New Year's Resolutions... Will You Keep Them?

As 2011 approaches, many of us will be making New Year’s resolutions. Some of the most popular resolutions will follow the usual tradition: to make a commitment to fitness, stop smoking, and lose weight. But times are changing, and so do the resolutions. Now, with economic stress and job pressure, many people may choose to "shoot" for a less stressful life.

In reality, 50% of those who start an exercise program drop out within less than 6 months and their treadmills become dust collectors; too many lost pounds are rapidly regained, and cigarettes continue to be a big seller. And soon after you enjoy a few days of rest, daily stresses resurface. So how do you succeed?

Don’t try to make too many changes. Identify the issues most important to you, and concentrate on the top two. For most people, this translates into increasing exercise, and managing stress.

Exercise: For beginners, it's extremely important to make realistic goals. Trying for a six minute mile on the first day is not realistic, and potentially dangerous. Cardiovascular exercise is the most important, with stretching and moderate muscle strengthening next.
Start exercising slowly. Gradually increase the intensity and duration in small increments until a relatively high level of exercise can be tolerated. Even if you are a regular exerciser and took a “holiday break,” restart at a lower level, and progressively return to your usual level. If you’re sedentary or over 35 years old, or are not known to be in excellent health, see your health care provider before strenuous exercise.

Stress: What is stressful to one person may not be stressful to another. Stress is best defined as a situation which requires a behavioral adjustment (Dr. Herbert Benson, Mind/Body Medical Institute). Stress increases the body's adrenalin production, and with it physiologic changes occur, including a rise in heart rate and blood pressure. This was the flight-or-fight response of the cave man, frequently unsuitable for dealing with “modern” stress. Some stress is important as a motivator for daily function and long-term achievement, but excess stress takes away from life’s enjoyment and productivity, and can make hypertension and other medical conditions permanent.
The Relaxation Response is an effective antidote to stress, which can be learned and practiced by almost anyone. It can be elicited by many techniques, including meditation, diaphragmatic breathing, imagery, yoga, and progressive muscle relaxation. All techniques involve a brief, intense focusing of attention, and the passive disregard of everyday thoughts. Many books have been written on the subject, and a copy of a progressive muscle relaxation routine can be obtained from our office (just give us a call or request it on your next visit).

There is a wonderful synergism between exercise and stress management. With regular exercise, the body produces its “relaxation hormones,” endorphins; and with relaxation management, the likelihood to succeed in exercise increases remarkably.

People who exercise regularly and practice stress management say that, to them, these habits have become an addiction. What a great “addiction” to have…

I Can't Exercise - Just Do It!

 

I am not here to convince you to exercise; you already know the reasons why you should. Yet, more than 60% of Americans under-exercise, and of these, more than 25% are simply sedentary. The remainder of this writing is taken from my previously published  EzineArticles and other articles.

Common reasons given for failure to exercise include: I don't have the time...I'm too tired...I don't know what type of exercise to do...I have a medical condition (usually a "bad heart," back pain or knee pain)...I'm too heavy... I become short of breath...I can't afford the gym...It's boring...I'm too old.

And there are more innovative excuses: my uncle lived to 106 and he never exercised (we should all be blessed with such good genes)...It's too cold outdoors in the winter...I'm always away... I do enough at work...

You get the idea.

Almost any form of physical activity is helpful, but a good exercise program should include at least 30 minutes of moderate, aerobic physical exercise most days of the week. Examples of aerobic exercise are brisk walking, jogging, bicycling, swimming and aerobic dance. An effective exercise program should include:

• Warm-up, 3 to 5 minutes. A warm-up gradually increases your heart rate and the blood flow to the heart and muscles preparing them for exercise. To warm-up, do the activity you have chosen to do (for example walking or biking), but at a slower pace during the warm-up period.
• Aerobic activity, at least 30 minutes (build up gradually from 15 minutes over several weeks). With aerobic exercise you use more oxygen to burn calories for the extra energy you spend. Exercise within your target heart rate zone (target charts are available in gyms, on the net, and at your doctor's office).
• Cool-down 3 to 5 minutes. Cooling down allows your heart rate, breathing and blood pressure to return to normal, and allows you to stretch better.
• Stretching, 5 to 10 minutes. Stretching will improve your flexibility, decrease muscle soreness and help you relax. It's important to stretch those muscles you were using during exercise. Hold each stretch for 15-20 seconds, but don't stretch to the point of pain.
• Strength training, which is a very important component of a good exercise program.

Before you start an exercise program, check with your doctor if you are over 40 or have a history of medical problems. If you truly have special needs, a reasonable exercise program can usually still be designed for you.

Start before it's time for New Year's resolutions

Are you interested in checking your degree of conditioning and your general exercise capacity? We have a unique testing facility where we measure your maximum oxygen capacity (known as vO2max) and tell you how fit you are. The test is done as part of a cardiopulmonary exercise evaluation, under medical supervision. We are the only free standing medical facility in our area performing this type of evaluation.

Watch those new HMO premiums

Beginning in January 2011, it is expected that most group and individual health insurance premiums will increase significantly. Most health insurers are seeking increases of more than 20%. It remains to be seen how much of it will be approved (I bet most of the requested increases will be approved). The biggest offenders appear to be Anthem Blue Cross and Aetna. In our experience, Anthem is also been shown to reduce benefits more than others.

This may be the right time for you to look at your health insurance plan, and, assuming you are in a position to do so, choose the policy that best fits your needs.

You may want to take a few points into consideration:

1. A high-deductible, lower premium policy, may save you money if you're generally healthy and able to take a limited monetary chance. Most of these policies still pay for yearly preventive care. Our practice does its part of cost control by keeping fees as low as possible for uninsured visits.

2. Our practice is not an Anthem provider (we're in litigation, we've filed suit).

3. We have special programs for the uninsured, which take into account your economic situation, and help you take advantage of cost saving programs outside our practice (e.g., lab tests and imaging studies).

Don't forget that, in the end, much of your future health is up to you. US health care is still reasonable, but the main reason we rank only number 37 in the world in longevity, is our faulty lifestyles.

So, make sure you don't smoke, limit sugars, starches and saturated fats, and please exercise!

Have a great holiday season.

Weight loss 101 - a beginner's primer

Weight loss should be taken seriously. It's a contract between you and your body. Guidance can come from many sources: your nutritionist, your doctor, or a recognized weight loss organization; but if you don't work at it, you'll be disappointed with your results.

Generally, you'll be given a diet and/or sensible eating guidelines. Our many years of experience have demonstrated beyond any doubt that "sticking to it" pays off handsomely in the end.

Your daily caloric consumption (your metabolic rate) can be estimated by measuring your REE (Resting Metabolic Expenditure), and adjusting this measurement for daily activity. The test is available at our facility.

If you decrease your calorie intake by 500 calories a day, you should lose approximately one pound a week. You'll lose more in the first week because of excess water loss.

If you increase your physical activity you'll lose more, depending on your type of activity. Walking a mile on flat ground burns 100 calories on average. Doing intense activity on a regular basis will also increase your metabolic rate, and further enhance the rate of your weight loss. Do not take on intense physical activity without consulting your physician.

Stick to your assigned daily caloric intake.

Weigh yourself frequently (daily is OK) on a reliable scale, same scale each time, preferably when you first wake up in the morning, before breakfast and before getting dressed. Record your weight on a single sheet (preferably on your computer, use Excel or a similar program if you have it), and bring it with you at your next visit with your health care provider.

Food calories
Fat: 1 gram has 9 calories
Protein: 1 gram has 4 calories
Carbohydrates: 1 gram has 4 calories
Alcohol: 1 gram of alcohol has approximately 7 calories

Fat is "calorie dense," it's packed with calories. Some fat is essential, and it helps keep appetite in check.

Most vegetables are "volume foods" with few calories and a lot of nutritional value; and they help fill your stomach.

Sugars of any kind (watch out for high fructose corn syrup, cane powder, "organic brown sugar" and others) are unhealthy carbohydrates. The same is true for white flour products and starch. Whole wheat products are a much better choice.

Take a close look at food labels, and make sure you look at the line that tells you how much sugar is in each portion; the less the better. There are acceptable sugar substitutes such as blue agave nectar (a liquid) and erythritol (sugar-like crystals).

Organic foods. Organic food is great. It's grown without chemical pesticides, hormones or antibiotics. But organic food may still contain unacceptable amounts of fat and sugar. So, again, don't forget to look at the food labels.

Snacks. It's OK to have snacks, but don't forget to take them into account when you calculate your calorie intake for the day.

Eating out. Eating out is not a sin. It's sometimes hard to keep a calorie count when you eat out. If you feel you over-ate, cut down the next day. Better yet, "bank" your calories by cutting down a little a day earlier.

Don't be embarrassed to ask the waiter to make sure that sauces are not too heavy, or to express other weight concerns you have. Don't rely on "iffy" answers: it's OK to ask to talk to the chef.

Use of special medications. Occasionally, medication may be prescribed to help you lose weight. These are usually meant to decrease you're appetite or the desire for food. Many of our patients have benefitted from the temporary use of appetite suppressants. But these medications are not meant to be a substitute for portion control, and their use has to be prescribed by a physician and monitored periodically.

Good luck in pursuing your weight loss goals.

A visit to Israel and a treatment for psoriasis and dermatitis

My wife and I returned today from a 12 day trip to Israel (which we have done many times before), and were back at work before noon.

This was a dual purpose trip: visit family, friends and new sites; and re-visit the developers of the new EdenSkin line of products designed to treat common skin conditions such as psoriasis, atopic dermatitis and seborrheic dermatitis.

Some of the exciting sites included the impressive IDF air force outdoor museum in the Negev; the Tel Aviv museum which exhibited the unusual and unique photos of David LaChapelle (born in Fairfield, CT); the Palmach museum in Tel Aviv commemorating the importance of this organization in the creation of the state of Israel, and the Druze village of Dalyiat el Carmel on the slopes of Mount Carmel overlooking the breathtaking Izrael Valley.

And on the medical front, we learned a lot more than what we already knew about the Israeli health delivery system, how effective it is, and how much simpler it is than what we have here. More about it in the future.

We also completed our review of the EdenSkin family of products, developed by a small company in Kfar Saba.

We have been watching the development of QoolSkin for several years. I've been using it successfully in the office for a while. It's herbal, and it contains no steroids, parabens, colors or fragrances. Most importantly, its side effect profile is extremely low, and it works where conventional therapy doesn't. We now keep the product at our office.

Other EdenSkin products include TopicSkin, also an herbal preparation, which I have used for the treatment of allergic dermatitis, and SeboSkin, which I intend to use for the treatment of seborrheic dermatitis.

Looking at the whole picture, this was a great trip, which also carries a potential benefit to our patients.

Avoid those extra winter pounds

Winter is approaching, and the natural tendency for many of us was to stay indoors. For many of us, lack of activity and overeating follows, and the result is those frustrating extra winter pounds.

Weight gain is not only a medical issue. Sure, there is an increase chance of diabetes, high blood pressure, accelerated heart disease, joint pain, and many other medical conditions. But also important are the social, financial and psychological aspects of overweight. Thin and fit is still the general desire of most people. Some of us would become depressed over gaining weight and the inability to lose it, and others would feel that they lost a promotion opportunity because of it. Very few of us would enjoy buying a new, larger wardrobe, or the inability to fit into our summer vacation clothing.

So what are you going to do about it?

Losing weight is a full time job; you have to be aware of your goal at all times. Some of us can do it without much help. Decrease food portions, decrease fat intake, increase exercise --- the usual steps --- works. For others, professional help is a must.
Professional weight loss focuses on the entire person and his/her needs, and includes:

Establishing realistic goals. The ultimate goal of weight loss has to be a target weight that can be both achieved and maintained. This target weight may not be immediately identifiable, but becomes apparent as you work with your health care provider.

Portion control. Both the portion size and content of the food you consume need to be controlled and monitored. Accurate record keeping, while tedious, is extremely important. Your ability to keep records is a good indicator of how successful you'll be in controlling your weight.

Increase in exercise. Exercise helps burn excess calories, but don't count on exercise alone to reach your target weight. Cardiovascular exercise is best, but stretching and muscle strengthening are very important. Exercise at least four days a week, don't be a weekend hero. Special testing before taking on a rigorous exercise program is advisable, talk to your doctor.

Use of appetite suppressants when appropriate. The days of fen-phen long gone, but other medications are available. Stay away from over-the-counter preparations and "miracle drugs," they can be harmful, and, at best, you'll waste your money.

Use of meal replacement. Low calorie meal replacements have been available in super markets for several years. Others, of much higher quality, are available through some physician offices, including ours (e.g., HMR products). These products help in portion control and record keeping, and may keep you from binging.

Treatment of depression. Depression is frequently a cause of weight gain, and if it exists, it must be addressed.
What about weight loss spas? Many of them are very good, effective while you're there. But when you're back at home, you may still need to consult your health care professional.

When addressed correctly, overweight is manageable. And when you need professional assistance, go with those who will focus on your overall medical needs, not just weight loss. We're here to help!

Our Medically Supervised Weight Loss Program

The terms overweight and obese often trigger anxiety and frustration. Weight is a part of our personal self image, and an integral part of our well being. When weight is not under control, distress occurs, and poor health may soon follow. Americans have begun placing a great deal of importance on the "ideal weight" and many have gone to extremes to achieve it.

 Our three decades of experience in weight management have shown that there is no single formula that fits everyone's needs. Weight loss programs have to be individualized; they must be designed to meet your individual needs. Genetics and personal habits must be taken into account in order to form a personal program that will help you achieve your desired goal.

We start our weight loss program with a thorough medical evaluation of your needs and your weight gain triggers. It includes a measurement of your daily caloric requirements and body fat analysis with the use of specialized equipment.

 

  Weight control is achieved through several methods, sometimes alone and often in combination, depending on your needs. A suitable program may include:

• Ways to achieve portion control
• Meal replacement options
• Appetite suppression
• Exercise capacity measurement and exercise prescription
• Stress management
• Chinese and herbal medicine methods

 Whether your reason is medical, cosmetic, or both, we can help you lose weight safely and maintain your weight loss over the long run!

  To find your Body Mass Index (BMI), look at the BMI calculator on the left hand column.

Your weight - setting realistic goals

Have you been repeatedly frustrated with your weight management efforts because you were not able to reach or maintain your goal weight? You may have been setting unrealistic goals for yourself, based on an “ideal of slimness” that comes from society.

Popular magazines and commercial diet programs still show you pages upon pages of beautiful, ultrathin models, many of which have been carefully touched up to make the models appear even thinner than real life. You may be comparing yourself not only to a model, but to an unreal model.

And then there is the Barbie doll. Barbie has the features of an anorexic person, but she still is a child’s role model. Her message is “if you get the body, you can get the guy.” Junior high and high school girls have described the ideal girl as 5’7”, 110 pounds, size 5, long blond hair and blue eyes. TV still shows the slim as the ones that are popular, successful and happy.

The ads keep you aware of how far from their ideal you are, and promote the feeling of failure. It is not surprising that we set goals that are not reachable or maintainable. Nor are they desirable.
The flip side of the drive to become slim is the continuing expansion of the fast food and the sweets industry. Advertising associated with this drive are directed at your emotions. They make it hard to resist unhealthy foods, and they confuse people. You feel guilty if you eat the advertised food, and deprived if you don't.

How can you develop realistic goals? Here are practical considerations:

• Slimness is not the only goal. Other health issues are just as important, including the maintenance of normal cholesterol, blood pressure and glucose levels, smoking cessation, stress management, and regular exercise.

• Your personal weight history and physical activity history should be taken into account. If you are a forty-year old woman who weighed 100 pounds when you were running track in high school, then 100 pounds might not be a realistic goal now.

• Metabolism slows with age. If you continue to consume the same amount of food as you become older, there will be a gradual weight gain throughout adult life. Frequently, you can compensate for this decrease in metabolism by increasing your physical activity.

• Metabolism slows with weight loss. When you are thinner, you require fewer calories to maintain your weight. Again, an increase in physical activity may help significantly.

• The ideal body weight, frequently determined from Life Insurance tables, is neither a good measure of your body fat, nor the best measure of the medical risk of obesity. Body mass index (calculable from your height and weight), the waist hip ratio, and body fat measurement by electrolipoanalysis, are much better ways by which to assess your appropriate weight.

When setting weight goals for yourself, remember this: don't compare yourself with someone else. You are an individual and your body likely behaves differently from someone else's body. When losing weight, make sure you exercise regularly. Feeling good and obtaining the benefits of healthy lifestyle changes is the real goal.

How do we handle emergency calls?

I hope you're having a great summer. I am trying to make the best of the warm weather by getting outside and exercising as much as possible. I hope you the same

I would like to make you aware of an important change in the way we now handle off-hour telephone calls.

As of June 21st, we stopped using our antiquated answering service. Instead, you can now leave a detailed voice message which will be retrieved directly by our office staff. This skips the answering service, and decreases the chance of miscommunication.

All emergency calls are forwarded to me directly, and are acted upon by me personally, or by the covering physician.

All non-emergency calls will be handled during the next working session. If you would like a response by email, leave your email address with your voice message.

This change has already shown a major improvement in our ability to accommodate your needs. Regardless, it's always more effective to call during working hours.

Please remember that before renewing any "routine" medications, each chart has to be reviewed. Charts are not always available electronically, so medications can not be renewed during off-hours.

In life-threatening situations, always call 911 first!!!

Continuing medical education and then some…

First the serious stuff: Just back from taking the Continuing Medical Education courses at the Javits Center in Manhattan.

Two and a half days attending lectures on important topics in the management of conditions which concern so many of us, such as diabetes, heart disease, COPD, sleep disorders, high cholesterol, low back pain, and the metabolic syndrome.

It doesn't matter how much you know, there's always something new you bring back with you from these courses.

And the patients benefit from it.

And now to the ridiculous: You must already know some of the restrictions placed on pharmaceutical companies promotional "giveaways" to physicians. They used to give away trips, tickets to Broadway shows, and engage in other promotional activities which are now considered unethical (don't get me wrong, I'm not taking sides or expressing my opinion here).

At the Javits center meetings, some drug manufacturers were allowed to offer minor refreshments such as coffee and nuts. At several stands, the following sign (or a version of it) was posted: Due to State regulations, we can not serve complimentary beverages to health care providers licensed in the state of Minnesota…

Don't the legislators and regulators have something better to do?

Stew Leonard’s in Norwalk to offer on-site physicals for team members

Stew Leonard's made the following announcement about their innovative way of making high caliber preventive health care more accessible to their employees. I'm here to help, and I hope it's a trend setter.

As part of an on-going commitment to preventive healthcare, Stew Leonard’s will launch a pilot program tomorrow offering on-site physicals for Team Members at the Norwalk store. The Stew Leonard’s “Wellness Mobile” will be led by Dr. Igal Staw, a local Norwalk physician who has served the community for more than 30 years.

“Stew Leonard’s surveyed our Team Members and we found that a lack of time and not having a trusted doctor locally kept many from getting their yearly physicals,” said Jill Leonard Tavello, Executive VP of Culture and Communications at Stew Leonard’s. “By bringing Dr. Staw directly to our store here in Norwalk, we hope to keep our Team Members healthy and reinforce the importance of preventive care.”

On June 3, the first eight Team Members will report to the Wellness Mobile, located in a private trailer behind the store, for blood work, an EKG, and preliminary paperwork with a staff member of Dr. Staw’s office. On June 7 and 8, Dr. Staw will perform the physicals as well as take time to meet with each Team Member regarding their healthcare-related questions. If the Wellness Mobile is a success in Norwalk, Stew Leonard’s plans to expand the program to their other stores in Yonkers, N.Y. and Danbury and Newington, Conn.

“Recent research shows that well over 40% of premature deaths in the United States can be attributed to lifestyle choices,” said Dr. Staw. “My work at Stew’s Wellness Mobile will of course focus on early detection of treatable medical conditions, but the real emphasis will be on assessing each Team Member’s risk for chronic disease and how they can lower that risk through smart, healthy choices in their everyday lives.”

The Wellness Mobile is just the latest example of how Stew Leonard’s has taken an active approach to preventive health care for their more than 2,500 Team Members. On-site cholesterol and blood pressure screenings, mammograms, and flu shots are offered throughout year and discounts on weight loss programs, smoking cessation aids, and fitness center memberships are also provided to both full and part-time Team Members. Additionally, between now and August 31, Stew Leonard’s will give Team Members $500 in Benefit Bucks – or money towards their deductible – to encourage them to visit their doctor for their annual check-up.

About Stew Leonard’s:

Stew Leonard’s, a family-owned and operated fresh food store founded in 1969, has four stores in Norwalk, Danbury, and Newington, Conn. and Yonkers, N.Y. Stew’s earned its nickname, the “Disneyland of dairy stores” because of its country-fair atmosphere, with costumed characters and animated entertainment throughout the store that keep children entertained while parents shop. Stew Leonard’s legion of loyal shoppers is largely due to the stores’ passionate approach to customer service: “Rule #1 -- The Customer is Always Right”; Rule #2 – If the Customer is Ever Wrong, Re-Read Rule #1.” This principle is so essential to the foundation of the company that it is etched in a three-ton granite rock at each store’s entrance. The company’s culture is built around an acronym for S.T.E.W.: Satisfy the customer; Teamwork gets it done; Excellence makes it better; WOW makes it fun. For more information, visit Stew Leonard’s website at http://www.stewleonards.com./

About Dr. Staw:

Dr. Staw’s motto in his practice has been, "We help you live a longer, healthier life..." He was a late comer to medicine; after receiving his doctorate in Biomedical Engineering and doing basic research in the area of pulmonary physiology and certain metabolic processes, he felt that his real calling was patient care. The next five years were spent in accelerated programs through medical school and training in internal medicine and pulmonary medicine. Dr. Staw has been in private practice for over 30 years, and in the last 22 years he has placed great emphasis on prevention. He practices preventive care by first identifying his patient’s health risk factors (the factors which predispose them to disease) and then by developing the best strategy to minimize or eliminate these risks. It is his firm belief that the practice of preventive care, in its broader sense, is one of the most important factors not only in keeping his patients healthier, but also in keeping the environment cleaner, and the economy stronger. For more information, please visit http://www.drstaw.com./

Learn To Meditate - at our facility

I am pleased to announce that, as an integral part of our complementary medicine practice, Ben Spang, our Psychotherapist and Yoga Instructor, will conduct a four week meditation course at our facility.

You may find meditation and the peace of mind it brings along, particularly useful in these-stress laden days. With the help of this course you will learn how to use meditation, mindfulness and relaxation techniques to:

• Develop more inner peace, acceptance and love
• Move beyond stress and live more fully in the present
• Transform destructive patterns of thoughts, feelings and behavior
• Live your life with more purpose, passion and love

Time: 4 Thursdays, 6:30-7:45 pm, starting May 27
Location: Our facility, 83 East Ave., suite #302, Norwalk, CT 06851
Cost: $99, payable in full before sessions begin, to Ben Spang.

To register and to get additional information, call our office (203) 853-1919.
 
Hope to see you there, fully ready to gain a new insight into what's really important in life.

Acupuncture, yoga and massage therapy at our facility

New and exciting things are happening at our facility. It's the integration of conventional medicine, alternative medicine, psychotherapy and massage therapy under one roof. Our professionals, and some of the services they provide, include:

Mark Gutkin, L. Ac., MS. Mark is a graduate of Pacific College of Oriental Medicine with a Master Degree in Traditional Oriental Medicine. He practices in a traditional Chinese and Korean (SuJok) style acupuncture incorporating Chinese herbal medicine, Tui Na bodywork, Eastern Nutrition and lifestyle counseling. He specializes in post-surgical rehabilitation, chronic pain and arthritis as well as Digestive and Pre/Post menopausal issues.

Mark is affiliated with Lifetime Learners Institute at NCC. He encourages his patients and students to take responsibility for their own health providing them with tools to aid in continued recovery.

Ben Spang, LCSW, M.Ed., MBA. Ben is a licensed psychotherapist and a professional-level yoga instructor who works with adolescents, adults and groups. Offering both a traditional and a holistic, mind-body approach, he helps people to source their own inner wisdom and innate healing capacity. Areas of specialty include stress and anger management, depression and anxiety disorders, low self-esteem, trauma, physical illness and relationship and career issues. Modalities and techniques may include cognitive behavioral therapy, EMDR, meditative dialoguing, mindfulness, creative visualization, yoga and meditation.
Services offered include Psychotherapy, Private Yoga and/or Meditation, Groups (Yoga, Stress Management, Meditation and Mindfulness).

Kristi Worden, LMT. Kristi is a licensed massage therapist in both Connecticut and New York . She is a graduate of the Connecticut Center for Massage Therapy’s Clinical Program where she received in-depth education and training in both Eastern and Western massage techniques oriented toward rehabilitation and relaxation. Using a combination of Swedish massage, deep tissue and acupressure, Kristi works with clients to help improve their range of motion, body awareness and muscular balance.

Stay tuned, new things are happening all the time...

Our Fairfield office

The carpet is in, the walls have been painted. Our Fairfield office is now fully functioning.

Beginning Tuesday, April 21, we will be spending two full days per week in Fairfield: Tuesdays and Fridays. We'll continue to be in the Norwalk facility Mondays, Wednesdays and Thursdays.

In order to accommodate patients with a need for immediate medical care, there will be "walk-in" hours, in both Fairfield and Norwalk as follows:

Fairfield:    Tuesday 9:00-11:30 AM
                  Friday    9:00-11:30 AM

Norwalk:     Thursday 2:00-5:00  PM

No advance appointment is necessary, simply give us a call or come in to the office and we'll see you as fast as possible.

Our focus remains on disease prevention. This means early detection, health risk identification, and the systematic reduction of health risks; doing our best to work with you to reduce your chance of developing debilitating conditions like heart disease, diabetes, and cancer.

We are doing or best to help minimize your health care costs in both office and lab service fees. Along with providing preventive medical care, we are fortunate to be able to continue our special arrangements for uninsured and underinsured patients. If you require a special arrangement, please speak up, we want to make sure that everything that can be done, is done for you.

One final thought for you, take care of you body and mind...

• Learn the Relaxation Response
• Minimize your use of refined sugars
• Walk, walk, walk, and use the stairs whenever you can

The health care dilemma

For better or for worse, health care reform is here. With some of the debate over, and with Congress having debated the issues more on party lines than on the merit, we must ask ourselves: are we addressing the real issues?

Here is one man’s opinion:

It has been said by many that, despite its many deficiencies, the US has “the best health care in the world.” There is not much argument about the quality of care, certainly for those who can afford it. After all, people come to the US for medical care; they don’t usually leave the US to get better care elsewhere. But, surely there are tremendous deficiencies.

A large number of Americans are still without medical insurance. Others, who became unemployed in the recent economic downturn, may still have Cobra insurance, but when this runs out, they too may become uninsured.

Yet, if you need an urgent procedure (cardiac catheterization, an MRI), you are more likely to get it with much less delay in the US than in other industrialized countries, insured or uninsured (hospitals accepting Medicare will lose their funding otherwise).

There’s also no question that we have the most expensive healthcare system in the industrialized world.

Despite our presumed best health care and the enormous expense, longevity and infant mortality in the US lag behind many industrialized countries. We are #37 in longevity, sharing an “honorable ranking” with Cuba, and way behind Andorra, Canada, Israel, Norway, Germany and Jordan… A similar picture holds for infant mortality.

Why is there such disparity between “best, most expensive health care” and longevity?

I’ll briefly make the case that it’s lifestyles, not healthcare reform, that’s going to keep us healthier and make healthcare less expensive. There’s a whole lot more to health than health care reform.

Faulty lifestyles, mainly smoking, lack of physical activity and overeating, account for more than 40% of premature deaths in the US. They undoubtedly account for much more than 40% of the medical expense associated with faulty lifestyles. Combine this with the tendency of Americans to run to the doctor for minor issues not requiring care, such as simple colds or minor anxiety, and the willingness of the system to accommodate these demands, you have written the script for a healthcare system that is destined to bankruptcy. But there’s another aspect to lifestyles, not completely the fault of each person individually.

Much of the fault for our relatively poor health lies with industry, especially the food industry. It is not my intention to write a treatise about it here, but suffice it to say that in the last few decades Americans have been exposed to progressively increasing amounts of processed foods devoid of nutritional value, or outright dangerous, especially corn-derived sugar, salty canned foods, and bottled drinks (the plastic ones are generally worse).

So what’s the answer? Sure, there’s a lot to be corrected with the present health care system. Open competition for HMOs and commercial insurers, taking away limits on HMO payments (now restricted to no more than 65 cents on the premium dollar), decreasing the enormous obstacles the FDA places in new drug approvals, and many other measures will help. But all of this will be of limited value.

The biggest effort has to come in educating the public to change its lifestyles, and make sure that these changes are adopted by the young children. It could be very easy to make changes in the way food is processed in the US. If the demand for processed food is diminished, then the manufacturers will respond to market demands and make more acceptable foods available. If you give incentives to people who keep acceptable lifestyle (for example, reduce their insurance premium), the people will respond.

We can each contribute to the solution of the healthcare problem by taking the right steps and improving our lifestyles. With our actions, industry will respond, and we’ll help the economy, healthcare, and, most importantly, ourselves.

For Seniors, falling could be dangerous

Almost 30% of people over 65 fall each year. Ninety percent of all hip fractures are associated with falls. Approximately 300,000 hip fractures and more than 700,000 vertebral fractures occur each year, mostly in the elderly. The yearly direct cost for fall-related fractures was estimated at 20.2 billion dollars in 1994, and is estimated to reach over 32 billion dollars im 2020. Unintentional fall is the seventh leading cause of death among people over 65 years old. Falls are a primary reason why Seniors become home bound.

Work done at our own office (when Health Extenders was active), funded by us and the South Western Connecticut Agency on Aging 5 years ago, arrived at interesting results.

Our study showed that Seniors of non-minority groups experienced more falls than minority Seniors. Thirty two percent of the non-minority Seniors fell in the year before the study. Hispanics had fewer falls, 26%, and Afro-Americans had the lowest rate, 10%. Risk factors for falling included: muscle weakness; instability due to poor balance; agility and endurance; the use of certain medications, especially sedatives and muscle relaxants, and impairment of gait, vision and hearing.

The danger of falling increased with each risk factor, and with the number of previous falls.

The risk of sustaining a fracture after a fall is associated with two important factors: low bone mineral density (osteoporosis), and neuromuscular integrity. Generally, the higher the bone density, the higher the ability of bone to withstand the abnormal forces of a fall, and the lower the risk of a fracture. Neuromuscular integrity is associated with muscular strength, balance and agility, and with an ability to absorb the high force of a fall.

Appreciable increases in bone density occur when new muscle groups become active over time and the forces generated by these muscles increase with time. Vigorous walking, by itself, does not generally bring about a sufficient increase in bone density to decrease the risk of fractures from falling. Despite the general health benefits of regular exercise, the main benefit of a fall prevention program is derived from increasing muscle strength and coordination, and from decreasing the instability of gait.

Despite the gloomy-looking statistics, the good news is that most risks for falling and sustaining a serious fracture can be controlled. When guided by an experienced exercise physiologist and/or physical therapist, muscle strength and agility can be increased, and balance and coordination can be dramatically improved. Medications may be adjusted to reduce dizziness; other medications, designed to decrease bone loss, can be used to decrease the chance of a fracture in the event of a fall. When necessary, specially tailored hip padding can be worn to absorb the shock of falling and prevent a fracture. In addition, home safety is extremely important. Helpful tools include rails in bathrooms, special chairs to sit on while showering, and the use of a walker. Avoidance of loose carpet edges and unstable pieces of furniture is a must.

The tendency to fall increases with age, but fall prevention is effective at any age, and should be a part of good health habits of every Senior Citizen.

For additional information on fall prevention, you may contact our office.

Are you a chocolate lover?

I must admit that I'm one, and it's bitter sweet.

Cocoa, the good ingredient of chocolate has a great quality, it's high in antioxidants (flavonoids), even more so than green tea or red wine. But most chocolate you see on the store shelf contains refined sugar, a real problem for many individuals, and for healthcare as a whole.

And if you think that "no sugar added" chocolate is better, think twice.

Most sugar free, or even those labeled safe for people with diabetes, contain unacceptable sweeteners. The most common one is maltitol.

Maltilol is classified chemically as a "sugar alcohol." In reality it's neither one. But it has nearly as many calories as table sugar, and its glycemic index (a measure of its effect on blood glucose level) is almost the same as table sugar.

Some chocolates are made with more nutritionally acceptable sweeteners, such as erythritol (present in Truvia), which a very low glycemic index, and as far as the body is concerned, have no calories. Admittedly, it's hard to find them.

So you're a chocolate freak and you're worried about the sugar content of chocolate, what should you do (from personal experience, I know that telling you to stay away from chocolate isn't going to work...)?

Choose bitter-sweet chocolates, they have less sugar. If you can find erythritol, fructose or oligofructose sweetened chocolate, choose that. You may want to try home made hot chocolate made of unsweetened, fat free cocoa (available in many super markets), an erythritol sweetener (Truvia is OK), and  low fat milk - it may satisfy some of your chocolate craving.

Happy hunting. If you have good chocolate suggestions, let us know.

Short of Breath?

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What is shortness of breath?

For most people "shortness of breath" or "having breathing difficulties" means a sensation of difficult or uncomfortable breathing, or a feeling of not getting enough air. Medically, this is referred to as dyspnea.

Does shortness of breath mean illness?

Shortness of breath can occur in both health and disease, and its significance varies accordingly. For example, when it occurs in a healthy person walking 100 feet at the top of a very high mountain, it may signify no disease. But if the same person had smoked a pack of cigarettes a day for 20 years, the same symptoms at lower altitude may be the first sign of progressive emphysema. In healthy individuals, shortness of breath may also occur at rest for no apparent physical reason.

Shortness of breath may be appropriate or inappropriate, real or perceived; and therefore, there is no standard lay person definition of shortness of breath. Physicians use the term dyspnea to describe "an abnormally uncomfortable awareness of breathing."

What causes dyspnea?

The issue of dyspnea comes up frequently when patients are seen in their physician's office for specific complaints, or for a periodic physical examination. It's the physician's task, not always an easy one, to determine whether the dyspnea is medically important, and to recommend a diagnostic plan and a course of therapy when needed.

Dyspnea can be acute, intermittent, or chronic, and can be caused by a heart or lung problem or physical de-conditioning; or it can be of psychogenic origin.

Common heart diseases causing dyspnea include coronary artery disease (the major cause of heart attacks), congestive heart failure, and conditions where heart valves malfunction. Lung problems include bronchial asthma, acute and chronic bronchitis, emphysema, and interstitial lung disease (diffuse scarring and stiffening of lung tissue). Exposure to allergens may precipitate an asthma attack, or dyspnea-producing post nasal drip; but the biggest undiagnosed culprit remains smoking.

Psychogenic dyspnea, precipitated by anxiety, panic or an irregular breathing pattern of frequent sighs ("sigh dyspnea"), is now diagnosed in increasing frequency. This is usually not dangerous, but it may be uncomfortable, and particularly hard to diagnose and treat.

Lack of conditioning is also a cause of dyspnea, especially seen in the "weekend warrior athlete." If you are short of breath playing basketball on Sunday afternoon, do you have a disease causing dyspnea, or is this lack of conditioning?

How is the diagnosis made?

Your account of the intensity, severity and frequency of dyspnea is very important.
This, combined with a physical examination and some basic testing, may rapidly establish the correct diagnosis.

Sometimes the diagnosis is elusive. Both asthma and heart disease can be "silent." Even lack of conditioning may be difficult to diagnose without meticulous testing. The diagnosis of psychogenic dyspnea, can be made on the basis of your symptoms, after medical causes of dyspnea have been ruled out.

For exercise-related dyspnea, we use cardio-pulmonary stress testing (CPST). This important, noninvasive test combines the familiar cardiac test with lung function testing during exercise (on a treadmill or exercise bicycle). With it, we can determine your level of cardiopulmonary fitness, and whether your shortness of breath is due to a heart problem, lung problem, de-conditioning, or "none of the above."

Treatment

Treatment of dyspnea, and its effectiveness, depends on the underlying cause. Frequently, medications are used, such as those needed to optimally control asthma, congestive heart disease and anxiety. Special lifestyle instructions may be given, such as smoking cessation and allergen avoidance. Reconditioning exercises and stress management may be advised, or you may be instructed in the proper performance of diaphragmatic breathing.

Working together with your physician, in the overwhelming majority of cases, shortness of breath can be controlled or completely resolved.

Most, if not all the tools necessary to establish the cause of dyspnea and treat dyspnea are available under one roof at our practice.

Prevent a heart attack

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Heart attacks continue to be the number one killer in the US. Heart attacks are also one of the major strains on the national and personal health budgets. It is essential that you know your risks for the development of heart disease and take the necessary steps to decrease the chance of a premature heart attack.

Heart attacks, the major manifestation of coronary heart disease (or atherosclerosis, plaque), continues to be the leading cause of mortality in the US, and will continue to be so as longevity increases, and as the number of senior citizens increases. And, yes, many of us feel that we know what puts us at risk for a heart attack, and what we have to do in order to decrease that risk. But do we really know enough? And do we do enough?

Most of us know the detrimental role of smoking, diabetes, obesity, lack of exercise, and hypertension. Many of us also know of the role of cholesterol, including the “good cholesterol” (HDL) and the “bad cholesterol” (LDL), or even triglycerides. Certainly we know that it’s better to be born with “good genes.”

But what about the more recently recognized risks factors and tests to better detect a potential heart problem early, when there’s still time to delay or prevent a heart attack?

Look at one cholesterol related example: We now can look not only at the total LDL and HDL, but also at their respective subclasses (These are not routinely done unless your physician specifically asks for them). There are at least two important LDL patterns, “predominantly small particles LDL,” also known as B Pattern, and “predominantly large particles LDL,” known as A Pattern. Pattern B is the dangerous one, and it’s the one that can usually be managed by lowering dietary fat intake. In contrast, Pattern A individuals may not benefit, or even become worse with severe dietary fat restriction. Similarly, there are other subclasses and markers, each of which has its own significance and therapeutic implications.

Inflammation of the coronary arteries accelerates the formation of coronary plaque. Cardio-CRP is one such marker of inflammation, and helps identify those at risk of a first and subsequent heart attack, even when the cholesterol risk is low.

Newer blood tests, such as the extensive profile offered by the Berkeley HeartLab, (partially on the basis of technology developed at Berkeley Unversity) or the VAP profile (by Atherotech, Inc.) go much further into analyzing inflammatory markers, cholesterol subclasses, and the benefit effect of certain drugs in the management of cardiac risk factors.

Early detection of plaque formation has become easier too. We’re all familiar with the common treadmill stress test, stress ECHO’s, nuclear Thallium or MIBI test, or even cardiac catheterization. But newer tools have evolved. A modern “fast cardiac CT scan” in experienced hands can show calcium in existing plaque, and thus estimate the degree of atherosclerosis. Computerized coronary angiography, which is only minimally invasive, can even better assess the extent of plaque formation. A carotid ultrasound, with particular attention to inflammation (usually reported as “intimal thickening”) may be useful in risk assessment.

Many other developments are just below the horizon. However, an important problem hindering the use of many new techniques is coverage by the health insurance companies as well as Medicare. They traditionally take years before paying for some of these very important tests.

Regardless, we’ve come a long way in our ability to identify the risk of coronary heart disease, and to detect it early. At our practice, early detection and prevention is a cornerstone. Information is a powerful tool, become informed! We’re here to help you live a longer, healthier life…

The many faces of asthma

Bronchial asthma, usually simply referred to as asthma, is a common condition, affecting well over 20 million Americans, increasing every year. The disease affects both children and adults, and its severity can vary from very mild to deadly. It account for more than 400,000 hospital admissions and more than 4,000 deaths every year.

While most people think of asthma as a disease of the lungs, in reality it’s a chronic condition of the bronchi, the airways that carry air in and out of your lungs. In asthma, the bronchial linings (mucosa) become inflamed, and become sensitive to a variety of irritants. The tiny muscles that surround the bronchi tighten and the mucus glands that are imbedded in the bronchial mucosa produce extra mucus.

Some people think of asthma as occasional wheezing. But in reality, asthma has many faces. It can indeed present as wheezing, mild and short lived, or as a chronic persistent condition, but it can also present in other forms such as a chronic or intermittent cough, excess mucus production, or shortness of breath at rest or associated with exercise.

The frequency and severity of asthma symptoms vary widely. Some people have infrequent “attacks,” or flare-ups, and are otherwise symptom-free, while others have severe, chronic symptoms. But no matter what your symptoms are, you must think of asthma as a chronic condition.

What triggers asthma or an asthma attack depends on how susceptible you are. Common triggers include allergens such as dust, molds, animal dander and cockroaches; tobacco smoke; viral respiratory infections; strenuous exercise; exposure to very cold temperatures; certain foods and food additives, and certain drugs such as the beta blockers used in the treatment of heart disease. Sometimes, psychological factors play a role. Hyperventilation, or excessive breathing, seen in some patients with anxiety, can lead to an asthma flare-up.

Asthma is usually easy to diagnose, but its severity should be thoroughly evaluated by a qualified physician. Occasionally, the diagnosis is elusive, and it has to be distinguished from other diseases that can masquerade as asthma.

Asthma is treatable. New research and an ever-increasing understanding of asthma have lead to better treatment. It is now clear that the overwhelming majority of flare-ups, hospitalizations and deaths can be prevented. But the success of treatment depends on the skill of the treating physician, and the patient’s compliance. Too frequently, especially in milder cases, there is a reluctance to treat or be treated, which may lead to disastrous outcomes.

Treatment depends on severity and triggers, and must be individualized. It ranges from the occasional use of bronchodilators (puffers), to long-term use of inhalers and oral plays a significant role, immunotherapy (allergy shots), or the use of a relatively new anti-allergy injectable medication (Xolair, omalizumab) may be appropriate. Relaxation methods, regular exercise and a thorough understanding of your condition are very helpful.

So if you have asthma, see to it that your needs are properly addressed, and take your treatment seriously; your mind and body will thank you for it. Need help? Contact us.

Don’t let fitness take a holiday

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The holidays are over; there's no need to let fitness take a holiday now.

Fitness is an elusive concept. According to the President's Council on Physical Fitness, it is "the ability to carry out daily tasks with vigor and alertness, without undue fatigue, with ample energy to enjoy leisure-time pursuits and to meet unforeseen emergencies." Yet physical fitness means different things to different people. One fact is clear: if fitness is the goal, exercise is the way to get there.

There are four basic elements of physical fitness: cardiovascular endurance, muscular strength, muscular endurance, and flexibility. Each can be measurably improved with regular exercise. But keep in mind that exercising to build physical fitness is not the same as working out to improve athletic performance. To be physically fit, you should develop all four elements, not just one or two.

While each element is a part of fitness, the most important one is cardiovascular endurance. Physiologically, cardiovascular endurance is the sustained ability of the heart, blood vessels, and blood to carry oxygen to the cells, the ability of the cells to process oxygen, and the ability of the blood, once again, to carry away waste products. Since every cell in the body requires oxygen to function, there is no more basic element of fitness than this, to see that the heart, lungs, and circulatory system do their job.
Cardiovascular endurance is built up through exercises that enhance the body's ability to deliver ever larger amounts of oxygen to working muscles. To achieve this, the exercise must include the large muscle groups (such as in the legs) and, most importantly, it must be sustained.

Muscular strength is the force a muscle produces in a single effort (a lift, a jump, a heave), as when you swing a mallet to ring a carnival bell. Muscular endurance is a measure of the ability to perform repeated muscular contractions in quick succession, as in doing twenty push-ups in a minute. Although muscular endurance requires strength, it is not a single all-out effort.

Muscular endurance and strength are interrelated, but are quite distinct. Endurance enables you to maintain a sustained effort, while strength will give extra force to your golf swing or tennis serve. Gains in strength come most quickly from exercising with the maximum amount of resistance, usually weights, that you can lift comfortably in a few repetitions, working at below your maximum level and gradually increasing the number of times you perform an exercise.

Flexibility refers to the ability of the joints to move through their full range of motion. It varies from person to person and from joint to joint. Good flexibility is thought to protect the muscles against pulls and tears, since short, tight muscles may be more likely to be overstretched. Some people find that stretching hamstring and lower-back muscles alleviates lower-back pain, and calf stretches help prevent leg cramps.
Developing strong, flexible muscles is important for everyone, not just for athletes and body builders. Well-conditioned muscles and joints help you perform better physically, assist you in maintaining good posture, and may help prevent injuries and chronic lower-back pain.

Most certified personal trainers are very good, but watch out for the overzealous ones, they may hurt you.

Need help? feel free to contact my office (contact information on the side bar).

New Year's resolutions revisited

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I hope you were able to stick to your health-related New Year's resolutions. I didn't make any, so I'm absolved.

The three most common and important health-related resolutions are: weight loss (or weight control), increasing physical activity/exercise, and smoking cessation. Have you done your share? Most Americans forget about their resolutions by the end of January. Don't let it happen to you.