Packing on the Pounds

The annual eating extravaganza lasts from Halloween through the Super Bowl. Most people estimate that they gain five pounds between November and the end of January. Actually, the news is not that bad – the average weight gain is one pound during the winter holidays. The terrible news is that the extra one pound is probably permanent, since few people lose it by the next summer. People who are already overweight tend to gain more than one pound and they too don’t lose it.

The tendency to pack on the pounds during the holidays starts in the late teens. People don’t just overeat at Thanksgiving and Christmas dinner: there is more snacking, more alcohol and more high calories foods.

My recommendation is the two-bite rule. Have two bites of whatever you want. I assure you that the third, fourth and fifth bites taste exactly the same, so why bother?

From The New England Journal of Medicine 

Saving the Earth

It’s the shopping season and the holiday catalogs are arriving daily. It will be a long time before we are paperless. As inhabitants of this planet we need think about our use of forest products. It is important to ensure that healthy forests will thrive for our children and grandchildren. The Forest Stewardship Council (FSC) uses the power of the marketplace to protect forests for future generations. Look for the FSC logo on catalogs and other printed materials. If the printed material doesn’t have the logo (which looks like a tree), contact the merchant to insist upon the responsible use of paper.

When shopping, look for the green frog seal to show that a product is certified by the Rainforest Alliance. Why this matters: Farming and the grazing of livestock are responsible for 70 percent of global deforestation. By choosing products that bear the Rainforest Alliance Certified seal, you’re supporting farms that protect soils from erosion and waterways from pollution and that support the well-being of farm workers and their communities.

You don’t have to go to the ends of the earth to save the rainforest: Follow the Frog.

Carbon Monoxide Poisoning

Almost everyone in the area has been without power for days. Some people are fortunate enough to have professionally installed hard-wired generators that click on as soon as the electrical supply is interrupted. These generators are located at a distance from the house and far away from windows. Other people will use ‘portable’ units that are typically only an extension cord length away from the house (and that cord may be run through the kitchen window). Another common tactic is to charge telephones in an idling car in the garage.

There is a considerable danger from carbon monoxide (CO) poisoning in the latter two scenarios. An open garage door is not sufficient - an idling car should be completely out of the garage, since CO can accumulate in garage corners and under the vehicle. Things might seem fine to the person in the car charging his phone and listening to the radio, but since CO cannot be detected by humans, he may never make it from the car back into the house.

The consequence of a slow leak of CO into the living quarters may not be as dramatic but could be equally deadly. Unfortunately, 500 people lose their lives to CO poisoning very year and the numbers go up following hurricanes.

Carbon monoxide makes it difficult for the blood to deliver oxygen to the tissues.  It also directly interferes with muscle activity at the cellular level and can lead to “myocardial stunning” even if there is adequate oxygen delivery. Forty percent of those who survive CO poisoning will have permanent neurocognitive impairment due to damage in the brain cells.

Every home needs CO detectors. If the CO detector goes off, get out! Call the fire department once everyone is out of the house.

The basics about carbon monoxide poisoning.

From The Centers for Disease Control and Prevention

Help - I'm falling ......

People fall all the time – and most of the time we brush ourselves off and resolve to be more careful next time. Unfortunately, 20-30% of older adults who fall suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death.  But are these falls ‘accidents’ or events that could be prevented?

Falls can be caused by faulty consumer products or products used in a way that was not intended. Chairs are for sitting – not to allow one to reach a high shelf or change a lightbulb. Towel bars and faucets are not designed to be grab bars.

At least one-third of all falls in the elderly involve environmental hazards in the home. The most common hazard for falls is tripping over objects on the floor. Reduce clutter and make sure that electrical and telephone cords are out of the way.

Alcohol is a risk, both alone and combined with medications. Another risk factor is poor vision (including poor lighting). Cataracts and glaucoma alter older people's depth perception, visual acuity, peripheral vision and susceptibility to glare. These limitations hinder their ability to safely negotiate their environment, whether in their own home or in a shopping mall. Young people use visual cues to perceive an imminent fall and take corrective action. Older adults with visual impairments do not have this advantage to the same extent.

A person who has fallen is at great risk to fall again – two-thirds of those who fall will fall again within six months. Don’t wait for the first fall to take action! Failure to exercise regularly results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. Clear out clutter and have grab bars professionally installed. Report side effects of medication and get your eyes checked regularly.

Preventing falls is not just for the elderly. Anyone can be temporarily off her game and not see the electrical cord. Anyone can sprain his ankle and be off balance and trip on the rug. Anyone can lose his mind and try to reach a high object by climbing on furniture.

Tips on preventing falls in the home.

Check for safety 

Sweet Dreams

If you need an alarm to wake up in the morning, you are not getting enough sleep. You have an internal clock and if that doesn’t correspond to your daily schedule you may have “social jet lag.” Socially jet-lagged people are three times more likely to be overweight and performance at work and in school may suffer.

Your biologic clock works best if you awaken at the same time every day. That said, your body needs enough time to complete the metabolic work of sleep:  tissue growth, energy is restored and hormones are released. The brain cools down and consolidates memories: much like a computer rebooting after having too many open programs.

Go to bed at least eight hours before you plan to awaken. Establish a regular relaxing, not alerting, bedtime routine. Create a sleep-conducive environment that is dark, quiet and cool. Turn off all screens well before bedtime.

When you do get up, try to get some sunshine on your face. You will get into gear faster.

The Harvard point of view.

Three Stars

When I get a letter from an insurance company the greeting is usually “Dear Provider,” since the same letter (usually bearing bad news) is sent to doctors, nurse-practitioners, physical therapists and social workers. The letter usually details how we “providers” will be paid less money or will face additional roadblocks in getting care for our patients.

I should have known that something was up when I received a letter addressed “Dear Physician.” The letter, from a major insurer, informed me that I received a 3 star designation for care – in fact, my score was 95%. I supposed that I should be flattered, but in actuality my score could have just as easily been 65%. I was being measured on the percentage of my patients that had received services such as mammograms.

I don’t have a mammogram machine in my office. Patients need to make another appointment at another office. I treat my patients as the grown women that they are and ask them to have a mammogram. I hand them a referral slip and hope that they will make an appointment. I remind the patient at almost every contact, but I cannot drag the patient to the mammography suite and hoist her breasts onto the machine. It's up to the patient to have a mammogram, not me.

Mammograms help find breast cancer. The jury is out if they actually save lives. They are inconvenient, uncomfortable and can be expensive (thank you to insurance companies that will weasel out of paying for services). I do think that they are a good idea and actively promote them.

So, this year I am a 3 star physician. From what I can see, my 2 star and 1 star colleagues are taking good care of their patients too.