Screening and Treatment of Alcohol Abuse, Eric's Tips, Jonah, MOPS & 5 Point checklist

Your are so very special and dear to God - Welcome! I hope your are enjoying the beautiful Fall colors! This past week I had the honor of speaking to MOPS (Mothers of Preshoolers) at my church, Trader's Point Christian Church. I will review the subject of alcohol abuse, my talk to MOPS, and lessons from Jonah, along with Eric's Tips. (Above picture is from my parent's 60th wedding anniversary celebration.)

Screening and Treatment of Alcohol Abuse

Alcohol abuse and dependence are associated with 100,000 deaths each year in the US (traffic deaths, cirrhosis of the liver, cancer, heart disease, and more), cause 30 - 40 percent of all traffic fatalities, and affect approximately 10 percent of Americans at some point in their lives. Unhealthy alcohol use affects 7 to 20 percent of Americans, and risky drinking affects up to 30 percent (and binge drinking affects over 40 percent of teens and college students). Early drinkers are FOUR times more likely to develop alcoholism than those who begin alcohol intake at age 21.

Binge Drinking = 5 or more drinks at one sitting for men, 4 or more for women

At Risk Drinking (or Heavy Drinking) = greater than 14 drinks per week or 4 drinks per occasion for men, and greater than 7 drinks per week or 3 drinks per occasion for women

Alcohol Dependence = maladaptive(problematic) pattern of alcohol use associated with 3 or more of the following:
-Tolerance
-Withdrawal
-Substance taken in larger quantity than intended
-Persistent desire to cut down or control use
-Time is spent obtaining, using, or recovering from alcohol
-Social, occupational, or recreational tasks are sacrificed
-Use continues despite physical and psychological problems

Standard drink = 12 oz of regular beer, 5 oz of wine, 1.5 oz of 80-proof distilled spirit

Moderate Drinking = LESS than 3 drinks per day for men, and LESS than 2 drinks per day for women

We work to screen all patients for alcohol misuse (current and past). Alcohol abuse and dependence run in families, and 1st degree relatives have a 3 to 4 fold increased risk of alcohol abuse than the general population. Depression and mental disorders are much more frequent in people who misuse alcohol, and it is estimated that alcoholism accounts for 25 percent of suicides. As many as 80 percent of people with alcohol problems smoke, and 30 percent of smokers have alcohol problems. Red flags for the possibility of alcohol abuse and dependence are driving while intoxicated, job loss, physical trauma, frequent emergency room visits, unexpected accidents, and frequent family problems.

Screening Questionnaires - These are better than laboratory tests for detecting heavy or problem drinking in groups of people (on routine physical labs, elevated liver enzymes can be a clue to heavy/problematic drinking). One of the best, easiest, and most common questionnaires is the CAGE Questionare.

CAGE Questionnaire
-Have you ever felt the need to Cut down on drinking?
-Have you ever felt Annoyed by criticism of your drinking?
-Have you ever had Guilty feelings about your drinking?
-Do you ever take a morning Eye opener (a drink 1st thing in the morning to steady your nerves or get rid of a hangover)?

The goal of treatment for alcohol misuse, abuse and dependence can be broadly seen as restoration of medical and social well-being by control of the alcohol problem. One group has defined recovery as "a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship". Treatments include: motivational enhancement therapy (motivational counseling), brief intervention (ask about alcohol use, Assess, Advise, Assist), cognitive behavioral therapy, hospitalization and referral, Alcoholics Anonymous (abstinence is encouraged "one day at a time", and the Twelve Step Program uses the acknowledgment that alcohol has led to loss of control that recovery is a spiritual journey through belief in a higher power, and through personal exploration and acceptance), and medicine therapy (naltrexone, acamprosate, nalmefene, disulfiram=antabuse, topiramate, and others), and nutrition and exercise.

Eric's Tips - coming soon

Family and Faith

MOPS Talk

I shared my most passionate topic for young mothers - make certain your actions and thinking and time show that God and then your husband are the most important things in your life. I made many mistakes in my first marriage, and know God wants me to use my knowledge from this to help keep marriages healthy and great for God. How you spend your time shows exactly what is most important to you (like tonight I made certain to read the Bible with my husband and nine year old before I started work on this blog, as well as going weekly to church, small group, and woman's bible study, and working to daily respect and affirm my wonderful God-given treasure of my husband Bruce, and then near daily exercise and healthy diet to maintain my health). As a wonderful Godly woman and patient of mine Kathryn discussed with me when she found out that I was talking with MOPS - "If a child sees he can manipulate you as a couple he will do so, but actually feels much more secure and less likely to act out if you and your husband love and respect each other and work as a team. A child must feel safe and if their foundation is not strong - then problems start - then this creates tension on the marriage -- stop all this before it starts by always keeping God first and husband. Work to always kiss/hug and greet each other first before kissing and hugging your children - even if they come running to you 1st, you will make a lifelong lesson of marriage the priority by making them wait until you hug and kiss Mommy or Daddy first."

I also discussed that mothers and fathers need to remember that you and God (the Lord of our lives and not our consultant) know your children the best. We physicians are here as your consultants - you listen to our recommendations, but you make the ultimate decisions with your children along with prayer and God's direction. I recommended reading or listening to the great parenting book/guide, "Shepherding A Child's Heart", which we have at our office for checkout of the audio cd and my detailed summary of the book under Resources on our website. Kathryn also has a great suggestion of praying with your child while you are driving (for example, behaving at school, giving the child strength through faith, tests, etc.), and having family hugs at the end of each day for forgiveness.

Lessons from Jonah

Our minister Aaron just finished a 5 week sermon series on Jonah (can listen free through itunes on the church website www.tpcc.org). He discussed that we all are at times like Jonah - running from God and making half hearted efforts. We need to make sure we are running to God and letting Him guide our hearts and actions - so that we can say "Yes God" before we even know His question. Our God pursues us as we run. We need to remember that God sends storms to reclaim us back to God and not to destroy us. We need to ask God to transform and grow us through the storm (not just deliver us from the storm). Deep change results from deep struggle.
Finally Aaron discussed the amazing topic of GRACE this Sunday. After being the beneficiary of God's grace, then Jonah did not want God to give grace to Ninevah. This well illustrates that grace is easy to receive but not easy to give. We need to remember that - I am saved by grace to give grace! Justice is getting what you deserve. Mercy is not getting what you deserve. GRACE is getting what you never expected to receive. If we live lives devoid of grace, we will seriously erode our integrity. We need to remember each one of us IS the church with the most important commandment to LOVE, and then to die to self and remember always that we are saved by grace to give grace.

5 Point Checklist - remember to teach our children to ask themselves these questions
Is it wise?
Is it safe?
Is it healthy?
Would God agree/approve,?
Would my parents agree/approve?

I thank our amazing God for each one of you so wonderfully and specially made, and thank Him for providing for us, blessing us, and always pursuing us. I pray for all of us to be wonderfully transformed through our storms; that God gives you and your family health and safety, and to be filled to overflowing with the fruit of His Spirit; and that we always remember and use for God's kingdom the supernatural all-powerful Spirit in us!
Dr. Lisa

Influenza, Eric's Fitness Tips, Please Forgive Me!, Annointed

Greetings and blessings to all in this beautiful Fall! Happy Birthday to Brendan (now 15) and Annika (now 9), and all of you dear special people on your birthdays! We celebrated Brendan and Annika's birthdays, and then early last week found out Annika had influenza A (most likely H1N1, but we do not send off a definitive culture because it takes too long). She missed last week from school and will return tomorrow. We thank God that she has not been very sick, with her highest fever being 99.7, and the rest of us have avoided the illness. I will give you a flu update below. At Northside Family Care, we have been extremely busy handling the flu outbreak and many other illnesses, along with having two staff and one doctor out with influenza. I am praying for all...
"Have compassion on me, Lord, for I am weak. Heal me, Lord, for my bones are in agony." Psalm 6:2
and thank Him that He promises, "I have heard your prayer and seen your tears; I will heal you!" 2Kings20:5

H1N1 Influenza
The government and CDC continue their work to distribute the H1N1 influenza vaccine. Ours and most offices will not be getting the H1N1 vaccine, and we continue to wait the announcement of vaccination sites. Many schools anticipate being sites for vaccination. As it is also in the seasonal flu vaccine, the H1N1 vaccine is available in the live attenuated nasal mist vaccine and the killed virus injectable vaccine. If the H1N1 vaccine had been discovered just 2 weeks earlier, it would have been included in the seasonal vaccine. Children under the age of 9 getting the H1N1 vaccine should get 2 vaccinations, each one month apart.

The CDC recommends the most important to immunize are pregnant women, household contacts and caregivers of children younger than 6 months of age, healthcare and emergency personnel who have direct contact with patients, children age six month to 24 years, then adults who have medical conditions that put them at high risk. People over 60 have developed the H1N1 flu much less frequently, probably from exposure to past flu strains (one benefit of being older!). I will be getting the H1N1 injectable vaccine for myself and all my children when/if it is available. I have already had all my children and family immunized with the seasonal flu vaccine.

Symptoms of infection with H1N1 flu virus are similar to those of seasonal flu, including fever, cough, sore throat, body aches, headache, chills, and fatigue, but with some H1N1 infections it also includes vomiting and diarrhea. The virus can be spread by coughing, sneezing or touching surfaces contaminated with the virus and touching your nose or mouth. You are considered contagious beginning 1 day before the symptoms appear, and at least 24 hours after your fever has resolved.

Most people with flu recover within 1 – 2 weeks without treatment. However, serious life-threatening complications can occur, such as pneumonia. If any of the following symptoms develop, call us immediately – shortness of breath or difficulty breathing, purple or blue discoloration of the lips, pain or pressure in the chest or abdomen, signs of dehydration (dizziness when standing, persistent vomiting, not passing urine, or in infants lack of tears or few wet diapers), confusion or less responsiveness than usual, unusual irritability, seizures or convulsions, severe vomiting or unable to keep fluids down.

Prevention and Control of Influenza

H1N1 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. Tamiflu and Relenza can help speed healing from the flu if taken within 48 hours of flu symptom onset, so please call us right away if you think yourself or a family member may have the flu. Per government direction we cannot write prescriptions for Tamiflu or Relenza to be kept on hand just in case of infection, because we could run out of the medicine for people infected with influenza.

The following are tips and actions to prevent the spread of germs that cause flu and other respiratory illnesses.

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 2000 - 5000iu/day (unless you have had kidney stones or 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

3. You can find out more information on the CDC website - http://www.cdc.gov/.

Eric's Fitness Tips - More on Nutrition!

More on Nutrition

By Eric Walden

Last blog we talked about how to cut some calories out of your everyday diet. This week I am going to talk a little more in depth about what you should be eating.

At the least, I recommend a 2000 calorie a day diet. The reason why I recommend this is because if you work out for an hour burning around 400-600 calories, your body really only gets 1400-1600 calories for the day. If you only consume 1200 calories a day, then you work out for an hour burning 4-600 calories your body only gets 4-600 calories to function on. This is not enough calories for your body to function. I bet you’re thinking by doing that you’ll just loose the weight faster, right? Not so. If you do this, your body goes into starvation mode. It stores all that it can as fat for energy later.

To help break down the 2000 calories here is what I recommend. Fifty percent should come from carbohydrates, 25% from proteins and 25% from fat. This is a balanced diet for the average person. With that said it can be adjusted for different individuals that have different needs/goals. This break down gives individuals enough nutrients to meet the daily needs.

To break it down even further we can break it down to grams. Grams are how the nutritional value is written on the packages of food. With a 2000 calorie diet it is easy to break down. One carbohydrate calorie equals 4 grams, 1 protein calorie equals 7 grams and 1 fat calorie equals 7 grams. From this information we figure out how many grams of each group you should consume. We already broke it down to 50%, 25% and 25%. Now just do a little math to get how many grams. To get the carbohydrates take (2000*.5)/4= 250 grams. 250 grams of carbohydrates is the amount you should consume in one day. To get proteins and fats use the same equation (2000*.25)/7=71 grams. 71 grams of protein and fat should be consumed each day. When you look on a food label it will tell you how many grams of each of these are in the food you are eating. Be careful because on labels they will tell you the nutritional value for one serving, but there will be more than one serving in the container.

For a weight loss diet I will typically adjust the carbohydrates and proteins. I will lower the carbohydrates by 10-15% and raise the protein value the same. This tells the body to build up the muscle and store less fat. I don’t adjust the fats much lower, because the fat does a lot for joint lubrication. I have done less and I have felt a big difference in my joints because of it.

I hope this has helped you understand nutrition a little better and helps you decide how you should eat. Nutrition can be a very tricky subject and there is a lot of information out there. I like to keep nutrition as simple as possible. With this set up it is easy to add your favorite foods (ie. Dairy Queen BlizzardJ my favorite). The nice thing is you can plan for such indulgences. One of the easiest ways is work hard 6 days a week at your nutrition then allow yourself a “cheat” meal or day. This helps with nerve racking of keeping to a stricter diet. Or you can start out slow and work your self up to the 6 days if you find it hard to start out with 6 days right away. The best advice I can give you is to PLAN AHEAD! By planning ahead you can avoid the pitfalls of stopping at a fast food restaurant when you have healthy food at home. Also by keeping healthy snacks in your purse or desk drawer at work will keep you on track instead of hitting the vending machine.
If you have questions about this article please get in contact with me at eric_walden@waldospersonaltraining.com or by phone at 765-404-7343. I would love to help you meet your goals when it comes to fitness and nutrition.

Family and Faith

For all ages! "Please forgive me for...."

Instead of simply saying yourself or instructing your children to say they are "Sorry", instead instruct yourself and your children to say with any offense, even if it is losing your calmness with your children, "Please forgive me for..." then humbly wait for a response. This has been revolutionary and so much so relational in our Bleeke/Miller household and beyond. I was so happy just the other day for my daughter Annika on her own to ask a friend for forgiveness for not thinking before blurting out something hurtful ("that outfit is ugly"). Please ask God to help you work on this in your household!

"Annointed, Transformed, Redeemed - A Study of David", from the Deeper Still event with Priscilla Shirer, Beth Moore, and Kay Arthur

I, Dr. Miller, am doing this study in my Friday AM woman's bible study this Fall. As with any time deep into God's word, it is great! I have just finished Priscilla Shirer's 1st third.

Annointed
"It is not that we are qualified to do anything on our own. Our qualification comes from God."2Cor.3:5

Priscilla reminds us that we need to be aware each day and each moment of our Lord's annointing upon our life - we have direct access to our most high God (through His word and prayer), and are guaranteed victory and supernatural results when we are obedient to God (and sincerely repentant when we are not). Prayer is the most potent weapon we have for access to God and to turn away Satan. Are we making time with God our priority? Because the better you know God, the better you hear Him. Remember that God is not our personal consultant (where we make the final decision and so He will not be as active or powerful), but the Lord of our lives and the All Powerful God!

Priscilla says.."Discovering that divine guidance is a benefit of the annointing has changed my life in unbelievable ways. Now I approach my time with the Lord and His written word (logos), fully anticipating that He has a specific word (rhema) for me. And since I believe He has direction to give me, I am more willing to patiently wait for His response before moving forward."

My hugs and prayers for all of you such dear and special treasures of God and your families - for health, safety, the fruit of His Spirit, and to be protected from everything except God's glory!
Dr. Lisa