Exercise

Many people are miserable this winter: feeling lethargic from eating too much junk food, spending too much time in front of screens and catching each cold that comes around. There is a solution to the winter doldrums: more exercise.

The empty calories in junk food don’t provide the nutrition needed for moving large muscles groups and thinking clearly. Too many chips and cookies will make anyone feel like a lump of clay unable to muster the oomph to get going. Thirty minutes of vigorous activity will stimulate the brain chemicals that will improve mood and cognition.

The American Academy of Pediatrics recommends limiting screen time to no more than one or two hours per day. Watching TV develops an appetite for junk food and many people overeat while watching. Screen time results in sleep loss and irregular sleep patterns; both are associated with fatigue and increased snacking. Excessive screen time leaves less time for active, creative play.

There is evidence that moderate daily activity decreases the incidence of colds. In a group of post-menopausal women, those ladies who exercised five times per week reported one-third fewer colds over one year.

Every member of the family will benefit from limiting “sit time.” In addition to limiting screen time, do something active. Challenge each other to see who can do the most pushups during a commercial break.

Even when stuck at home on a snow day, stick with a routine. Get some exercise. Give food the respect that it deserves. Sit at the table and enjoy your food rather than mindlessly snack at the keyboard. Go to bed at a reasonable hour.

Spring can’t get here fast enough.

Tips to reduce screen time. 

If you decide to exercise outdoors or want to stay inside.

Kudos to CVS

Much appreciation to the CVS Pharmacy chain: the announcement that they will stop selling tobacco products is an important step in health promotion. I would like them to continue the good work and stop selling soft drinks, chips, and other items that are contributing to the obesity crisis in America.

Look at photographs taken in the 1940's and 1950's - people were slender. Those were the days that pharmacies sold medicine, bandages and beauty products. It wouldn't be so terrible if both pharmacies and people took a step backward.

Osteoporosis

Osteoporosis is a common problem that results in thin weak bones that break easily. A hip fracture is a sudden event that can have life-changing consequences but not all bone fractures are as dramatic. Small fracture in the spine bones (vertebrae) can result in loss of height, a stooped posture and impaired breathing and digestion due to loss of volume in the chest and abdominal cavities. Both men and women should be concerned about bone health

Osteoporosis prevention starts in the teen years. Key factors are good eating habits, regular exercise and never smoking. The optimal diet to build good bones includes adequate calories and protein and optimal amounts of calcium and vitamin D. The main dietary sources of calcium include milk and other dairy products, such as cottage cheese, yogurt, or hard cheese, and green vegetables, such as kale and broccoli. A rough method of estimating dietary calcium intake is to multiply the number of dairy servings consumed each day by 300 mg. One serving is 8 oz of milk (236 mL) or yogurt (224 g), 1 oz (28 g) of hard cheese, or 16 oz (448 g) of cottage cheese. It’s unclear how much vitamin D a young person should take, but most guidelines recommend 600 IU daily.

Non-drug therapy underlies all osteoporosis prevention and therapy: adequate calcium and vitamin D, exercise, fall prevention, not smoking and limiting caffeine and alcohol intake. Medication may be needed. People with the highest risk of fracture are those most likely to benefit from drug therapy. The decision to add medication needs to be a shared patient-physician since the substantial benefits are associated with substantial risks

The National Osteoporosis Foundation has patient-friendly tips as well as links to new research and recommendations.

Medication Reconcilation

Medication reconciliation is a collaborative effort between patients, care-givers and prescribers that lists all medications (prescription and over the counter) and supplements such as vitamins. The list should include both the trade and generic names of medications as well as the doses and the time of day taken. Drug allergies should be noted. This reconciliation will guide prescribing decisions and will help prevent medication errors that could harm patients.

Older patients are at higher risk for medication errors since they may have several medical problems for which they see several physicians. The same medication may be ordered twice: once by the trade name and again as the generic. The medical reconciliation should also ensure that the patient is actually taking the medication (and if not, why not).

Adverse medication events include physical harm, mental harm or loss of function. The clinician should review the medication list at each visit and adjust medications as needed. All effort should be made to avoid high-risk drugs, unnecessary drugs, and drugs causing side effects. Computer programs are helpful in detecting potential drug-drug interactions and provide dosing guidelines if there is impaired kidney or liver function. The e-prescribing programs as also helpful but can be too inclusive: a potential drug-drug alert will pop up for an antibiotic that was used once three years prior.

Patients must take an active role in keeping their medication lists up to date. When in doubt, brown bag every medication bottle and bring it along to every doctor’s visit. Keep a list of medications in your wallet along with the list of allergies.

One study found that medication errors were responsible for 1.4 percent of hospital admissions, of which 28 percent were preventable. The FDA is developing systems to minimize errors. An excellent brochure (PDF) has recommendations and safety tips for patients. 

Blood Pressure

New goals for the treatment of high blood pressure were recently released. The standards were loosened a bit for patients older than 60, mainly because the panel that issued the recommendations was concerned about low blood pressure.

Our blood pressure is not static; it changes according to the body’s needs. In order not to pass out when you get out of bed, your heart needs to pump enough blood upstairs to perfuse your brain. If you need to suddenly run to catch a train, your body needs to get enough blood to your large leg muscles to get you going. On the other hand, one of the goals of blood pressure control can be to blunt this response since suddenly moving a large volume of blood can put a big strain on the heart.

The metabolism of blood pressure medications also changes with time. As we mature, we can expect kidney function to decrease. Therefore, medications that are metabolized by the renal system may appear to be ‘stronger’ to the body, requiring a change in dosage.  Tighter control of blood pressure may be important to prevent consequences of other diseases such as diabetes.

Blood pressure that is too low for the patient can have a dreaded consequence: a fall with a head injury. Breaking a hip or an arm is no fun either. Since diuretics are usually a part of blood pressure regimens, blood tests are needed to monitor electrolytes.

I like to see my hypertensive patients every three months for a blood pressure check. Depending on the individual patient, blood tests may be drawn at these visits. It’s a chance to monitor the patient’s weight and also review the potential side-effects of medication. Of course – the primary reason for the visit is to make sure that the blood pressure is in control.

More information:

A nice summary from Harvard Health Publications.

The full set of guidelines.

Unraveling

New year resolutions are always about change – doing or not doing something. I prefer to reframe the argument: make a resolution to strip away the layers to reveal your true self.  Don’t resolve to lose weight but instead figure out how to be the healthy sized person that you really are. Don’t resolve to quit smoking but rather take steps to become the non-smoker that you once were.

Every healthy full term baby starts out at a good weight. No one becomes fat overnight. What steps along the way led to weight gain? Can those behaviors be slowly unraveled? I suggest approaching the problem in reverse chronologic order. The most recent bad habit will be easier to change than one that dates back to childhood.

Starbucks introduced the Frappuccino in 1995 and the Frappuccino juice blend in 2006. McDonalds started serving fruit smoothies in 2011. Giving up a grande mocha Frappuccino will save 460 calories daily and will lead to a 3 lb weight loss in one month. And really, who needs a fruit smoothie (330 calories) when water is a far better thirst quencher?

Unravel the new unhealthy habits first. Once you have achieved that success, tackle an older one. If you think about it, it’s not your favorite food that Mom made that is getting you into trouble.