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Wednesday, June 1, 2011

How to Prevent the Flushing Associated with Niacin Products for Cholesterol

The standard advice has been to take 1 adult aspirin about 20 minutes before the dose. This works reasonably well for most people. Another approach I recently heard from a patient was to take 3/4 cup of applesauce directly before taking the dose (in this case it was 2000 mg a day). The patient reports she has had no trouble since.

Comment: This is a new one for me. It sounds like a great idea. I certainly prefer applesauce to an aspirin. For any of you in the community on niacin, give this a try and let me know how it works for you. Our own little Portola research project!

Thursday, April 21, 2011

What is Relaxation?

Answer: In my formula for health-- 0-5-10-30-150 (0 cigarettes, 5 servings of fruits and vegetables, 10 minutes of relaxation or stress reduction each day, a BMI < 30, and 150 minutes of exercise, e.g., walking, each week), I call for 10 minutes of relaxation each day. When I ask patients questions about the 5 elements of the formula for health, they seem to have the most trouble answering the question about relaxation. The way I usually ask it is, "Do you do anything on a regular basis, daily or nearly daily, just to unwind and relax?" 
     I get a wide range of answers. Some of which do truly count as relaxation in the sense that I mean, and others that do not.

     Answers that are obviously acceptable are "meditation" or "yoga."  We have lots of excellent resources for learning how to this in town. So contact some of our fellow wellness committee members.
     Also acceptable and well within the intent of this question is "prayer" or "reading the bible."
     In fact, reading, if you sustain it for at least 10 minutes at a time, is also a good answer.
     "Taking a walk," is also a very good answer and adds to the amount of exercise you get as well.

     Some people answer, "I watch TV." TV generally is not a good answer, but there are some exceptions. The problem with TV is that most shows and all commercials are designed to get you wound up. The exception would be watching a good movie with a strong narrative, no violence, no sex, and no commercials. This would be genuinely relaxing in a healthy way. In general, it would be far better to turn the TV off and sit in your favorite chair and do nothing. Just be silent. For a full 10 minutes. This is perfectly what I am asking for with the Formula for Health. This 10 minutes of silently doing nothing (and handling no interruptions--no phone calls, text messages, conversation with guests) is as simple as one can make relaxation, and it is highly effective. You do not want to spend this 10 minutes, however, worrying about bills, or stress at work, or problems with the kids. Your job is to let all this go for just 10 minutes. If you need help keeping these kinds of thoughts out, you can turn on some peaceful music (no loud bass or clashing cymbals) or just concentrate on your breathing, paying attention as your chest wills up with each breath all the way until the point where the breath turns around and high tails it out of there, slowly, and pay attention all the way until the next turning of the tide. It is almost impossible to do this without relaxing.

     Some people suggest "having a glass of wine or beer or a cocktail" as their preferred moment of relaxation. This is actually not a great way because alcohol, while it does tend to help you relax, it also helps you to escape from yourself, to tune out as it were.  This is not a desirable form of relaxation. To really relax you have to be fully present with yourself and just letter go of all the everyday, ordinary busy stuff of life. Alcohol will take you too far out of that zone.

Another question people have is, "Well, honestly doc, how much benefit am I going to get from only 10 minutes of relaxation?" This is a very good question. Here are some basic facts:
     1. Stress kills. Ultimately stress accounts for about 33% of all heart attacks. It also contributes to higher levels of lipids, adrenalin, calcium deposits in the arteries, etc.
      2. Stress is treatable and needs to be treated. The treatment is explicit relaxation or stress reduction. 10 minutes is the minimal effective dose. You can get your heart rate to slow down and your breathing to slow down and your muscles generally to relax in 10 minutes.
      3. Of course, a single dose of almost any medicine doesn't do you very much good. The real value lies in repeating the dose until you complete the whole course of therapy. With respect to stress, the whole course of therapy is daily for the rest of your life.

     4. When you do relaxation for 10 minutes daily, the benefit you get is more than just adding up all those 10 minute periods, but, of course, you do get that. But if you relax daily, especially if you relax at around the same time each day, you are actually creating a positive addiction. When your body gets used to the idea that you  are really going to take some time out just to relax every day at a specific time, your body starts looking forward to it, and relaxing, hours in advance of the actual time. [Remember how all the fun of waiting for Christmas was in the weeks before Christmas, and how it rapidly faded on Christmas Day itself, and was generally gone by the day after.] This period of "anticipatory relaxation" is how a habit of relaxing formally for only 10 minutes a day can page huge dividends, far more than the accumulation of multiple units of 10 minutes, when maintained on a daily basis. Your body will like it. It will really look forward to it. In fact, after a while, you will feel incomplete, if you don't do it. And ultimately your body will thank you for it by developing fewer and smaller quantities of behavioral responses (stress reactions) that contribute to heart and vascular disease. 
     Try it. For just 10 minutes a day. Every day. At the same time.

Wednesday, April 13, 2011

Tuesday, April 12, 2011

Does a woman ever get to stop having to get Pap smears?

The answer is YES. Since cervical cancer is caused by human papilloma virus, which is almost exclusively a disease of younger women, if a woman has had 3 negative Pap smears between the ages of 55  and 65, she may safely elect not to get Pap smears any more.

Also, if a woman has had a hysterectomy for a benign (non-cancerous) condition like fibroids or bleeding, then it is no longer necessary to have Pap smears done.

If a woman has had a hysterectomy for any kind of cancer, then she should continue to get a Pap smear every 5 years up to age 65.

For how long should a child take fluoride if there is not adequate fluoride in the water?

The experts state that children should take fluoride up to and through age 16. Many parents are not aware of this and think fluoride supplements are only for young children. As long as teeth are growing, fluoride is especially important. Remember, by at 55 in the US 33% of the population will be edentulous (i.e., have no teeth). The prevention of this tragedy begins in childhood. Protect your children with fluoride.

The recommended doses of fluoride for children in places where the water has less than 0.3 ppm of fluoride (i.e., Plumas country) are:

Birth to 6 months: 0
Age 6 months to 3 years: 0.25 mg daily
Age 3 to 6 years: 0.5 mg daily
Age 6 year up to 16 years: 1 mg daily.

If your older child (up through 16) is not taking fluoride, just ask for a prescription the next time you're in.

Does periodontal disease make you more likely to get bronchitis or pneumonia?

The answer is YES. Periodontal disease represents a marked overgrowth of ordinary oral bacterial germs. When you get a bronchitis or pneumonia, these infections come from your own germs getting somewhere they're not supposed to be.  The more germs you have in your mouth the easier it is to get an infection like this. People who have periodontal disease have far higher oral bacterial counts than the average person.