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.