2x2: Two Minutes Twice per Day

Teeth are the only non-shedding surface in the body.  Bacterial levels in dental plaque can reach very high levels and can easily spread to the blood stream. Periodontal (gum) disease can facilitate the spread of the bacteria.

Dental disease can lead to loss of teeth and jaw damage. Periodontal disease has been associated with heart disease, possibly due to increased amount of bacteria introduced into the blood stream. The resulting chronic inflammation can start a chain of events that lead to artery blockage. Other conditions that may be related to chronic periodontitis are difficult to control diabetes and pneumonia.

Adult dental care is as important now as it is for kids. Everyone should brush teeth for two minutes twice per day as well as floss once per day. Use a soft toothbrush. Contrary to what toothpaste commercials show, the amount of paste or gel does not have to be a heaping amount. A pea-sized dab is plenty. Unless there is a reason otherwise, buy toothpaste with fluoride.

If brushing is impossible, rinse with warm salty water after eating.

A refresher.

E-Cigarettes

E-cigarettes are a nicotine delivery system to the lungs that doesn’t involve the carcinogenic byproducts of burning tobacco leaves. Rather, a liquid nicotine solution is vaporized into steam that is inhaled. There has been no association to date of e-cigs with cancer, but that doesn’t mean that they are a good idea.

As a replacement for regular cigarettes, e-cigs might be a public health win by reducing lung cancer but the risk of cardiovascular disease would remain. Nicotine constricts blood vessels, increasing blood pressure and reducing delivery of oxygen-rich blood. Unlike conventional cigarettes, there is no learning to inhale or initial coughing bouts leading to concern that e-cigs might be the gateway to other tobacco use, especially for teens. E-cigs are so easy to use that one reviewer said that she could smoke them while on the treadmill.

E-cigs come in a variety of ‘flavors’ and different concentrations of nicotine. Nicotine is known to improve mood and many find it an effective appetite suppressant. There is a small amount of contested evidence that it might delay the start of Alzheimer’s disease – not a reason to start using nicotine in any form.

Another danger of e-cigs is that it might become socially acceptable to use them indoors, exposing others to the nicotine-laced steam. New York City, among other places, limits the use of e-cigs the same way as conventional cigarettes including the proscription against use in outdoor public places.

Both tobacco companies and pharmaceutical companies have financial interests in e-cigs, but the final say lies with both regulators and the users. If society thinks that smoking is a bad idea the type of nicotine delivery won’t matter.

Shoulder Pain

The shoulder has greater mobility than any other joint in the body. Pain in the shoulder may indicate a problem in the shoulder itself or elsewhere in the body. The shallow depth of the shoulder joint contributes both to its mobility and its susceptibility to instability and injury.

Shoulder pain that is poorly localized may be pain that is referred from elsewhere in the body. The classic symptom is left shoulder pain that indicates a heart attack. Nerve impingement or entrapment in the neck or upper back can cause shoulder pain. Irritation of the diaphragm from an abdominal catastrophe (ruptured ectopic pregnancy, perforation of the bowel or rupture of the spleen) can cause shoulder pain on the same side.

One of the easier diagnoses is shoulder pain following trauma. The evaluation will consist of taking a history, examination and sometimes imaging. The history and examination will determine the type of imaging (X-ray, ultrasound or MRI). Pain that arises months after the injury may be due to adhesive capsulitis from immobility.

Excessive use of the shoulder can lead to inflammation of the fluid filled cushioning sacs around the shoulder (bursitis). Tendonitis is can be due to a sudden injury, advancing age or overuse. Osteoarthritis resulting from wear and tear can also cause chronic shoulder pain.

Surgery may be required to resolve some shoulder problems; however, 90 percent of patients with shoulder pain will respond to simple treatment methods such as altering activities, rest, exercise, and medication.

Some exercises, after checking with your physician. 

It Can Happen to Anyone

Winter weather brings snow, sleet and ice – along with slips and falls. Any one of us could be temporarily disabled, making it difficult to get around our own homes. I recommend that anyone who remodels consider this, particularly when designing a bathroom.

If this is new construction, consider having enough room around the toilet to pivot a wheelchair. Clear floor space for one wheelchair must be 30” x 48” (760 mm x 1219 mm) or more to accommodate the chair with ease. The equipment to be used must be approachable from the front or the side. Some of this clear floor space may be located underneath fixtures, lavatories, or accessories as long as the necessary knee and toe clearance is available. Even if not using a wheelchair, having enough clearance will allow another person to assist.

Grab bars provide stability and support for people getting on and off the toilet. There are many attractive surface materials available. Grab bars should also be in the shower, along with a seat. The grab bars are permanently installed; the seat can be put in as needed. Adding a seat improves safety and allows for more independence in personal care. The seat should be against the wall so that one can lean for additional support. Don’t forget to put the shower controls within reach.

If possible, the entrance to the bathroom and the shower should be roll in. Even a low saddle can be hard to navigate on crutches or with an unsteady gait.

Even a minor remodel will make a bathroom friendlier. Consult with an architect or certified planner for grab bar placement. Consider a hand-held shower. A fold-up shower seat would be appreciated by anyone.

Anti-Resolutions

It’s three days in - how many New Year’s resolutions have you already broken? Chances are at least one, and by this time next week several more. Here’s a contrarian notion: anti-resolutions.

Think about the past year – what didn’t work? Not successful in losing ten pounds? Then how about resolving not to gain ten pounds.  Never got around to sorting through the closets? Then how about resolving not to increase the mess. Didn’t retire the credit card debt? Then how about not increasing the amount owed.

Once you figure out what didn’t work – don’t do it. I’ll bet that at the end of 2015 you will be in a better place than you were in December 2014.