BRAKE FOR BREAKFAST – Even though mornings may leave you sprinting for the door, taking time to eat breakfast has been shown to decrease unhealthy snacking and overeating later in the day. If you try to get as much sleep as you can, therefore creating the habit of “I don’t have time to eat breakfast”, why not keep some healthy items in the office? Foods like oatmeal and walnuts, natural peanut butter on whole wheat toast, or low fat cottage cheese and fruit are easy to prepare and store. If you go to work hungry you may be surrounded by unhealthy options, which increases the chance you will eat those unhealthy options. On another note, if you are one to say “I’m never hungry in the mornings” – the only reason for this would be if you overate the evening before. It is in your own best interest to trust the research about the benefits of breaking your nighttime fast and beginning your day with ‘food fuel’ for your brain!

PLAN AHEAD – Preparation is the key to healthy workplace munching and integral to helping you make successful food choices for both mealtime and snack-time. You know you are going to be hungry, so plan for it. Instead of running to the fast-food outlet across the street or relying on the junk foods brought in by coworkers, make a plan to have healthy foods available for your meals and snacks. It is too easy to get into trouble when we wait to look for something to eat when we are already hungry.

If you think you are too busy to pack snacks daily, pack once, eat for five days. In other words, pack up a bag of snacks for the week to take to work with you on Monday. Most offices have a refrigerator and a toaster oven or microwave, so use them.

HEALTHY DESK DRAWER SNACK IDEAS

Whole wheat fig bars

Individual servings of fruit

Raw almonds, walnuts, peanuts – ¼ cup

Dried fruit and nuts – limit to ¼ cup each

Instant soup cups – low salt variety

Plain granola bars (no mix-ins/candy)

Fresh, crisp vegetables in a baggie

Natural peanut butter on WW crackers

Whole wheat crackers and hummus

Nonfat yogurt with ground flaxseed

High-protein, high-fiber snack bars

Apple and low-fat string cheese

Oatmeal in a baggie (not instant)

Hard boiled egg and fresh fruit

Whole grain pretzels

Healthy, homemade muffins

Baked potato and tortilla chips

Single-serving pouches of tuna

Snacking should be purposeful. Snack to avoid overeating at meals and to keep your metabolism working along with you during the day. Appropriate and strategic snacking can help bridge the hunger gap between meals and keep you better focused, more productive and help with health and weight goals.

Brooke Douglas is a registered dietitian who contributes an article to this health blog on the first of every month. Have you had a ‘Nutrition Checkup’? You know who your doctor is. But who is your Registered Dietitian (RD)? If you would like to meet with a registered dietitian and schedule your ‘nutrition check-up’, contact Brooke Douglas, RD by logging on to her website at www.NutritionAuthority.com or call Brooke at 253.227.8284.

Also see:

Healthy Fruits – Healthy Vegetables.  Brooke Douglas Tells it All

How to Eat Healthy on Vacation

Inflammation and Diet: Inflammatory and Anti-inflammatory Foods

With estimates ranging from $35 billion to a whopping $850 billion, the true costs of “defensive medicine” are difficult to pinpoint. A variety of government reports, physician surveys and studies have attempted to pinpoint exactly how much of U.S. healthcare costs are generated by defensive medicine, but the varied definitions of “defensive medicine” make the real number hard to determine.

Defensive medicine refers to the costs associated with doctors protecting themselves from medical malpractice lawsuits. These costs include liability insurance premiums, malpractice judgments and settlements, and sometimes extend to unnecessary testing or other physician services provided to patients solely to avoid malpractice claims. Indirect costs associated with defensive medicine can also include “assurance behaviors,” such as ordering tests or delivering additional services that have only marginal medical value, or no value at all, to discourage malpractice lawsuits—which can cost more than even earning PhDs. A 2005 study published in the Journal of the American Medical Association discovered that doctors may perform these unnecessary services in the hopes that if a malpractice claim were to arise, the court would be satisfied that the physician met the standard of care.

A Look Behind the Numbers

The Congressional Budget Office estimated that defensive medicine accounted for $35 billion—or 0.2 percent—of the total U.S. healthcare expenditures for 2009. This figure is significantly lower than the estimated $650 to $850 billion in annual expenditures attributed to defensive medicine by Gallup and Jackson Healthcare surveys of physicians. The Jackson Healthcare survey gathered data from thousands of physicians across the United States on the indirect and direct costs generated by defensive medicine, concluding that physicians considered defensive medicine the primary driving force behind rising healthcare costs—the result of an overly litigious healthcare environment.

Nine out of ten surveyed physicians said they practice defensive medicine, and general estimates predicted an average of 34 percent of overall healthcare costs arise from defensive medicine. A subsequent Gallup poll of physicians found that approximately 73 percent of surveyed physicians admitted to practicing defensive medicine within the past year, but estimated overall costs at only 26 percent. The 2005 JAMA study by researchers from Columbia and Harvard Universities also revealed that for physicians practicing in “high-risk” specialties, these monetary figures may be much higher; 59 percent of the physicians surveyed admitted to ordering more diagnostic tests than medically necessary to prevent malpractice litigation. Plus, the physicians avoided caring for high-risk patients, referred patients to other specialists, prescribed more medications than medically necessary and suggested unneeded invasive procedures—all to avoid malpractice lawsuits. Another study by the American Academy of Orthopedic Surgeons discovered that defensive medicine accounts for a startling 20 percent of all imaging orders, and half of these imaging orders were for expensive MRIs.

Why the Disparities?

So why is the Budget Office’s number so low when the Jackson Healthcare survey is so high? Because physicians aren’t regularly logging every single expenditure arising from defensive medicine, and no one is entirely sure what even qualifies as “defensive,” quantifying the costs with exact accuracy is nearly impossible. The great differences in estimated costs, however, is likely due to the particular expenditures included in the figures for defensive medicine. For instance, the CBO’s low estimate of $35 billion includes “malpractice insurance premiums together with settlements, awards and administrative costs not covered by insurance,” but does not include unnecessary procedures, medications and other services, so long as they are covered by insurance. This difference in accounting is more than enough to explain the disparity.

The Jackson Healthcare survey adds a myriad of other direct and indirect costs to the CBO’s numbers, including all the excessive diagnostic testing and medical services provided in the spirit of defensive medicine. The survey results then translate the percentages into dollar amounts using the calculations of estimated overall U.S. healthcare spending released by the Centers for Medicare and Medicaid Services. Thus, this number includes more items than the CBO’s report, and bases its numbers on another estimate.

With healthcare costs rising rapidly in the United States, combined with increasing tort reform and malpractice fears, defensive medicine is becoming a more and more expensive slice of the healthcare-cost pie. Regardless of the actual monetary amount, defensive medicine practices strain not only Medicare and Medicaid, but also the insured and uninsured healthcare consumer alike, contributing to increasing prices for medical services and greater costs to insurance companies. Unless something is done to relieve the legal pressures placed on physicians, defensive medicine will continue to generate billions of dollars in healthcare expenditures every year.

Brittany is a blogger-in-residence at PhDs.org 

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Overdiagnosis

by Patrick Maguire, MD 

As we near the end of Prostate Cancer Awareness Month this September, hopefully many of us have learned a thing or two that we didn’t know about the disease in August. Just last week, a major study of predictors of sexual function after prostate cancer treatment was published in the prestigious Journal of the American Medical Association (JAMA). I found some important info in the paper and recommend it highly to men who are considering their options for treatment. The link for the full document is:  http://jama.ama-assn.org/content/306/11/1205.full.pdf. An in-depth discussion of the topic can be found at on my blog The Cancer MD. As opposed to various treatment choices, one option for men after a prostate cancer diagnosis that we don’t hear too much about in theU.S. is active surveillance.

Many terms have been used to describe what is now most often called active surveillance. These include: watchful waiting, close observation, and expectant management, among others. Given the right circumstances, the option of avoiding prostate cancer treatment altogether is often best. Which men are candidates for watchful waiting after their diagnosis?

To be sure, prostate cancer is a spectrum of disease that can range from indolent to extremely aggressive. Men with low-risk prostate cancer may be good candidates for no immediate treatment. These cancers can’t be felt or are only felt in part of one side (lobe) of the prostate, produce a low level of prostate specific antigen (PSA) in the blood, and appear not too aggressive under the microscope (Gleason score of <7). Among this group, younger, healthier men are usually the best served by treatment.

Men with low-risk disease who are either older or in poor overall condition should strongly consider expectant management. In general, it takes more than a decade for early prostate cancer to spread to other sites in the body (metastasize) and ultimately kill a man. Therefore, men who have a life expectancy less than 10-15 years should think long and hard about the option of no treatment. In medical school, we docs agree to abide by the Hippocratic Oath, a major principal of which is “primum non nocere” (do no harm). We don’t want to put a man at risk for possible side effects of treatment, unless we have reason to believe that the treatment has a good chance to improve survival or quality of life.

So, if you or your loved one has been diagnosed with prostate cancer that’s found very early, ask your urologist or radiation oncologist whether active surveillance or watchful waiting is a reasonable option. Sometimes, though it may feel strange, you might have to tell him or her, “Doc, don’t just do something. Stand there!?

Dr. Maguire regularly posts on TheCancerMD.com and is the author of a book that I have enjoyed reading that helps laypersons understand the language, facts and treatment options for the most common cancers. When Cancer Hits Home: Cancer Treatment and Prevention Options for Breast, Colon, Lung, Prostate & Other Common Types. 

Almost Everything You Ever Wanted to Know About Fruits and Vegetables

Research shows that people who eat even 2½ cups of fruits and vegetables a day have only half the cancer risk of those who eat less than one cup a day.  Hundreds of studies show that increased fruit and vegetable consumption may also help prevent heart disease, stroke, hypertension, birth defects, cataracts, diabetes, obesity and other serious conditions.

Healthy Fruits and vegetables are nutritional powerhouses which:

• Are excellent sources of vitamins and minerals and contain disease fighting fiber
• Contain antioxidants and phytochemicals
• Are virtually fat-free (exceptions: coconut, olives & avocado) and cholesterol-free
• Are helpful in weight management, due to their high-fiber, high-water, and low-fat content

Vitamins and minerals: Are essential in maintaining the health of the brain, heart, bones, teeth and nerves; making/repairing red blood cells; regulating body’s balance of fluids; and in other vital functions.

Many healthy fruits and vegetables are particularly good sources of vitamins A, C, E and K, some B vitamins, and many important minerals needed for healthy bodies.  Beta-carotene and related compounds called carotenoids are converted by the body to Vitamin A. Carotenoids are found in high concentrations in carrots and other orange and yellow vegetables and fruits such as winter squash and cantaloupes.  Dark green, leafy vegetables, such as spinach, kale, broccoli, and other members of the cabbage family, also contain high concentrations of carotenoids.

Dark green vegetables are also excellent sources of folic acid (a B vitamin needed during pregnancy to reduce the risk of neural defects in the fetus), Vitamins E and K, and minerals such as calcium, magnesium, manganese, iron, and potassium.  Many fruits are also a good source of minerals, such as chromium (grapes), iron (cherries), manganese (pineapple), and potassium (apricots, bananas, orange juice, peaches and prunes).

Citrus fruits are good sources of Vitamin C, as is the family of plants that includes tomatoes, red and green peppers, potatoes, and eggplant.  Other good sources of Vitamin C include papayas, strawberries, kiwis, cantaloupe, and the cabbage family, including broccoli, cauliflower and Brussels sprouts.

While there is overlap in the vitamins/minerals supplied by fruits and vegetables, you need a wide variety of colorful healthy fruits and vegetables to fully benefit from the various nutrients they contain.

Antioxidants: Disease-fighting compounds found in many foods, especially healthy fruits and vegetables. Antioxidants neutralize free radicals (compounds that damage cells and lead to cardiovascular disease, cancer, cataracts, premature aging, and impaired immunity.)  Antioxidants include vitamins A, C, and E; beta carotene, minerals (selenium, copper, zinc, and manganese) and some of the phytochemicals.

Phytochemicals: From plants, “plant chemicals” are recognized as powerful disease-fighting compounds. Fruits and vegetables contain thousands of different phytochemical compounds. Categorized as carotenoids, flavenoids (compounds that give flavor/colors to fruit/veg), and other compounds, such as allicin, indoles, lycopenes, lutein, and phenols.  Scientists studying phytochemicals are finding an impressive range of health benefits.

Not all foods listed above, even within the same group, have the same health benefits.  Foods with the same phytochemicals may contain different concentrations of the phytochemicals, and the compounds may be absorbed differently.  Even different varieties of foods within the same category (such as different varieties of apples or lettuce) may contain widely varying concentrations and kinds of phytochemicals.  However, those darker in color usually contain higher concentrations.  So think “more color and more variety” in making your selections!

What is considered one serving of fruit?

• • 1 medium whole fruit (apple, banana)              • ½ cup of fresh, frozen or canned fruit
• • 6 oz. (¾ cup) 100% fruit juice                             • ¼ cup of dried fruit

What is considered one serving of vegetables?

• • 1 cup of raw, leafy vegetables                 • ½ cup cut up fresh, frozen or canned vegetables
• • 6 oz. (¾ cup) 100% vegetable juice         • ½ cup cooked beans, peas, or lentils

How Can I Get More…Healthy Fruits and Vegetables in My Diet?

At home:

• • Top your hot or cold cereal with fresh fruit.
• • Enjoy a glass of 100% real fruit or vegetable juice with breakfast.
• • Make smoothies with fresh or frozen fruits and juices for a great breakfast or lunch choice.
• • Choose hundred percent fruit and vegetable juices as delicious alternatives to soft drinks.
• • At dinner, include salad/raw veggies; use low-fat or non-fat dressing to reduce fat and calories.
• • Steamed vegetables are always a good side dish.
• • Add vegetables to your favorite entrees, like tacos, lasagna, casseroles, and pasta dishes.
• • Add pureed vegetables to sauces to fortify them.
• • Try more vegetarian meals, like tofu, rice or pasta with vegetables, and Asian stir-fry dishes.
• • For dessert, bake sweet potatoes, apples, peaches, pears, or bananas, or make fruit cobblers.
• • Discover some of the many cookbooks that specialize in fruits and vegetable recipes.
• • For a snack or when you’re on the go:
• • Choose fruits and vegetables that can be eaten out of hand, like apple wedges, baby carrots, broccoli spears, or cherry tomatoes, grapes, bananas, and seasonal items like peaches and plums.
• • In place of candy, choose dried fruit (easily packs in a bag/take on the road or eat at office.

When dining out:

• • Order a dinner salad to begin your meal.
• • Request an extra serving of vegetables as a side dish.
• • Order meals that include vegetables or fruits as a major component. To keep fat and calories in check, request vegetables steamed without the addition of butter, oil or cream sauce.
• • Ask for extra lettuce and tomato (or other vegetables) on sandwiches and burgers.
• • Choose healthful desserts; fresh fruit, sherbet, sorbet, or angel food cake topped with fruit.
• • Choose dishes on the nutrition charts of Healthy Dining Finder that have more servings of fruits/vegetables.

What is Hospice?

Hospice is not a death sentence. It is an opportunity to live life to the fullest until you die.

I have been a Hospice volunteer since 1994. It is my passion. To be of service to others during such an important and intense time of life is an honor. The more I give, I am repaid tenfold. In order to qualify for Hospice a patient must be  diagnosed with a terminal illness that if it were to progress at the normal rate, would only have six months to live. To be eligible a patient can’t be involved in treatment to try cure the illness. Their doctor must write a referral for the patient to be evaluated for Hospice care.

Once enrolled, if the patient lives to the six month timeframe they can be evaluated and reinstated in the program. Hospice provides many services that assist both the patient and the family. I have had many conversations with family members and friends of terminally ill patients who were anxious because of unresolved issues with the patient or because they just felt they needed to share something and had not done so. I always encourage them to make time to talk about the issues. It will be too late once the patient has passed. If left unresolved these situations can lead to the survivor feeling regret, sadness, guilt or frustration. Grief is natural but adding the pressure of not talking openly before someone dies can make the grieving process much harder.

Many patients have talked with me about the importance of relationships in their life. They have never expressed regret about wishing they had more money, possessions or fame. It is so important to most people to know that they don’t have any unfinished business, which allows them to pass peacefully. Once a patient has been diagnosed with a terminal illness, Hospice is the best way to have their wishes met. The Hospice team; Nurse, CNA, Chaplain, Social Worker, Medical Director, Volunteer Coordinator and Volunteers work together to accomplish the patients desires. This team effort helps address the patient’s complete needs; physical comfort, emotional and spiritual support. Treating the entire patient is very important. Then, after the patient passes the family has a great support system and grief counseling, and support groups available anytime there is a need. I have had many heart-to-heart talks with patients in addition to fun and silly times together. After every assignment I take time to reflect on the experience. I have always learned something from each patient. The patients and families have always thanked me and said how much my service and the Hospice services in general made a positive difference.

I encourage anyone interested in Hospice or in volunteering to call your local Hospice organization. If you have questions please contact me at christinalufkin1@yahoo.com. Christina is also available for interviews or guest speaking engagements. Christina Lufkin, Author “Live with Purpose:Die with Dignity” www.christinalufkin.weebly.com

Comments by Dr. Pullen:  Over the years I have had nothing but positive experiences with hospice.   When my Mom passed last spring Hospice was involved and they definitely made for a better experience all around. See my post, Saying Goodbye.  Hospice has several major advantages from a flexibility and financial standpoint also for terminal patients.  The Medicare reimbursement for Hospice is on a per-diem basis, and the Hospice team has a great deal of flexibility in choosing services to provide to patients, many of which would not be eligible for regular Medicare coverage.

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by Charles Boren

The ancient Greeks used running as a form of training and competition. It was a way to test personal fortitude and improve physical health. Many of the health benefits of running were known even in those ancient times. In modern times, many start running for the same reasons. They run to improve their physical endurance, lose weight and build muscle. While these common health benefits of running influence many to start running, runners are surprised to learn just how extensive the health benefits are. Running improves the quality of sleep, fights off depression and anxiety, and improves joint health and stability.

Sleep disorders affect a surprising percent of the population today. There is good news to those who suffer from them. Running can actually improve the decrease the symptoms of sleep disorders and improve the quality of sleep. It also appears to help people sleep more efficiently. That is, the amount of time spent actually sleeping while in bed increases. Running helps people fall asleep more quickly, toss-and-turn less through the night, and wake up more rested than those who do not run.

The runner’s high is a well-documented phenomenon, and major benefit, of running. This is a unique feeling often reported during long, strenuous amounts of exercise. The feeling can range from relaxed and peaceful to intensely euphoric. It is produced when endorphins flood the brain as part of a stress response to running. These endorphins are the natural drugs of the body. They reduce pain and are responsible for the happy and content feelings similar to many those produced by narcotics. While many runners experience this phenomenon, many do not realize the long-term positive effect that is has. Over time, the regular doses of endorphins to the brain can combat both anxiety and depression. In fact, many studies have shown that following a regular running program markedly reduces the symptoms of these disorders.

A common misconception is that the high-impact nature of running negatively affects the joints in the body. The truth is that running may actually improve joint health and stability. (1) This is done in a number of ways. First, running helps keep excess weight off. Just a ten-pound increase in body weight can cause a 45-pound increase in stress on the knees (2).  Second, running causes cartilage to expand and contract with the natural movements created while running. This forces nutrients and oxygen into the cartilage cells. Without this, the cells will slowly die from oxygen depletion and starvation. Third, running strengthens the tendons and ligaments that support and stabilize joints. This prevents injury in the long-term. Overall, running greatly improves joints and prevents the onset of arthritis.

Building muscle, losing weight, and strengthening the heart are the health benefits that motivate people to start running. However, it is the unspoken benefits that keep them running. As a whole, runners have better sleep, improved mental states, and healthier joints. Many runners feel that they are taking responsibility for their health by running. They physically feel better, less stressed and they have peace of mind. This is a reward all in itself.

Bio: Charles spends much of his free time running. On the side he also runs an automotive company, where he purchases vehicles.

Originally posted at Common Sense Family Doctor by Kenny Lin MD

Intuitive eating teaches you to listen to your inner signals of hunger and fullness, and to respond accordingly. The plan does not mean that you should eat whatever you want, whenever your stomach starts to growl. You still must pay attention to proper nutrition. However, people are encouraged to not deny themselves. So, if you want ice cream, and nothing else will do, go ahead and have ½ cup. Savor every bite and eat it slowly. The point is to stop telling yourself that you “cannot” or “should not” eat certain foods. Moderation not Deprivation!

Food habituation research has proven that the more times a person is exposed to food, the less appealing it becomes over time. This is why people on traditional weight-loss diets find themselves obsessing with what they cannot have. For instance, some people do not allow sweets into their house, because they feel that they cannot trust themselves to have control. When these people are confronted with sweets in a social setting, they are likely to find themselves eating more than they want, because they are not sure when they will have the chance to eat sweets again.

What’s wrong with traditional weight-loss diets? A review of the scientific literature on diets proves two things. First, diets do generally lead to weight loss. An average of 5%−10% of body weight is lost in most clinical trials. Second, the weight loss is not maintained. The question is not whether or not the weight is regained, but how long it will take for this to happen following completion of a weight-loss plan.

Furthermore, these diets teach people to ignore their natural hunger cues and to look at food as the enemy. Frighteningly enough, weight cycling seems to lead to overall higher rates of mortality. Links are hypothesized between weight cycling and myocardial infarction, stroke, diabetes, hypertension, and suppressed immune function.

What are the benefits of intuitive eating? A study conducted at Brigham Young University showed that 24 female students following the intuitive eating plan had reduced body mass index (BMI), lowered triglyceride levels, increased high-density lipoprotein (HDL) levels, and reduced overall risk for cardiovascular disease. In addition, the plan leads to better body image and a diet with a higher nutritional quality, which has multiple health benefits.

Who is a candidate for this approach? Intuitive eating is a wise-eating approach for all people. However, it originally was designed for “chronic” dieters. It is especially useful for people with „perfectionistic‟ tendencies, addictive personalities, a strong-learned connection between love and food, distorted body images, and for people who are no longer reliable judges of when they are and are not hungry.

How should I get started? Consulting a nutritionist is a great way.  In my consultations we will start by observing when you are eating. Are you eating in social situations as a way of keeping busy? Are you eating at the movie theater, simply because it is a tradition for you? Are you eating as a way to expel nervous tension or to deal with boredom? These are all signs that you are not eating intuitively.

Pay attention to your hunger level. Rate your hunger on a scale of 1−10 every time that you eat. If the number is low, try to figure out why you are eating. Understand that one “not so healthy‟ meal or one “not so nutritious” day will not have any long-term effects on your health or weight. Nutrition is progressive, and your health is built on a pattern of lifestyle choices. You are not a “good” or “bad” person because of what or how you eat, and “good” or “bad” foods do not exist.

What about exercise? Exercise is strongly encouraged. It leads to a better understanding of the mind-body connection. Do not concentrate on how many calories you are burning on those digital displays at the gym. Instead, focus on how good it feels to move your body and how the food that you ate is fueling your activity.

You can find Brooke by calling 253-227-8284 or at NutritionAuthority.com  Most insurance is accepted!

Editorial Comment from Dr. Pullen:  This is a lot like the way people eat in cultures where the diseases of the first world are much less common.  Eat when you are hungry, eat lots of vegetables, and get lots of day to day exercise through activities that you do naturally.   Nice post Brooke!

Dr. Watson and the 7 Qualities of an Ideal Physician

FEBRUARY 27, 2011

After the computer known as Watson easily dispatched of the best two human Jeopardy contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered.  Read more.

The Anti-Aging ‘Anti-Inflammatory’ Diet

By Brooke Douglas

In the past several years, numerous books and articles have been written about inflammation, proclaiming that we can halt or reverse the aging process by paying more attention to what we eat. But is this true? You bet it is! Many foods contain the highly beneficial ‘anti-inflammatory’ compounds which are very helpful in preventing oxidative damage. The ‘antioxidants’ (good guys) do away with the ‘free radical’ (bad guy) damage caused in our bodies. Inflammation, caused by free radical damage is at the root of many chronic and common diseases of aging, such as arthritis, diabetes, heart disease, cancer, osteoporosis, and Alzheimer’s.

The foods which are necessary to strictly limit or avoid due to their (damaging) pro-inflammatory compounds are: saturated and trans-fatty acid containing foods, sugars and starches, red meat and all processed meats.

Nutrition recommendations for an anti-aging diet include the following:

Fresh fruits and vegetables: Consume as many as you can, but ideally more than 7 fruits and vegetables (combined) daily.

Tea: Must be brewed! Drink black or green tea, both provide an excellent source of antioxidants

Cold-water fish: Choose omega-3-rich varieties, such as salmon and tuna, at least twice/week.

Whole grains: Eat foods made with 100% whole-wheat grains to help lower blood sugar and cholesterol levels while also putting more antioxidants into your diet.

Legumes (dried beans/peas): Aim for 3-4 servings/week; legumes are an excellent source of vitamins, minerals, and lean protein (very little or no fat).

Yogurt: Make yogurt a part of your daily diet; yogurt has plenty of calcium and a small amount of vitamin D, with the added benefits of probiotics to encourage a healthy gastrointestinal system.

Nuts: Include nuts as a snack or in foods you prepare; nuts provide the B vitamins that are essential for your heart and brain, along with plenty of healthy fats.

Red wine or Dark Grapes: Excellent sources of antioxidants; helping to protect arteries and reduce the risk of heart disease.

Lean protein: Select lean cuts of meat to maintain muscle.

Healthy oils; including canola/olive oils: When looking at mayonnaise, margarine, and salad dressing labels look for the majority fat to be a monounsaturated fat vs. a polyunsaturated or saturated fat.

Flaxseed: Grind and stir into yogurt, cereal, etc; Ground flaxseed provides omega-3’s and fiber.

Reduced-fat milk/milk products: Fat-free (nonfat or skim) are ideal. Excellent source of protein.

Fresh herbs/spices: These provide another, often overlooked, excellent source of antioxidants.

Dark chocolate: Keep blood vessels healthy. Don’t overdo it—only 3 ounces/week is necessary.

In general, a reduced-calorie diet appears to lengthen the average life span of both humans and animals. In short, underfed rats live longer than overfed rats! Here are a few more anti-aging tips:

Divide your plate so that you fill 2/3 with fruits, vegetables, and whole grains, and the remaining one third with a lean protein.

Extra weight puts stress on the body, reduces life span, and increases the risk of many diseases.

Exercise—it is impossible to overemphasize the importance of keeping active. Be less sedentary!

Drink plenty of water, low-calorie or calorie-free fluids.   All this plus eat lots of the anti-inflammatory foods above.

If you would like to have a one-on-one nutrition consultation with Brooke call 253-227-8284 or log on to NutritionAuthority.com. Most insurance is accepted.

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Contact Lenses for Children

by Brett Olivera

When it comes to a child’s eyesight, parents often assume their child only has the option to wear glasses until they’ve reached their teenage years. Although many parents choose to transition their children to wearing contact lenses when they are a bit older, the delay in switching eyewear isn’t due to the child’s eye health. It really depends on the eye care needs and overall disposition of the child.

Some infants can be safely fitted with contact lenses to manage various vision complications that may have existed since birth. Although controversial, some eye doctors argue that young children can wear contact lenses to actively slow the progression of Myopia, or nearsightedness. Otherwise, the most popular age for children to transition from glasses to contact lenses is around 8-12 years old.

Since contact lenses are safe for children of all ages, the decision to switch really depends on the sense of responsibility your child has. If your child tends to be independently responsible when it comes to schoolwork, daily chores, and taking care of their pets, he or she may be ready to handle the responsibility of wearing and caring for contact lenses. Your child’s eye doctor will prescribe a specific wearing schedule, and explain how to clean and care for your child’s contact lenses. In general, when children take well to the responsibility aspect of wearing contact lenses, children are perfect candidates to wear them.

Playing sports and participating in other outdoor activities can be difficult with bulky glasses. Contact lenses can improve your child’s vision and focus, while eliminating the barriers of frames or goggles in his or her peripheral vision. Kids are less likely to have problems with dry eye, and studies show that children often adapt to the routine of contact lens care better than most adults, therefore are less likely to over-wear them or neglect to clean them.

Many children and teenagers prefer to wear contact lenses over regular glasses simply because contact lenses boost their self-esteem, motivate them to participate more, and make them feel more confident with their overall appearance.

Whether you are considering having your child wear contact lenses to possibly slow the progression of nearsightedness, or simply make playing sports and seeing the blackboard a bit easier, speak to your child’s eye doctor about all the options and aspects of eye care to see if contact lenses are right for your child.

Brett Oliveira works with BuyMoreContacts.com, where you can order contact lenses online at discount prices. BuyMoreContacts.com offers a variety of contact lenses, including lenses such as Proclear contact lenses, Biofinity Toric, and Air Optix Aqua contacts.

Inflammation is the normal and natural response to body injury; however, unnecessary and chronic inflammation can wreak extreme havoc on the body and promote illness. Many times chronic inflammation goes unnoticed for years but eventually may lead to serious illness including heart disease, stroke, cancer, diabetes, sleep and mood disorders, arthritis and Alzheimer’s. Due to the increase in chronic disease, the anti-inflammatory diet has gained popularity and media attention. In general, the anti-inflammatory diet is similar to the Mediterranean style of eating and is designed to reduce risk of age-related disease and improve overall health.

Dietary Factors Contributing to Inflammation One of the largest players in the fight against chronic inflammation is excess body weight. The inflammatory state is a vicious cycle starting with infection or illness that produces inflammation, then insulin resistance followed by weight gain and more inflammation. When an individual starts to gain weight, it can become difficult to get the body out of this constant inflammatory pathway. Typically drastic nutrition and exercise changes are needed. The modern diet contributes to inflammation through a variety of body mechanisms that are not completely understood. Eating too many fried foods, processed foods, omega-6 fats, saturated fat, refined sugar and trans fats have all been linked to increased pro-inflammatory chemicals and hormones that cause cell damage.

Foods to Eat The anti-inflammatory diet promotes well-balanced eating, but for true success it must be a lifestyle change and not a temporary fix. Due to the anti-inflammatory effects, omega-3 fatty acids such as fresh oily fish, walnuts, ground flaxseed and fortified eggs are the staples. The primary source of fat is extra virgin olive oil. Only lean meats (turkey/chicken breast meat and seafood) and vegetable proteins (soybeans, tofu, and soy milk) are allowed. Because of their high levels of antioxidants, a colorful variety of fresh fruits and vegetables are strongly encouraged along with a variety of nuts, 100% whole wheat grains, beans and legumes. Herbs and spices such as garlic, turmeric, ginger, cinnamon, red pepper, cayenne, basil, oregano, paprika and chili peppers play a key role in flavoring foods. As far as beverages, 2-4 servings of green, white and/or oolong tea are recommended and red wine is allowed in moderate amounts (1 glass daily).

Foods to Avoid The first step in following the anti-inflammatory diet is to eliminate refined, white sugar found in most breads, white potatoes, crackers, chips and other snack foods and sugary beverages. All fast food should be avoided. Foods which are high in ‘pro-inflammatory’ fats include some margarines, all fatty meats, all processed meats, all fried foods, regular cheese, vegetable shortening and products containing partially hydrogenated vegetable oils. In order to further avoid the damaging ‘pro-inflammatory’ fats, the anti-inflammatory diet plan suggests avoiding all dairy products, unless they are the skim/fat-free/non-fat variety. Be sure to obtain calcium from other sources or supplements, if dairy products are avoided. Excess sugar and derivatives are not recommended. But artificial sweeteners are allowed.

Does it Work? Many aspects of the diet have been associated with better health. Research has shown cultures who eat a diet high in fruits, vegetables, nuts, seeds, fatty fish and healthy oils have lower rates of chronic disease. Keep in mind that the overall pattern of eating, maintaining a healthy weight and being physically active are the three most important factors in reducing inflammation. The inclusion or elimination of certain foods and nutrients are important but improvement will be blunted if you do not look at the big picture!

On a more serious note: Inflammation is considered the ‘silent’ killer. The problem occurs when chronic inflammation occurs inside our body and we can’t see it or feel it. This chronic inflammation does not allow for natural repair and healing caused by the damaging ‘pro-inflammatory’ (saturated and trans) fats. Being overweight or obese increases inflammation. Inflammation is a cause of many diseases, such as Rheumatoid Arthritis, Diverticulosis, Crohn’s disease, some kidney diseases, chronic skin problems, and many forms of cardiovascular disease.

The most popular lab test used to confirm inflammation is the C-reactive protein test (CRP),  although, the CRP test can’t diagnose where in the body, or why the inflammation is occurring.

Preventing inflammation

The first step is to maintain a normal body weight and get enough sleep. Skimping on sleep can increase the level of stress hormones and CRP in our blood. Frequent exercise and smoking cessation also help, as does practicing stress reduction techniques, such as prayer or mediation.

As part of a healthy diet, eat the following each week (not necessarily daily) to assist in lowering chronic inflammation:

• Several servings of: Green leafy vegetables, Flaxseed, Canola oil
• Therapeutic dose of Omega-3 fatty acids: >3,000 mg of EPA and DHA combined.
• Foods high in selenium and zinc may help as well.
• Selenium is found in: grains, onions, meat and milk.
• Zinc is found in: oysters, shellfish, herring, liver legumes, milk (non-fat), wheat bran.
• Vitamins C, E, and A in foods are also are useful antioxidants in the fight against inflammation.
• Vitamin C is found in: yellow peppers, citrus fruits and juices, broccoli, Brussels sprouts, strawberries, cantaloupe, tomatoes
• Vitamin E is found in plant products, such as vegetables, fruits, grains, and oils.
• Vitamin A is found in dark green leafy and yellow-orange fruits and vegetables. Especially rich sources include: carrots, greens, spinach, orange juice, sweet potatoes and cantaloupe.
• 2-3 servings of fatty fish, such as: Tuna, Salmon, Mackerel, Trout, Sardines
• Fiber: fruit, vegetables, nuts (especially almonds/pecans), dried beans. High fiber helps normalize the inflammatory response that occurs following a rapid increase/decrease in blood sugar levels.
• Antioxidants: eat 9 – 12 servings of fruit/veggies daily. Eat dark chocolate (in moderation), fresh herbs, and green tea.

If you would like to schedule a nutrition consult, contact Brooke at http://www.nutritionauthority.com or call 253-227-8284. Let a ‘Registered Dietitian’ help you clear up any nutrition confusion you may have. Brooke can personalize a ‘nutrition lifestyle plan’ to meet your specific needs. Most insurance is accepted.

Meditation, when used as a health tool, can significantly increase an individual’s sense of well-being, while simultaneously reducing stress.  Abundant research has shown that meditation can lower blood pressure, ease chronic pain, reduce stress and depression, improve concentration, and even boost the immune system.  All of this from the basic practice of sitting and quieting the mind.  There are so many external stressors in today’s society that finding a way to slow down and focus the mind will do wonders for the body.

Charles L. Raison, MD is the clinical director of the Mind-Body program at Emery University School of Medicine in Atlanta and has participated in a study on just how meditation can improve physical and emotional responses to stress.  What he has found is that stress reduction is the key component of the health benefits of meditation.  No matter who the patient is they will benefit from stress reduction because it will enable their minds and bodies to better handle any health issues that may be present.  Even if the only concern is an inability to sleep, meditation can help with that too.

Stress is a contributor to all major modern killers like cancer.  When you think about it, it is actually quite hard to have a disease that does not include or create stress in some way.  In severe cases, stress can even be a cause of the ailment.  Finding a way to minimize or remove stress altogether can only be of great benefit to the entirety of a person’s health.

Many people view meditative practices as hippy dippy techniques, and don’t give them adequate credit for their proven positive impact on overall health.  Many are under the impression that sitting with legs crossed fingertips touching saying “ohm” is the only way to practice meditation, when in reality the only requirement of the practice is to narrow your mental focus and still the body.  This does not necessarily require a specific posture, although some are known to be more effective than others.  You can find alternative ways to achieve the same end.  Some popular, less demanding methods include counting breaths, staring at a candle, or sitting quietly – the only real challenge is finding a way that works for you.

It feels like common sense that taking ten or twenty minutes out of your day to sit quietly, breathing deeply is a great way to unwind and relax, but so many people are unable or unaware of the benefits of meditation.  Call it mediation, call it sitting, call it quiet time; taking a moment to focus your energy and calm the mind will reduce stress, promote well-being, and help bring you back into the present which is all your ever have anyway.  People that live in the present experience a greater sense of well-being, and are much less prone to stress. Try for yourself and experience the health benefits of medication personally.

About the author: Jenni Sunde is a freelance fashion writer and pop culture junkie. Jenni specializes in all things lifestyle-related. From home and design to health and beauty. With her love of art and all things beautiful, she delights in sharing her sense of style from her life to your computer monitor. Her title pegs her as an editor at a website that specializes in providing people with a car insurance quote, but her passion leads her into writing with a little more substance and a lot more heart.

Book Review: “Overdiagnosed” and the paradox of cancer survivorship

According to the National Cancer Institute and the Centers for Disease Control and Prevention, the number of cancer survivors in the U.S. has increased dramatically in my lifetime, from 3 million in 1971 to 11.7 million in 2007. From 2001 to 2007 alone, the number of persons living with a cancer diagnosis rose by nearly two million. Most people would probably see these statistics as good news: an indication that our cancer treatments are improving and allowing people to live longer, or that earlier diagnoses are giving people a better chance to survive by catching localized cancers before they spread and become impossible to cure.

Although there is some truth to both of these explanations, they are far from the whole story. As H. Gilbert Welch and colleagues argue convincingly in their new book, Overdiagnosed: Making People Sick in the Pursuit of Health, much of the rise in cancer diagnoses over the past several decades has been the result of overdiagnosis: the detection (through screening or incidental finding on medical images obtained for other reasons) of cancers that would otherwise never have caused problems for patients. In the absence of screening, patients would not have developed symptoms because the “cancer” would not have progressed, or the patient was destined to die from some other cause (typically, heart disease). In the presence of screening, however, they suffer the psychological effects of knowing that they have cancer, the complications of diagnostic procedures, and the consequences of unnecessary treatments.

Seen in this light, the rise in cancer survivorship is not a modern medical success story. For millions of patients who received diagnoses that they didn’t need and would do nothing to improve their health, it is a catastrophe.

Consider the example of prostate cancer. In a 2009 analysis published in the Journal of the National Cancer Institute, Dr. Welch and prostate cancer expert Dr. Peter Albertsen used data from the NCI’s Surveillance, Epidemiology, and End Results (SEER) program to estimate that the introduction of prostate-specific antigen (PSA) screening in 1986 led to an additional 1.3 million U.S. men receiving a prostate cancer diagnosis through 2005. More than 1 million of those men were treated with surgery, radiation, or both. If one assumes optimistically that the entire decline in prostate cancer deaths during this time period can be credited to earlier detection of curable prostate cancers, then 22 out of 23 men who were diagnosed, and 17 out of 18 men who were treated, received no health benefit from their cancer diagnosis. (And that’s an optimistic estimate; a 2009 European study put the figure at 47 out of 48.)

When we look harder for asymptomatic cancers and other “silent” diseases such as diabetes and osteoporosis, Dr. Welch argues, we occasionally catch them at more curable stages, but far more commonly find diseases years earlier than we needed to, or that we didn’t need to find in the first place. I recall the timeless advice passed on by one of my attending physicians in residency regarding the dangers of heroic interventions: “Don’t just do something, stand there!” But doctors (myself included) have a very hard time doing nothing in a patient with a cancer diagnosis, even if patients weren’t already conditioned by the popular “War on Cancer” to want to eradicate every abnormal cell from their bodies, regardless of the risks.

I recommend Overdiagnosed to all health professionals and patients as a highly readable cautionary tale of the excessive diagnostic capacity inherent in modern medicine. Screening for selected diseases has its place, of course, but overenthusiastic and uninformed screening in the pursuit of health is more likely to do harm than good, by making people sick for no reason. And stripping away a person’s sense of wellness is no small thing, as Dr. Clifton Meador wrote in his 1994 essay “The Last Well Person“:

The demands of the public for definitive wellness are colliding with the public’s belief in a diagnostic system that can find only disease. A public in dogged pursuit of the unobtainable, combined with clinicians whose tools are powerful enough to find very small lesions, is a setup for diagnostic excess. And false positives are the arithmetically certain result of applying a disease-defining system to a population that is mostly well. … If the behavior of doctors and the public continues unabated, eventually every well person will be labeled sick. Like the invalids, we will all be assigned to one diagnosis-related group or another. How long will it take to find every single lesion in every person? Who will be the last well person?

Just How Fat are Americans?

We hear a lot of reports about the growing obesity epidemic, but what does it mean?

America’s Obesity Epidemic

Obesity is defined as a body-mass index (BMI) of 30 or higher.  Although, this number is not

equally distributed around the U.S.  Check to see how your state lines up in the prevalence of

obesity:

15 – 19% Fat   Colorado is ‘thinnest’ state and the only state to average less than 20% body fat.

20 – 24% Fat   Hawaii, California, Nevada, Idaho, Montana, Wyoming, Utah, New Mexico, Wisconsin, Illinois, Vermont, New Hampshire, Massachusetts, Maine, Rhode Island, Connecticut, New Jersey, Florida and Virginia.

25 – 29% Fat Washington, Oregon, Alaska, North Dakota, South Dakota, Nebraska, Oklahoma, Texas, Minnesota, Iowa, Missouri, Arkansas, Louisiana, Michigan, Ohio, Indiana, Kentucky, New York, Pennsylvania, West Virginia, Delaware, North Carolina, South Carolina, Georgia, Maryland.

> 30% Fat      Tennessee, Alabama, Mississippi.

The World Obesity Epidemic

I know it may be hard to believe, but the U.S. isn’t the most ‘obese’ country on earth.  In fact, we’re also not the most ‘overweight’.  After a quarter-century rise, obesity prevalence has not increased since 2004.  Still, 72 million adults (34%) are obese. Many health professionals would like this number to be less than 15%, a level not seen since 1980.

Below are the top eight ‘obese’ countries and the top eight ‘overweight’ countries:

% Overweight                                                % Obese

62% Israel                                           29% Kuwait

63% Bosnia                                         29% Bahrain

64% Kuwait                                       34% United States

66% United States                            34% United Arab Emirates

67% United Kingdom                      36% Saudi Arabia

67% Germany                                   41% French Polynesia

73% Saudi Arabia                             56% Tonga

75% French Polynesia                      79% Nauru

What’s Your BMI

Underweight = <18.5

Normal weight = 18.5-24.9

Overweight = 25-29.9

Obesity = BMI of 30 or greater

Counting Calories -

Not only are we consuming too much fast food, processed white foods and drinking too many liquid calories but we are also way too sedentary.  It only takes an extra 100 calories daily to manifest to a ten-pound weight gain in one year.  That’s not that much food (maybe a couple of Oreos with some nonfat milk).  Instead of, “Where’s the Beef?”  How about, ‘Where’s the Fruit and Vegetables?’ It is our own responsibility to ‘provide’ and ‘enforce’ healthy eating principles.  Adults need to eat right and expect the same of their children.  Keeping a food record for a few days can be a real eye-opener to how many extra calories you (or your child) are consuming each day.

Children should consume around 1,300 calories a day, or about 430 calories per meal (on average).  One typical kids meal provides 570 to 740 calories per meal.  These extra calories are very cumulative and can really add up and contribute to the obesity epidemic in children and adults.

The USDA recommends the average adult consume only 2,000 calories daily. The average American adult consumes from 1,883 up to 5,649 calories daily, as estimated by the World Health Organization.  It is also estimated that over 40% of our calorie intake comes from both fat and excessive sugar intake of any form (corn syrup, molasses, honey, high fructose corn syrup, maltodextrin, etc.).  What this means is that we are eating more calories, 24% more to be exact.  Although, there is no finger pointing, one single food group is not to blame.  It’s the big picture of too many calories (regardless from sugar or fat) and not enough exercise.

What Can We Do About It?

The likelihood of developing Type 2 diabetes and hypertension rises steeply with increasing body fatness. Confined to older adults for most of the 20th century, this disease now affects both moderately overweight and obese children. Approximately 85% of people with diabetes are type 2, and of these, 90% are obese or overweight.

Effective weight management for adults and children at risk of becoming overweight and developing obesity involves a range of long-term strategies. These strategies may include:  Nutrition and Lifestyle Changes, Food-Nutrient Timing and Portions Sizes, Diagnosis Specific Nutrition Education, Physical Activity Education/Monitoring, Laboratory Assessment/Target Ranges, Nutrient Supplementation, Stimulus Control/Behavior Barriers, Personal Goal Setting, and Self Monitoring via Food Analysis.

Ask your physician if he thinks you are an appropriate patient to benefit from Medical Nutrition Therapy?

Brooke Douglas, R.D.

www. NutritionAuthority.com.

You may also enjoy:

Leading Preventable Cause of Death in America 

Healthy Snacks for the 9-5′er

If there aren’t already plenty of reasons to envy life in the Mediterranean, here’s another: The traditional Mediterranean diet continues to be the healthiest, as well as one of the most delicious food lifestyles, in the world. 

For years, Registered Dietitians have been lauding the Mediterranean diet as a way to lower heart disease risk.  Now the latest evidence also suggests that it doesn’t just lower heart disease risk but may also protect people who already have had a heart attack! 

In the GISSI-Prevenzione Trial, presented at the conference of the American Heart Association, Italian scientists followed 11,324 Italians who had suffered heart attacks, keeping track of the amounts of Mediterranean-style foods they ate as well as their intake of butter, a decidedly non-Mediterranean food.  Those who slathered on butter were three times more likely to succumb to disease earlier in life as those who filled their plates with the four traditional Mediterranean foods (vegetable, fruit, fish, and olive oil).

Other new findings suggest that the Mediterranean diet also:

• Prevents LDL (the bad cholesterol) in the blood stream from damaging the lining of blood vessels (a process known as oxidation).
• Lowers blood pressure, which would further decrease heart disease danger.
• Lowers the risk of developing Alzheimer’s disease.
• Helps prevent allergic rhinitis and asthma symptoms in youngsters.

OK! So what is the Mediterranean Diet?  

To be exact, there is not merely one Mediterranean diet.  What is eaten varies significantly from one Mediterranean country to another.  However, the shared features of what is usually spoken of as the Mediterranean-style diet are as follows:

• High consumption of fruits, vegetables, bread and other cereals, beans, nuts and seeds
• Olive oil is the key monounsaturated fat source used in cooking
• Dairy products, fish and poultry are consumed in low to moderate amounts
• Little red meat is eaten
• Eggs are eaten zero to four times a week
• Wine only in moderate amounts

What makes the Mediterranean diet different is this is a low-fat diet that focuses on limiting saturated (and trans) fats.  This means replacing your red meat, butter, and full-fat milk with fish high in omega-3 fatty acids, olive oil, and skim milk. Although this is not a vegetarian diet, there is a strong emphasis on plant foods. 

Eating the Mediterranean way is definitely a more healthful eating choice for your life.  But without clear and precise nutrition guidance, you can easily become frustrated and confused (for instance, binging on nuts just because they are healthy).  Therefore, figuring out your individual needs with the help of a Registered Dietitian is key.  Without knowing how much to eat, you are going to have a tough time watching your portion sizes.

Ask your physician if they think you are an appropriate patient to benefit from nutrition therapy (a physician referral is warranted).  Many insurance companies will cover up to 90% of the cost of the ’Physician Prescribed Medical Nutrition Therapy’ consultation, with qualifying diagnoses.  Also, check your employee benefits plan at work.  Some plans cover up to $500 for counseling by a Registered Dietitian per year.

Once you experience the delicious and healthy choices the Mediterranean diet has to offer, it just might become your new lifestyle!  Glittering beaches, hillsides stitched with gnarled grape vines, lemon trees glistening in the sun……………….

Brooke Douglas, RD, CD  

NutritionAuthority.com

also see Dr, Pullen Lives the Mediterranean Diet 

Myringotomy for Treatment of

Acute Otitis Media

By Dr. Mark Grubb:

The ear infection (medical term: acute otitis media, or AOM) is the most common childhood disease in America, and is also the leading cause for antibiotic prescriptions among children.

After antibiotic resistance was recognized as a global problem in the late 1990’s, physicians began to consider alternative therapies for AOM.  Current AOM treatment options include oral antibiotic therapy, topical medications, observation (wait & see), and tympanocentesis (a puncture of the ear drum to relieve pressure and aspirate fluid).  Most of these therapies are usually accompanied by oral analgesics (acetaminophen or ibuprofen).

This article examines the pros and cons associated with each treatment method.

Immediate antibiotic therapy:

Systemic (oral or intravenous) antibiotic therapy today remains the most common treatment method for AOM.  The antibiotics are intended to eradicate the pathogen causing the ear infection, thereby curing the disease.  If there were no harmful effects associated with antibiotic usage, antibiotics would be the permanent ideal therapy for ear infections, and for any and all other infections potentially caused by bacterial pathogens.  Unfortunately, this is not the case.

Widespread use of antibiotics contributes to the ability of the targeted pathogens to develop resistance to the antibiotic drugs, i.e. antibiotic resistance.  The more we use a certain antibiotic drug, the more bacterial pathogens will become resistant to that drug over time.  This is an unavoidable outcome associated with use of antibiotics, but it is manageable, because resistance is directly related to usage rates.  Medical studies have shown that careful and judicious use of antibiotics within a population reduces the frequency with which resistant pathogens are encountered.

This brings us back to ear infections.  We know from a few decades of research that AOM is primarily a self-resolving disease.  Evidence shows that approximately 75% of AOM episodes will resolve satisfactorily in one week or less without systemic antibiotic therapy.  Other medical studies have demonstrated that about 13 AOM patients must receive an antibiotic drug for 1 to obtain benefit that otherwise would not have occurred.

Pros – blanket antibiotic therapy for AOM patients can provide a slightly increased “cure rate” and may reduce the duration of AOM pain by up to 1 day, as compared to a similar population of AOM patients who do not receive antibiotic therapy.

Cons – our habit of giving many kids antibiotics so that a few can benefit contributes significantly to the development of resistant pathogens.  Systemic antibiotics are also associated with other adverse drug-related events such as eradication of beneficial bacteria from the mouth, throat, and digestive tract, contributing to thrush, increased risk of subsequent illness, skin rashes, and diarrhea.

Topical antibiotic drops:

Pros – because they are localized to the ear drum and middle ear space, these non-systemic antibiotic drops have the potential to be effective against AOM pathogens without causing many of the problems associated with systemic antibiotics.

Cons – the antibiotic drug in these drops will not pass effectively across the ear drum to reach the infected fluid on the other side unless there is a perforation in the ear drum.  Because only a minority of AOM patients have a perforated eardrum (spontaneous perforation, tubes, or tympanocentesis), the drops are ineffective for most patients.

Other topical medications:

There is very little evidence available on the effect of antipyrine/benzocaine or herbal topical pain relief medications.  These solutions may provide a slight benefit in terms of temporary pain relief, but do not contribute to overall resolution of AOM episodes.

Observation Option:

Otherwise known as the wait-and-see approach, this treatment method employs a 2 or 3 day observation period during which AOM symptoms are treated with analgesics and we wait to see if the episode resolves on its own.  If the patient is still symptomatic after the observation period, another treatment method is employed.  This approach takes advantage of the self-resolving nature of AOM.

Pros – this approach helps reduce the amount of antibiotics that are prescribed for AOM.

Cons – about 25% of AOM patients can be expected to remain symptomatic after an observation period, which means that this percentage of patients will have spent a few “tough” days purely for the purpose of being identified as candidates for another therapy.  Furthermore, at the end of the observation period, no more is known about the specific pathogen causing their disease than when observation was begun.  This approach relies heavily on the use of analgesics to manage AOM symptoms, which may not be in the best interests of the patient (see the next paragraph below).  Lastly, the observation option is not a very pro-active treatment method, and therefore can be difficult for providers and parents to embrace.

Oral analgesics:

AOM is frequently a painful condition, with significant discomfort associated with the infected fluid trapped in the middle ear space.

Pros – oral analgesics (acetaminophen & ibuprofen) can be helpful in reducing AOM pain and contributing to more normal sleep patterns.

Cons –a growing body of evidence suggests that there are potential harms associated with analgesic use.  Acetaminophen use has been associated with increased risk of childhood asthma and also liver toxicity.  Ibuprofen use has been associated with increased risk of soft tissue infections and gastrointestinal bleeding after only one or two age-appropriate doses.

Myringotomy:

This approach involves a needle perforation of the ear drum to relieve the pressure of trapped fluid in the middle ear space, and to obtain a sample of the infected fluid for culture analysis.  When used as an adjunct to the observation option, myringotomy (also called tympanocentesis) eliminates the cause of AOM pain and allows identification of the pathogen so that precisely targeted antibiotic therapy can be chosen for the minority of patients who remain symptomatic after the observation period.  Myringotomy also promotes therapeutic drainage of infected fluid from the middle ear space, which is beneficial to the patient in the same manner as draining any other form of abscess.

Pros – myringotomy eliminates pain, which reduces or eliminates the need for analgesic therapy.  Therapeutic drainage contributes to clinical resolution.  Identification of causative pathogen eliminates the need to empirically select antibiotics, thereby reducing the incidence rate of ineffective antibiotic prescriptions.

Cons – myringotomy is infrequently employed in primary care.  Some training is necessary for the procedure, but most residency programs do not train for it.

Discussion:

Although the frequency of ear infections in children seems to be somewhat lower after introduction of the pneumococcal vaccine, AOM is still a prevalent disease, and the way we manage it has a profound impact on our children and their families.

To read more about myringotomy, including full citations for the evidence summaries above, please visit Dr. Grubb’s blog at http://www.earinfectionblog.com.  Also check out a video of what the device looks like and how it works.

Dr. Mark Grubb works as a full time pediatrician at Woodcreek Healthcare in Puyallup, WA.

Does Botox Paralyze Emotions as well as Muscles?

Written By: Dr Kristie McNealy

We know that Botox paralyzes muscles, but could it paralyze your emotions too?

Botox Cosmetic, a pharmaceutical product made from botulinum toxin, is used by many to paralyze facial muscles in order to reduce fine lines and wrinkles.  Because of this muscles paralysis, Botox has the potential side effect of preventing people from conveying their emotions through facial expressions. 

New evidence suggests that the effects of Botox may actually go beyond preventing people from expressing their emotions.  It may also prevent people from fully feeling emotions.

Recent research published in the journal Emotion compared emotional responses to video clips in people who received Botox injections to those treated with Restylane, a dermal filler which reduces lines, but does not paralyze muscles.  They found that the patients who received Botox exhibited an overall significant decrease in the strength of emotional experience as compared to the Restylane group.

The data isn’t quite as clear cut as many articles have made it out to be though.  Much of the difference between the groups can be attributed to the fact that there was a pre- versus post-treatment decrease in the emotional response to mildly positive clips in the Botox group, as well as an unexpected increase in response to negative clips in the Restylane group.  When looking at data for Botox patients alone, there was actually no pre- to post-treatment changes in emotions caused by the most positive and negative video clips.

This study suggests an interplay between facial expressions and the perception of emotion.  However, while having a Botox treatment might make you look like a statue, it probably won’t make you feel like one!

Reference:  Davis J, et al. The effects of BOTOX injections on emotional experience. Emotion, Vol 10(3), Jun 2010, 433-440. doi: 10.1037/a0018690

Dr Kristie McNealy is a doctor turned medical writer and regularly writes at Family Health Guide

VBAC and home birth: evaluating the evidence

Thanks to a recent pronouncement from the American College of Obstetricians and Gynecologists, my two-year old daughter, who arrived via a vaginal birth after Cesarean section (VBAC), may not be a medical rarity for much longer. In a previous post, I discussed possible causes for the steep 15-year decline in the percentage of U.S. women who have delivered a child vaginally after a previous Cesarean birth (currently fewer than 1 in 10). In March, at a conference held at the National Institues of Health in Bethesda, Maryland, an expert panel concluded that the scientific evidence did not support ACOG’s existing recommendation that surgical and anesthesia personnel be “immediately available” during a trial of labor. However, they found evidence that this restrictive requirement had caused many hospitals without 24-hour availability of these services to discontinue VBAC entirely.

To its credit, last week ACOG released an updated version of the guideline that states that a trial of labor is a reasonable option for the vast majority of women who desire a vaginal delivery after a previous Cesarean, including those who have had more than one prior Cesarean and those carrying twins. While continuing to assert that mothers and babies are best served by access to emergency resources, they add: “Respect for patient autonomy also argues that … [an institutional no-VBAC policy] cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.” Amen.

Now I’ll to turn to another controversial maternity care topic: home birth. The subject of a widely viewed 2008 documentary and Time Magazine story, out-of-hospital births represented less than 1 percent of all births in the U.S. in 2005, according to government researchers. A recent meta-analysis of previous studies comparing planned home and planned hospital births that concluded that the former was “associated with a tripling of the neonatal mortality rate” elicited a variety of reactions from health professionals in the U.S. and abroad, ranging from ACOG’s reiterating its opposition to home births to calls for more research by the American College of Nurse Midwives and the UK’s Royal College of Obstetricians and Gynecologists.

I agree that more research is needed. But as for the analysis itself, there are at least two reasons to question whether it should cause many (or any) women to reconsider their home birth plans. First, while “tripling” in neonatal deaths sounds scary, this is a relative rather than an absolute difference in risk. Reading the fine print, neonatal death occurred in 0.15 percent for planned home and 0.04 percent for planned hospital births. That’s an absolute risk difference of just 0.11 percent, or about 1 extra death for every 1000 births. This difference is very close to the small increased risk of neonatal death during attempted VBAC versus repeat Cesarean section (0.8 extra deaths for every 1000 births), which ACOG has acknowledged should be a mother’s choice.

Second, all but 3 of the 12 studies included in the meta-analysis were conducted prior to the year 2000, in populations with much lower Cesarean rates than in the U.S. Overall, only 9.3% of women in the planned hospital birth groups had Cesarean deliveries – a far cry from the 32% that currently occur in the U.S. So while this study’s results are most applicable to countries in other parts of the world that have Cesarean rates of 10% or less, it’s not clear if it captured the maternal complications that invariably result from doing 3 times as many surgeries.

The bottom line? The available evidence indicates that planned home birth is no riskier for babies, compared to planned hospital birth, than is attempting VBAC compared to choosing a repeat Cesarean delivery.

by Brooke Douglas 

Eating Out…Be Your Own Nutrition Authority!

Eating out frequently has become a way of life for most Americans. This need not change because you are trying to eat healthier. The key is to order wisely. Don’t be afraid to ask how something is prepared or to make a special request. Most restaurants are eager to please their patrons. The following tips should make dining out a little easier.

• Choose entrees that are grilled, baked or broiled; avoid anything fried.
• If you crave a steak, order a petite filet.
• Steamed vegetables are best. Avoid items that are described as scalloped, au gratin, bathed in cream, butter sauce, alfredo sauce.
• Ask for fat-free salad dressing or have regular dressing served on the side.  Dip fork into dressing then stab salad for optimal taste with minimal fat.
• Broth, tomato based soups/sauces are better than fatty alternatives.
• Avoid fries, chips that usually accompany sandwiches. Replace with fruit…
• Choose fresh fruit or sorbet for dessert. If an occasional high fat, sugar laden dessert can’t be resisted, share it with a friend

Chinese: Oriental foods can be good choices, if you choose wisely.  It can be difficult eating at Chinese, Japanese, or Tai restaurants. So be alert!   Order steamed rice and stir-fried entrees that feature small portions of chicken, fish, or lean meat with lots of vegetables. Always request that your dinner be prepared with less oil.  Avoid fried foods, cream or cheese sauces, nuts and fatty meats.  It would be best to opt for vegetarian dishes as much as possible.  Ask for your favorite dish to be steamed or stir-fried without oil.  Worst Choice: Kung Pao Chicken.

Mexican: Order a la carte.  Skip the refried beans and refried rice (both are made with lard).  Ask the cook to go light on the cheese.  No sour cream or guacamole, and avoid the fried foods ie: enchiladas and tortilla chips. Instead, ask for soft flour or corn tortillas for dipping into your salsa.

Pizza:  By having no meat on your pizza you will eat much less salt and fat!  Ask that only half the regular amount of cheese be used on your pizza, or better yet, ask for your pizza without cheese.  Also, ask for extra vegetables and then ‘lightly’ sprinkle each slice with some grated parmesan cheese.  Hand tossed pizza, thick and thin crusts are ‘OK’…..but be sure to stay away from pan pizza, cheese filled crust pizza and triple decker pizza.

Burgers: Avoid cheeseburgers as much as possible.  If you must have mayonnaise and cheese then pick just one, don’t have both.  Skip the bacon-double, triple and double decker, deluxe burgers.  Also, say no to those ‘special sauces’, fried fish and chicken sandwiches.  Forego the French-fries and instead order a salad, fruit, large orange juice or a milk.