Greetings and Blessings to ALL!
Prevention and Control of Influenza
Swine and other flu is transmitted through coughing, sneezing, or by touching something with flu viruses on it and then touching your mouth or nose. The symptoms include fever, body aches, cough, fatigue, headache, chills, and sore throat. Per government direction we cannot write prescriptions for tamiflu to be kept on hand just in case, because we could run out of the medicine for people infected or in close contact with someone with influenza. The following are tips and actions to prevent the spread of germs that cause flu and other respiratory illesses (and there is no vaccine now available to prevent swine flu).
1. Healthy Living (all of these help build your immune system)
-get plenty of sleep (at least 7 or more hours a night)
-eat a healthy diet (at least 5-10 servings of healthy veggies and fruits/day)
-exercise regularly (at least 1/2 hour a day 5 days/week of aerobic exercise)
-drink plenty of water (at least 64 ounces a day)
-take your Vitamin D!!! - A large study is to come out the end of the year showing significant help to avoid viral infections in people who take high doses of vitamin D taken for several weeks around viral outbreaks. Vitamin D is a steroid hormone that has profound efects on our immune system, and has been shown already that Vitamin D deficiencies predispose children to respiratory infections. Please read my earlier March blog for more about the vital importance of Vitamin D. During this several week time of the swine flu pandemic, I recommend taking for most teenagers and adults 5000iu/day (unless you feel you have a special condition/multiple problems that you want to consult us for your own dose). We carry a well absorbed and very inexpensive Vitamin D 5000iu capsule, and if we are not close to you or are currently out of stock (we have been going through a lot), please go to your local good health food store. Once the flu pandemic is over, then return to 1000-2000iu/day, unless we advise you differently. At your yearly physical and well child exams, please ask us to check your Vitamin D level to assess your individual ongoing need.
-take your other vitamins, especially a good multivitamin (in my For Your Health information sheet accessed on our website tabs see an article written by chiropractor and nutritionist Dr. Zimmer about how to pick out good vitamins and supplements), Vitamin C, and omega fish/flaxseed oil
2. Prevention Steps
-avoid close contact with sick people
-wash your hands with soap and water often (or alcohol based hand cleaners), especially after a cough or sneeze
-avoid touching your eyes, nose, or mouth (germs spread this way)
-cover your nose and mouth when you sneeze with a tissue
-if you get sick with influenza, stay home from work or school and limit contact with others
-if you are in close contact with a person diagnosed with influenza, please see us for evaluation and tamiflu prevention
Fitness Tips by Eric
My name is Eric Walden and Dr. Miller asked me to write for her blog to bring a different side of exercise. I am a fitness supervisor at Westview Healhtplex Sports Club. I have my BA from Purdue in Health and Fitness and I am a Certified Personal Trainer through American College of Sports Medicine.
The first part of what I want to share about exercise involves behavior. A lot of us are currently exercising, but there are also a lot of us that do not. I can give you a 10 minute or 20 minute routine to do, but the reality is most of you won’t do it because you are not ready to change. Your behavior is what makes you who you are and do the things you like to do. Below is the Transtheoretical Behavior Change Model.
Pre-contemplation - "people are not intending to take action in the foreseeable future, usually measured as the next 6 months"
Contemplation - "people are intending to change in the next 6 months"
Preparation - "people are intending to take action in the immediate future, usually measured as the next month"[nb 1]
Action - "people have made specific overt modifications in their life styles within the past 6 months"
Maintenance - "people are working to prevent relapse," a stage which is estimated to last "from 6 months to about 5 years"
Termination - "individuals have zero temptation and 100% self-efficacy... they are sure they will not return to their old unhealthy habit as a way of coping"[nb 2]
Where do you fall? Which stage best defines where are you at with your exercise? Once you figure this out you can start working towards your exercise routine. At first keep your routine simple. It doesn’t need to last long. Next time I’ll get more into the meat and potatoes of exercising. Change doesn’t come easy. It takes time, but once you do change you have to set your self up for success. Remember “KISS” Keep It Simple Silly.
Parenting Tips for Teens (taken from "For Parents Only", by Feldhahn and Rice)
1. Remember your teen has a desparate quest for freedom and fear of losing it. Get to know you teen. Set specific expectations, especially regarding driving, internet and cell phone use, informing you where they are/when they will be home, never lying (and the worst consequences for this). Choose discipline with their fear triggers in mind.
2. Who are you? Your teen is finding out who they are, and expect them questioning your values to be able understand and become their own individual. As parents, we need first to lead by example, and affirm who they are becoming (and spend the time to get to know them!). Say something like, "I love and value you and want to understand who you are becoming."
-more to come in my next blog
Remember, work to not worry or be anxious, even with the flu outbreak- carry one stick at a time!
"I compare the troubles which we have to undergo in the course of the year to a great bundle of sticks, far too large for us to lift. But God does not require us to carry the whole at once. He mercifully unties the bundle, and gives us first one stick, which we are to carry today, and the another, which we are to carry tomorrow, and so on. This we might easily manage, if we would only take the burden appointed for each day; but we choose to increase our troubles by carrying yesterdays stick over again today, and adding tomorrow's burden to the load, before we are required to bear it." by John Newton
Two antidotes to anxiety
Prayer - "Pray and let God worry." by Martin Luther
Trust - "Oh, how great peace and quietness he would possess who should cut off all vain anxiety and place all his confidence in God." by Thomas a' Kempis
"If we worry, we are not trusting God." by Dr. Lisa
"The Lord himself goes before you and will be with you, He will never leave or fosake you. Do not be afraid; do not be discouraged." Deut. 31:8
My prayers for all of us and our families and the world for health, safety, and to be filled to overflowing with the fruit of His Spirit - love, peace, joy, patience, kindness, goodness, gentleness, faithfulness, and self control!
Dr Lisa
Thursday, April 30, 2009
Sunday, April 19, 2009
Natural Hormones Men&Women, Job Search Tips, Money Saving Medical Tips, PSA Screening Blood Tests
Happy Easter & Happy Spring! – Natural Hormones for Men and Women, Job Search Tips, Money Saving Medical Tips, PSA Screening Tests, and More!
Welcome back to our blog!
Natural (Bioidentical) Hormones for Women and Men
Natural or bioidentical hormones are the same hormones naturally found in our bodies. The postmenopausal hormone replacements we used most commonly in the past were synthetic hormones without the exact chemical structure as hormones naturally occurring in our bodies. Large studies 5 to 10 years ago showed mild increases in cancer and cardiovascular risks with these synthetic hormones. We therefore stopped recommending them routinely for postmenopausal women (commonly for bone health and menopause symptoms). There have been no large studies on natural hormones and risks, because they do not have the funding of large drug companies because they are generic. When searching whether women should or should not be routinely on postmenopausal natural hormones, you can find experts solidly on either side. While I continually review literature and my experience with patients, I feel the decision of whether to be on natural hormones needs to be on an individual basis in consultation with your own knowledgeable physician. If your physician does not know about natural hormones, then seek a consult with a reputable physician who does (and even a nutritional specialist like pharmacist Jeff Jackson, chiropractor Dr. Ed Zimmer, and more). We are not taught about natural hormones in medical school, so this has to be acquired by Family Physicians, Gynecologists, Urologists, and Internists and others.
Women and Men both go through menopause – where our natural hormones decrease enough to cause symptoms. This hormonal decrease begins for each sex in their thirties. For most women, symptoms do not start until their forties and are a result from decreasing progesterone, testosterone, and estrogen. There are many possible symptoms for women, including hot flashes, night sweats, fatigue, sleep disorders, mood changes, inability to concentrate/fuzzy thinking, vaginal dryness, decreased libido, dry skin, weight gain, joint aches, decreased muscle and more. For most men, symptoms do not start until their fifties or even sixties and are a result from decreasing testosterone. The symptoms in men are low energy/fatigue, decreased libido, erectile dysfunction/weaker and fewer erections, mood changes and poor concentration, reduced muscle mass/strength, and increased body fat.
I suggest trying natural hormones for my female and male patients if they are having some of the above symptoms which bother and impact their lives. They can always stop the hormones if they do not like them enough for their effects, expense, and time. I first check blood hormone levels, and then discuss the hormone preparation options. Once they decide to try hormones, then I recheck levels after a couple months and see them in follow-up. If their symptoms and their hormone levels are in a good range, I just check them again at their yearly physicals. (Some specialists check saliva tests or fingertip blood tests, and each have their benefits.)
The costs of natural hormones vary, depending if your insurance plan covers them and what type you choose. For Men, they only usually need testosterone replacement, and this can be by a topical gel, patch, or injection. Testosterone cannot be well absorbed by our GI system, because the liver rapidly metabolizes it before it can get into our blood stream. This is why testosterone requires topical absorption or injection. Most men choose topical testosterone (usually 50mg/day) because we can get more consistent testosterone levels with topical absorption. There are drug company branded testosterone gels Testim and Androgel and patch Testoderm. These cost well over $100/month, but are often paid for by insurance companies with branded co-payments (you need to check with your own plan). You can also purchase quality testosterone gels from custom pharmacies like Custom Med Apothecary, and a month supply costs a little over $50. The gels are applied in the morning to the chest and upper arms, and usually significantly help with the male menopause symptoms.
Women commonly need all three hormones, estrogen, and progesterone, and testosterone (especially if libido issues or low bone density) once they are in full menopause. Prior to this, many women can benefit from only progesterone the last ½ of their cycles to help with PMS symptoms and pain with their periods. Testosterone (usually 0.5mg/day) for women is not made by any drug company, so it must be acquired from a custom pharmacy and is about $20-25/month. This can be applied in the morning to the arm or even to the clitoral area. Natural estrogen can be purchased in pill form, or as cream applied to skin or troches dissolved between gums or vaginally. The pill form, estradiole (1-2mg/day), is less expensive, but only has one of the body’s natural estrogens. The tri-estrogen troches (.125 - .25mg bid) or creams have all three of the body’s natural estrogens and help more for symptoms including vaginal dryness. These are only from custom pharmacies and cost about $15-25/month. Natural progesterone taken nightly (helps with sleep and other symptoms), comes in a brand name pill form, prometrium, and custom cream. Prometrium (100mg/night) is expensive unless your insurance company pays well for it. Progesterone cream (usually 30mg/day) is about $20-25/month from a custom pharmacy.
Money Saving Medical Tips
Check out several pharmacy discount programs especially for 3 month quantities, like Community's Wellspring Pharmacy, Kroger, Target, Walmart, and others. Remember, you do not have to be a member to get your prescriptions filled at Costco or Sams clubs. They often have the lowest prices on prescriptions. When you walk in the door, just let the greeter know you are going to the pharmacy to fill a prescription.
Many brand name medicines have coupons to significantly cut your co-payments available online or at the pharmacy (and often we have them in our office to be able to give to you). Another place you can check for discounts is a website http://www.medisave.ca/. A patient of mine gets generic Singulair there.
If your insurance does not pay for your lab tests or you do not have insurance, PA Labs (with several draw sites around the city) has a Health Fair Profile for $15. This consists of a metabolic profile (checks your blood sugar, kidney and liver enzymes, calcium, and more) and a full lipid profile. PA Labs prices for other labs are consistently good. Mid America Labs offers discounts on labs to patients with no insurance as long as the doctor notes it on your lab requisition,
If you have no insurance, our office offers 20% off your office visit charge if you pay at the time of service.
If you have a medical savings account, we can write you a note to be able to approve vitamins and other alternative medicine when appropriate (such as acupuncture, chiropractic, and even massages if we have seen you for neck/back/muscle pain) as medically necessary.
Job Search Tips
A patient of mine this week, Kelly, gave me some great information for those of you searching for jobs. First, the city libraries (especially the downtown library) offer classes to help you look for employment, and at one class that Kelly attended, they gave everyone a free flash drive. Librarians are trained to help you write your resume and search for jobs, so just ask them!
There is a book of 1500 key words which are what employers look for in their online job applications. You need to make sure that your first few lines in your application will grab their attention, because employers use this to weed out the many applications. So if in their job description they want someone who can “think quickly on their feet” or “multitask” and you can do that thing, make sure to say it at the very first!
Remember most jobs are obtained from networking. So let everyone you can know what you are looking for, and remind them when appropriate (like your hairdressers, friends, old coworkers, family, church family, schools, banker, etc.). Many churches (like College Park Church, http://www.yourchurch.com/) offer job search bulletins, bible studies, and classes.
Finally, once you get an interview, make sure to send a handwritten thank you card. Keep a file of who you have applied to and call or email again. Be organized and nicely persistent. I pray we all have/get jobs that we enjoy and can best utilize our God-given talents and abilities to their best!
And thank your Kelly for all your information!
New questions about the PSA screening prostate blood tests
A recent study in the news questions the merits of screening for prostate cancer. I have been discussing this with my patients when needed. I feel the PSA blood test should be drawn yearly, so we have the information to decide if the patient wants to do something if it is elevated. For elevations, I strongly recommend seeing a Urologist for consult and likely biopsy. If the biopsy is positive for cancer, then the Pathologist who interprets the biopsy and the Urologist can discover if it is an agressive fast growing type that should be agressively treated. Indianapolis Star copy editor, Carl Sygiel, wrote an excellent article about this in Thursday's, April 16th Indianapolis Star. He had surgery that day for agressive prostate cancer that he only found out about through a screening PSA test. My prayers and thanks are with him!
Faith and Family
Finally, celebrate we are among the living! My minister Aaron Brockett finished his sermon series, “One Month to Live”, and gave us many insights and thought provoking questions. (His sermons can be downloaded on itunes for free through Trader’s Point Christian Church’s website, http://www.tpcc.org/.)
Am I living passionately? (Am I living intentionally with clarity on the brevity of life, and what do I need to let go to move forward?)…
Am I loving completely? (Love is a decision, not a feeling. If I die today, would I be at peace in my relationships or is there a person I need to love more completely?)…
Am I living boldy? (Am I living in confidence with no regrets, and where and how well am I in this race?)…
Am I living humbly? (Do I have a teachable spirit and am I operating in wisdom – rather than asking if something is OK, ask if something is WISE. Am I a follower of Jesus or just a fan?)
Parenting Tip (from Milan and Kay)
Deliver your instructions in the positive whenever possible!
Instead of: "You get in and clean that room now and do not come out until you do!"
Try: "Feel free to join us for lunch after you have cleaned your room."
Instead of: "If you chew with your mouth open again I am going to send you to your room!"
Try: People at the table with good manners will get a special treatment tonight. I hope you can remember to chew with your mouth closed."
Marriage/Relationship Tip (observed from the Obama's and other great marriages)
Be persistent and intentional to have a lot on nonsexual intimacy - holding hands, hugging, touching each other when close, arm in arm at church while singing or other events. When you first get home after work, seek each other first before the kids and kiss, hug, and hold hands! Smile and laugh together daily!
With my thanks, hugs, and prayers,
Dr. Lisa
Welcome back to our blog!
Natural (Bioidentical) Hormones for Women and Men
Natural or bioidentical hormones are the same hormones naturally found in our bodies. The postmenopausal hormone replacements we used most commonly in the past were synthetic hormones without the exact chemical structure as hormones naturally occurring in our bodies. Large studies 5 to 10 years ago showed mild increases in cancer and cardiovascular risks with these synthetic hormones. We therefore stopped recommending them routinely for postmenopausal women (commonly for bone health and menopause symptoms). There have been no large studies on natural hormones and risks, because they do not have the funding of large drug companies because they are generic. When searching whether women should or should not be routinely on postmenopausal natural hormones, you can find experts solidly on either side. While I continually review literature and my experience with patients, I feel the decision of whether to be on natural hormones needs to be on an individual basis in consultation with your own knowledgeable physician. If your physician does not know about natural hormones, then seek a consult with a reputable physician who does (and even a nutritional specialist like pharmacist Jeff Jackson, chiropractor Dr. Ed Zimmer, and more). We are not taught about natural hormones in medical school, so this has to be acquired by Family Physicians, Gynecologists, Urologists, and Internists and others.
Women and Men both go through menopause – where our natural hormones decrease enough to cause symptoms. This hormonal decrease begins for each sex in their thirties. For most women, symptoms do not start until their forties and are a result from decreasing progesterone, testosterone, and estrogen. There are many possible symptoms for women, including hot flashes, night sweats, fatigue, sleep disorders, mood changes, inability to concentrate/fuzzy thinking, vaginal dryness, decreased libido, dry skin, weight gain, joint aches, decreased muscle and more. For most men, symptoms do not start until their fifties or even sixties and are a result from decreasing testosterone. The symptoms in men are low energy/fatigue, decreased libido, erectile dysfunction/weaker and fewer erections, mood changes and poor concentration, reduced muscle mass/strength, and increased body fat.
I suggest trying natural hormones for my female and male patients if they are having some of the above symptoms which bother and impact their lives. They can always stop the hormones if they do not like them enough for their effects, expense, and time. I first check blood hormone levels, and then discuss the hormone preparation options. Once they decide to try hormones, then I recheck levels after a couple months and see them in follow-up. If their symptoms and their hormone levels are in a good range, I just check them again at their yearly physicals. (Some specialists check saliva tests or fingertip blood tests, and each have their benefits.)
The costs of natural hormones vary, depending if your insurance plan covers them and what type you choose. For Men, they only usually need testosterone replacement, and this can be by a topical gel, patch, or injection. Testosterone cannot be well absorbed by our GI system, because the liver rapidly metabolizes it before it can get into our blood stream. This is why testosterone requires topical absorption or injection. Most men choose topical testosterone (usually 50mg/day) because we can get more consistent testosterone levels with topical absorption. There are drug company branded testosterone gels Testim and Androgel and patch Testoderm. These cost well over $100/month, but are often paid for by insurance companies with branded co-payments (you need to check with your own plan). You can also purchase quality testosterone gels from custom pharmacies like Custom Med Apothecary, and a month supply costs a little over $50. The gels are applied in the morning to the chest and upper arms, and usually significantly help with the male menopause symptoms.
Women commonly need all three hormones, estrogen, and progesterone, and testosterone (especially if libido issues or low bone density) once they are in full menopause. Prior to this, many women can benefit from only progesterone the last ½ of their cycles to help with PMS symptoms and pain with their periods. Testosterone (usually 0.5mg/day) for women is not made by any drug company, so it must be acquired from a custom pharmacy and is about $20-25/month. This can be applied in the morning to the arm or even to the clitoral area. Natural estrogen can be purchased in pill form, or as cream applied to skin or troches dissolved between gums or vaginally. The pill form, estradiole (1-2mg/day), is less expensive, but only has one of the body’s natural estrogens. The tri-estrogen troches (.125 - .25mg bid) or creams have all three of the body’s natural estrogens and help more for symptoms including vaginal dryness. These are only from custom pharmacies and cost about $15-25/month. Natural progesterone taken nightly (helps with sleep and other symptoms), comes in a brand name pill form, prometrium, and custom cream. Prometrium (100mg/night) is expensive unless your insurance company pays well for it. Progesterone cream (usually 30mg/day) is about $20-25/month from a custom pharmacy.
Money Saving Medical Tips
Check out several pharmacy discount programs especially for 3 month quantities, like Community's Wellspring Pharmacy, Kroger, Target, Walmart, and others. Remember, you do not have to be a member to get your prescriptions filled at Costco or Sams clubs. They often have the lowest prices on prescriptions. When you walk in the door, just let the greeter know you are going to the pharmacy to fill a prescription.
Many brand name medicines have coupons to significantly cut your co-payments available online or at the pharmacy (and often we have them in our office to be able to give to you). Another place you can check for discounts is a website http://www.medisave.ca/. A patient of mine gets generic Singulair there.
If your insurance does not pay for your lab tests or you do not have insurance, PA Labs (with several draw sites around the city) has a Health Fair Profile for $15. This consists of a metabolic profile (checks your blood sugar, kidney and liver enzymes, calcium, and more) and a full lipid profile. PA Labs prices for other labs are consistently good. Mid America Labs offers discounts on labs to patients with no insurance as long as the doctor notes it on your lab requisition,
If you have no insurance, our office offers 20% off your office visit charge if you pay at the time of service.
If you have a medical savings account, we can write you a note to be able to approve vitamins and other alternative medicine when appropriate (such as acupuncture, chiropractic, and even massages if we have seen you for neck/back/muscle pain) as medically necessary.
Job Search Tips
A patient of mine this week, Kelly, gave me some great information for those of you searching for jobs. First, the city libraries (especially the downtown library) offer classes to help you look for employment, and at one class that Kelly attended, they gave everyone a free flash drive. Librarians are trained to help you write your resume and search for jobs, so just ask them!
There is a book of 1500 key words which are what employers look for in their online job applications. You need to make sure that your first few lines in your application will grab their attention, because employers use this to weed out the many applications. So if in their job description they want someone who can “think quickly on their feet” or “multitask” and you can do that thing, make sure to say it at the very first!
Remember most jobs are obtained from networking. So let everyone you can know what you are looking for, and remind them when appropriate (like your hairdressers, friends, old coworkers, family, church family, schools, banker, etc.). Many churches (like College Park Church, http://www.yourchurch.com/) offer job search bulletins, bible studies, and classes.
Finally, once you get an interview, make sure to send a handwritten thank you card. Keep a file of who you have applied to and call or email again. Be organized and nicely persistent. I pray we all have/get jobs that we enjoy and can best utilize our God-given talents and abilities to their best!
And thank your Kelly for all your information!
New questions about the PSA screening prostate blood tests
A recent study in the news questions the merits of screening for prostate cancer. I have been discussing this with my patients when needed. I feel the PSA blood test should be drawn yearly, so we have the information to decide if the patient wants to do something if it is elevated. For elevations, I strongly recommend seeing a Urologist for consult and likely biopsy. If the biopsy is positive for cancer, then the Pathologist who interprets the biopsy and the Urologist can discover if it is an agressive fast growing type that should be agressively treated. Indianapolis Star copy editor, Carl Sygiel, wrote an excellent article about this in Thursday's, April 16th Indianapolis Star. He had surgery that day for agressive prostate cancer that he only found out about through a screening PSA test. My prayers and thanks are with him!
Faith and Family
Finally, celebrate we are among the living! My minister Aaron Brockett finished his sermon series, “One Month to Live”, and gave us many insights and thought provoking questions. (His sermons can be downloaded on itunes for free through Trader’s Point Christian Church’s website, http://www.tpcc.org/.)
Am I living passionately? (Am I living intentionally with clarity on the brevity of life, and what do I need to let go to move forward?)…
Am I loving completely? (Love is a decision, not a feeling. If I die today, would I be at peace in my relationships or is there a person I need to love more completely?)…
Am I living boldy? (Am I living in confidence with no regrets, and where and how well am I in this race?)…
Am I living humbly? (Do I have a teachable spirit and am I operating in wisdom – rather than asking if something is OK, ask if something is WISE. Am I a follower of Jesus or just a fan?)
Parenting Tip (from Milan and Kay)
Deliver your instructions in the positive whenever possible!
Instead of: "You get in and clean that room now and do not come out until you do!"
Try: "Feel free to join us for lunch after you have cleaned your room."
Instead of: "If you chew with your mouth open again I am going to send you to your room!"
Try: People at the table with good manners will get a special treatment tonight. I hope you can remember to chew with your mouth closed."
Marriage/Relationship Tip (observed from the Obama's and other great marriages)
Be persistent and intentional to have a lot on nonsexual intimacy - holding hands, hugging, touching each other when close, arm in arm at church while singing or other events. When you first get home after work, seek each other first before the kids and kiss, hug, and hold hands! Smile and laugh together daily!
With my thanks, hugs, and prayers,
Dr. Lisa
Subscribe to:
Posts (Atom)