Moving interrupts life

This is the time of year that many people move – the school calendar sets many schedules. That first lease signed after college graduation sets the timetable for all subsequent moves and no one wants to disrupt a child’s school year. Even with optimal timing, it’s never easy to move.

Moving to a new community is one of the most stressful experiences a family faces (and a family might be a singleton). Moves are even more difficult if accompanied by death, divorce, loss of family income and change of job/school. Many people don’t anticipate the physical and emotional toll of moving.

It’s important to plan and to break things down into smaller tasks. It’s crucial to communicate with others – having a grand plan is of little use if no one else knows how to help. Be kind to one another – alleviating a child’s stress will help the entire family. Share happiness as well as concerns. Set reasonable goals and reasonable boundaries. Reality shows are not real – don’t expect to host a housewarming party in a beautifully decorated home two weeks after the moving vans pull away.

After the move, spend time together getting to know the new area, even if it’s only a few blocks from the old home. Get involved in the new community as quickly as possible, but be sure to take breaks to regroup and recharge.

Moving disrupts the everyday routines that add order to our lives. We develop confidence when the home life is stable. Try to maintain a good exercise regimen and make wise food choices. Get enough sleep. Try to find some fun among the chaos. Moving is not easy, but staying put is not an option. 

Dr. Oz

I recently saw a cartoon in a magazine targeted to physicians: an older male doctor is speaking to a middle-age woman. On the wall is a poster, “Please don’t tell me what Dr. Oz said.”

My colleagues find the cartoon to be apt. Let’s skip the stereotypes: older male doctor, middle age female patient, and get to the point. Those of us actually treating patients practice in a different world than that of Dr. Oz and his boss, Oprah.  Dr. Oz is fortunate that he is able to buy the freshest, most exotic food stuffs and prepare them in an ecologic sensitive manner. There is plenty of time to exercise. There is no need to discuss Oprah – she truly has unlimited resources to maintain health.

However, this is not my biggest complaint about Dr. Oz. He is a well-trained surgeon and generally ‘gets’ the big picture about health. He tries to educate his television audience. What he does not do is choose his words carefully; I cringe when he goes off-script. When discussing a medical topic, he makes a casual statement (every woman should be tested for xxxx) that has a kernel of truth but is terribly incorrect.  Patients will come to the office requesting unusual, inappropriate, unavailable tests and are disappointed when their doctors are not quick to order those unusual, inappropriate and/or unavailable tests. Precious office time is spent discussing why Dr. Oz’s recommendations and why they are not a good idea.

Very few people have the resources of Dr. Oz and even fewer the wealth of Oprah. Rather than give blanket recommendation or glib opinions, I would rather see a less casual and more scientifically focused program. Perhaps Dr. Oz should watch Dr. Nancy Snyderman on NBC. 

The Million Hearts Campaign

The Million Hearts Campaign is an initiative that aims to prevent a million heart attacks and strokes over the next five years.  The campaign seeks to empower Americans to make healthy choices, such as avoiding tobacco use and reducing sodium and trans-fat consumption, as well as to improve care for people who need medical treatment. The Million Hearts campaign focuses on the "ABCS": Aspirin for people at risk, Blood pressure control, Cholesterol management and Smoking cessation, addressing the major risk factors for cardiovascular disease.

The Million Hearts website offers interactive tools to assess the future risk of a heart attack, as well as educational resources to reduce the risk.

Electrocardiogram

The electrocardiogram  (ECG or EKG) records the electrical activity of the heart. The ECG is used to measure the rate and regularity of heartbeats, as well as the size and position of the chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart, such as a pacemaker.

During each heartbeat, a healthy heart will have an orderly progression of electrical activity that starts in the pacemaker (natural or artificial), spreads through the upper chambers and then travels to the lower chambers. The lower chambers (ventricles) provide the main pumping action of the heart.

The ECG can measure and diagnose abnormal heart rhythms caused by electrolyte imbalance or damage to the heart muscle. In the event of a heart attack, the damaged area can be identified. The ECG can also discern scar tissue resulting from a heart attack.

Serial ECGs are a valuable diagnostic tool. Comparison of an ECG during chest pain to one performed during a health examination can help determine if the chest pain is cardiac. In the case of a heart attack, the progression can be mapped over time or can monitor therapeutic interventions.

The ECG is also of great value in evaluating valvular heart disease, thickening of the heart wall and inflammation around the heart.  A stress test will measure electrical activity when the heart is working hard, a resting ECG is just that.

More about ECG and stress tests.

Breakfast Dessert

I am a devoted breakfast eater. Since I don’t snack after dinner, it’s been many hours since I last ate and I am famished in the morning. My usual breakfast is a slice of whole-grain bread with a protein, such as peanut butter or cheddar. I do sit down and enjoy my food, but I have just enough time to get out the door to make sure that I get in front of the school bus. However, on leisurely Sundays I add a second course: breakfast dessert.

Breakfast dessert ranges from pumpkin pie in November to birthday cake in the summer to cookies at any time. Tastykakes are a given down the Jersey shore. I suppose that pain chocolat could also be considered breakfast dessert as well.

It turns out that I have been on the forefront of nutritional science. Researchers in Israel studying weight loss strategies reports that obese participants who ate a breakfast high in protein and carbohydrates that included a dessert were better able to stick to their diet and keep the pounds off longer than participants who ate a low-carb, low-calorie breakfast that did not include sweets.

In the study, all participants ate the same number of calories and lost about the same amount of weight. However, during a follow-up period in which participants were advised to stick to the diet, but could eat more if they were motivated by hunger cravings, the small breakfast group gained 24 pounds, while the big breakfast group lost 15 pounds, on average.

Those who ate the big breakfast with the dessert had lower levels of the "hunger" hormone ghrelin, and fewer food cravings than those who ate the small breakfast, without dessert. When we diet, we're hungrier, ghrelin levels rise and there's a decrease in our metabolism. A larger breakfast that includes protein, carbs and sweets may counteract these changes.

Enjoy breakfast dessert! As always, moderation is key: make wise choices and control portion sizes.

Osteoporosis

The FDA released a review this week that indicates that certain osteoporosis medications (bisphosphonates) may not provide additional fracture prevention benefit if taken for more than five years. Patients with less severe osteoporosis are most likely not to benefit from additional therapy. The information comes in the wake of previous studies showing troubling side-effects from such medications.

A hip fracture can be a life-changing event; it is too often a life-shortening event. An ounce of prevention is worth a pound of cure! The most important interventions to prevent osteoporosis are diet, exercise and not smoking. These recommendations apply to both men and women.

Experts recommend that premenopausal women and men consume at least 1000 mg of calcium per day; this includes calcium in foods and beverages plus calcium supplements. Postmenopausal women should consume 1200 mg of calcium per day (total of diet plus supplements). Adequate vitamin D intakes reduces bone loss and fracture rate when the calcium intake is adequate. Blood tests can measure the vitamin level; generally a daily supplement of 800 to 1000 IU of Vitamin D3 will ensure a good blood level.

Exercise may decrease fracture risk by improving bone mass in premenopausal women and helping to maintain bone density for women after menopause. Furthermore, exercise may decrease the tendency to fall due to weakness in both men and women.

Stopping smoking is strongly recommended for bone health because smoking cigarettes is known to speed bone loss.

One can read further information about preventing osteoporosis in Up to Date. The National Osteoporosis Foundation has a response to the bisphosphonate controversy and is an excellent resource for bone health for men, women and children.