementary treatments to their conventional care. Dr. Elizabeth Carter, chairwoman of the department of family medicine with Fort Worth’s JPS Health Network, says she was intrigued by her exposure to alternative medical treatments and eventually trained in acupuncture to provide this treatment option to her patients. “For years, I have been interested in offering more than prescriptions for different symptoms,” she says. “I think there is a place for treatments that may complement traditional Western medicine and some treatments that should be offered before a pharmaceutical medication is offered.” Dr. Carolyn Matthews, of Baylor University Medical Center at Dallas, is a physician who says she headed

2016 MEDICAL HANDBOOK

down the integrative path as a result of personal experience with illness. A battle with thyroid cancer during a pregnancy— and three years of being treated with “massive doses of radioactive iodine” — inspired great personal interest in nutrition and mind-body medicine. Later, she addressed a gluten sensitivity for herself and her son with dietary changes that she describes as “profoundly beneficial.” “Since starting the integrative medicine program at Baylor,” Matthews says, “I have seen time and again how much better people can feel by making a few tweaks to their diet.” D’Agostino says people commonly seek nutraceuticals and complementary and alternative medicine for medicinal purposes, “not just for wellness.” He says he believes it is a course of action that ought to be implemented with physician approval. “Those dialogues are really important,” he says. “We really need to get to a point where people go to their doctor when they’re healthy and become a partner with their physician to become healthy and stay healthy, rather than just going when we’re sick.”

Healthy hands: soap and sanitizer

By Mayo Clinic News Network

ccording to the Centers for Disease Control and prevention, frequent hand washing is the No. 1 way to prevent the spread of infections. But what kind of soap is appropriate? And what about using hand sanitizers? Why not antibacterial soap? “The simple answer is that plain soap and running water coupled with good technique are just as good against common childhood respiratory and stomach viruses and bacteria as antibacterial soap. Plain soap doesn’t induce the risk of creating resistant organisms, according to a review article published by Infectious Diseases Society of America,” says Dr. Peggy Decker of the Mayo Clinic Health System. Health care settings, such as hospitals and clinics, may have different recommendations. Comprehensive information is available from the Centers for Disease Control.

Because of the high alcohol content, there are several safety concerns with hand sanitizer. Kids shouldn’t use it unsupervised. Some experts recommend limiting how often young children use hand sanitizer, and it should not be used on children under 2 years of age. Alcohol is flammable, so sanitizer needs to be stored safely away from flames and heat sources. There are strict guidelines for placement in schools and day care centers to reduce the risk of fire. “Due to high alcohol content in hand sanitizer, alcohol poisoning and intoxication are possible if a large amount is absorbed by drinking, using on damaged skin or using on babies who don’t have a fully developed skin barrier. Because the alcohol concentration is high — more than hard liquor — and young kids have a low body weight, prevention of accidental or purposeful ingestion is important,” says Decker.

Supervision of hand sanitizer use (dime-size amount is all that’s needed) and safe storage are important. If accidental ingestion of more than one squirt of hand sanitizer occurs, call the poison control center at 1-800-222-1222. Despite the risks of alcoholbased hand sanitizers, children should avoid alcohol-free hand sanitizer due to concerns about resistant organisms with the antibacterial agents benzalkonium chloride and the possible toxic degradation products of triclosan. “Remember, frequent hand washing keeps germs at bay and can go a long way in protecting your child from viruses and bacteria,” says Decker. “By teaching your child the importance of hand hygiene and how to properly clean their hands, you can help them establish healthy habits that will last a lifetime.”

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How can you find happiness?

By Barton Goldsmith Tribune News Service

ometimes the quest for happiness can be as confounding as Indiana Jones looking for lost treasure. Just when you think you have a clue, some giant boulder comes rolling toward you. Here are some tips to help you find some joy. 1. Reach out to others. You may have good people in your life but have been out of touch. Picking up the phone and giving old friends a call can brighten both of your days and perhaps your lives as well. 2. Remember that happiness is an inside job. That means that no one but you can really make you happy, even though it may not feel that way. When I see a smile on the face of someone I care about, it makes me happy, especially if I helped put it there. Maybe it is an inside job after all. 3. Don’t put all your eggs in one basket. If you are relying on one set of circumstances or person to

make you happy, it probably won’t happen. You need to broaden your scope of friends and activities. Also, know that engaging in new adventures creates brain chemicals that add to your happiness. 4. Trust your gut. When we go against our instincts, and it backfires, we usually feel sad. Follow your intuition and let it guide you toward people and things that will make your life just a tiny bit better. Day by day, your happiness will grow. 5. Is meditation for you? Most books on happiness say that meditation is key, but most people don’t know how to get started. There are classes all over the place, CDs, downloads, and websites, and you can also try just being in nature. The idea is to allow you to calm yourself, so you can feel the good things that your fear and sadness are pushing away. 6. Organize your thoughts. Many people push away happiness when they are overwhelmed. When you keep everything in your head, it can be difficult to get the perspective you need. Try making lists of the things that seem too big to manage on your own.

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You may find that you can do most of these things on your own and that the list isn’t as long as you thought, but if you need help, ask for it. 7. Stay away from people who bring you down. This may sound simple, but if you are living with those people, it can be very complicated. In that case, a family therapy session could be very helpful. Many people don’t recognize that they are making life difficult for others, and in a group setting with a trained professional, they can learn to behave differently without feeling attacked. 8. Look at the big picture. Most of the things that prevent us from feeling happy are day-to-day life issues. Once in a while, you go through something that makes the little things seem inconsequential, and this is when you need to remember that life is still going on, and whatever the issue is, it will end. Look at your life as a whole, not just the bad parts. 9. Value your values. We all have a value system, a way we have decided to go through life, which

makes us feel like a good person. When you know what works and what doesn’t, it can make your life a whole lot easier. The important thing to remember is to not lose sight of your values when life becomes a roller coaster. Keeping your values strong will help create happiness. 10. Play more. Sometimes we get so involved in doing our lives and problem solving that we forget to take time to have some fun. You may have to block out a day for fun in your calendar. But the important thing is to have a little joy every day to keep you going and growing. Happiness can be hard to feel at times, so don’t think there is something wrong with you if you don’t feel it. We all go through phases, and some people are just naturally happier than others, so try to avoid comparing yourself with others. The truth is that happiness is here for you, and using the techniques above will allow you to feel more of it.

Try making lists of the things that seem too big to manage on your own. You may find that you can do most of these things on your own and that the list isn’t as long as you thought, but if you need help, ask for it.

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What healthy posture is and how to maintain it

By Mayo Clinic News Network

odern lifestyle factors, such as texting, reaching for your keyboard or wearing high heels, can create postural stressors that often cause muscle imbalances and injury. Having good posture is essential for good health; however, understanding what good posture is and maintaining it are hard. “When some people try to work on their posture, they tend to overdo it,” says Alynn Kakuk, physical therapist at the Mayo Clinic Healthy Living Program. “They get into a superextended position with their shoulders way back — enough that it creates too much of an arch on their back. So, they just start shifting their weight too far back.” Bad posture habits can cause imbalanced body alignment, strain on ligaments and muscles, chronic pain, injuries, impingement, low back pain, neck pain, hip pain, joint stiffness and muscle tightness, according to Kakuk. Simple exercises, stretches and being conscious of your posture can eliminate these ramifications. Stand up against a wall and make sure your upper back, shoulders and bottom touch the wall. Your feet don’t have to be against the wall — just a couple of inches away from it. You should have a slight space in your lower back and be able to fit your hands in that space. But make sure it’s not a big gap. Then, step away from the wall, and try to see if you can maintain that position. Keep in mind, strengthening your muscles will make it easier for you to maintain that posture over time. Be careful of overdoing it or hyper-extending your back. In a world filled with modern technology, reaching for your cellphone and keyboard are common movements. These movements can place stress on your upper back and neck, resulting in rounded shoulders and forward head. This can cause chronic upper back, shoulder, neck pain and headaches. Also, people may text so much that they develop pain and injury in their thumbs from that overuse. Here are some tips on how to maintain the correct posture while using technology. l Try to have your cellphone at eye level, so you’re not bending forward.

2016 MEDICAL HANDBOOK

l Do exercises that strengthen your upper back and shoulder, such as chest exercises to strengthen your pectoral muscles and diaphragmatic breathing techniques to release tension. l Stay aware of your posture throughout the day. Those who sit at a desk all day should be conscious of posture and the importance of getting up at least once an hour to move. “Standing up and focusing on good posture for a few minutes can relieve muscle strain and improve breathing and circulation, which also helps improve attention and engagement,” says Dr. Deborah J. Rhodes, physician and cancer researcher at Mayo Clinic. Nonetheless, having good office ergonomic habits can keep your muscles and ligaments healthy. Here are some tips on ergonomics at the office. l Ensure your keyboard is at elbow height, so your hands can rest on the desk. l Place your computer at eye level. Place laptops on platforms for them to be at eye level. l Set your chair at a height that your feet touch the ground. l Take a walk or stretch break every hour. Walking in high heels is essentially walking on your toes, which results in a chain reaction on the rest of your body. It causes the knees to hyperextend, the pelvis to tip forward, the lower back to tighten, and the abdominals to become weak. Here are some tips on how to maintain the correct posture while wearing high heels. l When wearing heels, ensure you draw in your abdominal muscles to prevent that extra curve in your low back. l Try to limit the use of your heels. l Pick a heel that is smaller with a wider surface area that will help distribute your foot and weight better. Maintaining good posture can help you walk, sit, stand and lie in positions that cause the least pressure on your muscles and ligaments during movement and weightbearing actions. It also gives confidence. “People who have better posture tend to appear more confident and knowledgeable to others. It makes them feel confident internally as well,” says Kakuk.

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