Author Archives: ushealthworks

Are There Really Healthy Fat People?

Posted on February 19, 2013 by ushealthworks| Leave a comment

It seems one of my fellow doctors in Arizona has entered the fray with a fat guy from New Jersey. The results were somewhat predictable.

Following the recent news regarding hefty New Jersey Governor Chris Christie, the question remains – can you be fat and healthy?

Fat is the last personal characteristic that people in this country feel perfectly fine about discriminating against. Given the direction our society seems to be going, many of us may face that discrimination in the future.

More than a third of us are obese right now. The impact of obesity on life has been well studied. Obese women make 24 percent less money than women equal in every way, except thin. There is an often quoted study in 1988 where students choose criminals (felons) as more desirable spouses than an obese person.

Obesity more than any other common negative personal characteristic gives other people the impression that they know exactly what a person is all about. We don’t presume all bald people or those with one leg share the same personality.

Prejudice against the obese is so pervasive that the mere notion that you could be fat and healthy is absurd to even educated people.

But what is healthy? Is it a 20-year-old who is young, fit and good looking? I guess that leaves my 80-year-old mother out, although she gets more done in a day than I do.

We could talk about risk factors, some are choices (smoking, diet, blood pressure and cholesterol), and some are not (age, sex, genetics, and your diet as a child). If I had to pick the worst offender to a healthy body, I would pick smoking, not obesity.

But unlike many things that happen to us as we struggle through this mortal plane, being fat is interpreted as simply getting what we deserve. It is the “just dessert” for having poor self-control and weak willpower.

How weak is the body or the will that forces someone 300-plus pounds out into the world, when the rest of us are severely tested by a bad hair day.

The fight against obesity is a longer and harder road than most other challenges in life. A pound of fat has 3,500 calories, and that is enough fuel to go for two or three days even if you eat nothing. A pound or two a week is about the best you can do with hard work and a strict diet; every day for a year!

Obesity is a risk factor, not the sum total of a human being, or even the worst health offense. Obesity can make high blood pressure, cholesterol and diabetes worse, but most obese people don’t have hypertension, high cholesterol or diabetes.

Ultimately we are talking about blood vessel disease – atherosclerosis (hardening of the arteries) – when we talk about any of these risk factors. Besides obesity, high blood pressure, cholesterol and diabetes, many other factors influence atherosclerosis. There are genetics, age, sex, stress, diet, exercise, disposition, addiction, socioeconomic level and marital status, to name a few.

How many risk factors does it take to be unhealthy? This is partly a game of genetic roulette.

The bottom line is: There is room in the world for some healthy fat people.

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona center.

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Just How Many Heartbeats Do We Get?

Posted on February 15, 2013 by ushealthworks| Leave a comment

Since February is designated as “American Heart Month,” this is a good time to take a look at the heart and how it pertains to exercise.

In talking recently about exercise and the heart, a really weird question came up. Sometimes those are the best questions, aren’t they?

Exercise makes the heart beat faster; so why doesn’t exercise wear the heart out faster? Why don’t you run out of heartbeats sooner if you spend a lot of time exercising?

After all, the heart has a lot of moving parts – heart valves, blood vessels and muscle. These presumably wear out, like anything else, kind of like the 100,000-mile powertrain warranty on your car. After the warranty expires, you’re on your own.

So you exercisers watch out, you might just shake something loose! Actually the heart is an absolute wonder of durable construction and lasts an astounding number of beats.

Let’s play with some numbers. How many beats do we get in a lifetime? If an individual averages 80 beats per minute, that’s 4,800 beats per hour, 115,200 beats per day, and more than 42 million per year, which calculates to roughly 3 billion if you live to age 72.

When you think about them that way, heartbeats are the most precious commodity on the planet. Hate to waste ‘em.

Assume a really compulsive 40-year-old exerciser does something strenuous and aerobic five days a week for 30 minutes. He will drive his heart rate up to 160 beats per minute (220 – your age is maximum heart rate and we like to exercise at 65 to 85 percent of that).

The math works out to an extra 2,400 heartbeats on your exercise days. That is a 2 percent increase in heartbeats per day for those who are keeping count.

But exercisers have slow heart rates – not in the first week, but after a month or two. Let’s assume exercise brings your resting pulse down from 80 to 60 beats a minute, a pretty reasonable goal.

The 72-year-old at the 60-pulse rate uses only 2.2 billion heartbeats. To put it another way, to use up 3 billion heart beats, at a pulse rate of 60, you have to live to age 95. Startling, isn’t it?

But lower pulse rate isn’t the whole story because your heart is living tissue, not a car. That’s a subtle distinction I know, but one that comes up every day in medical practice.

A mechanic comes in with a cut hand that requires sutures. He thanks me for fixing it and I usually say, “you’re doing the hard part, I just got it pushed together. You are healing it.”

A mechanic has to fix your car engine 100 percent or it won’t run properly. Cars can’t heal themselves, but people can.

Using your heart’s muscle makes it strong. You don’t wear tissue out by using it; you wear it out by not using it. So invest as little as 15 minutes a day in exercise and you will extend your warranty for more trouble-free years of body ownership.

Get that pulse down to 50 and it takes 105 years to use up 3 billion heartbeats.

Take care

Dr B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic

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Debunking 3 Weight Management Myths

Posted on February 13, 2013 by ushealthworks| Leave a comment

Overweight? You have lots of company. It is one of the greatest public health issues of the last 20 years. Let’s discuss a few myths, as well as a few ideas.

Myth: Eat three meals a day.
Not so! Three meals a day is a modern concept. Historically there never was enough food for the average person to eat three meals a day. In many parts of the world, that is still true. If you eat three “reasonable” meals a day, you will be overweight.

Chinese Food Macro 12-6-08 7

Myth: The kind of food you eat dramatically affects your weight.

That also is more myth than science. Your body needs somewhere in the neighborhood of 2,500 calories per day. If you take in more calories, you gain weight; taking in less means you lose weight. If you eat 4,000 calories of carrots per day, you will gain weight (and turn orange – I’m not kidding). The body happily converts protein, carbohydrates and fat in your diet to whatever the body needs. Carbohydrates are not the great Satan, nor are fats. Fats do happen to be twice as calorie-rich per weight as everything else. So you can only eat half as much fat. On that thought, it really is too bad that the body stores extra calories as fat (4,100 calories per pound). If it stored excess as carbohydrate or protein, it would only take 1,800 calories to burn a pound.

What is a calorie anyway? The calorie is a certain amount of energy that is contained in food. It can be thought of as “stored work.” You use it when you exercise or to keep your heart beating. Calories are good stuff, in moderation.

Myth: Exercise absolves you of food sin.
Unfortunately, there is no absolution. You need to exercise, and it is one of the most important health habits you can have. Exercise will burn 200-500 calories per session. That will help you lose weight or keep you trim. Keep in mind that 200-500 calories isn’t even a candy bar’s worth of calories. So exercise alone won’t do the job.

Now I would like to suggest the concept of dining for enjoyment vs. for fuel. I define fuel as calories I take in only to keep going. These are not tasted, savored or enjoyed. They are simply thrown down my throat hastily. Here is the important thing, in my opinion: if I am not going to savor and enjoy a meal, I might as well throw down something good for me (a protein or yogurt drink). If I have time to sit down and really enjoy a meal, I might as well eat something tasty, even if it’s not that great for me.

So get some exercise and don’t throw down bad food without enjoying it. If you are trim, it will help you stay that way, and if not, you will make steadily progress toward a lesser you.

Stay well,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

photo © 2008 Steven Depolo | more info (via: Wylio)

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Our Youth-Crazed Society Misusing Testosterone

Posted on February 7, 2013 by ushealthworks| Leave a comment

The airwaves are full of it: talk of testosterone.

Testosterone has had a colorful history. Early work on the steroid had a Harvard professor self-injecting a “rejuvenating elixir.” This was prepared from an extract of dog and guinea pig testicles. It seems even professorial types yearn for virility.

It wasn’t until the 1930s that testosterone was identified, and shortly afterward was synthesized (made from scratch). It didn’t take much longer for men to start experimenting with it.

Testosterone is the primary male hormone. It is classified as an androgenic steroid. All hormones are steroids and androgenic ones help build strong muscles.

Testosterone is closely related to, and synthesized from cholesterol (of all things). In men, 90 percent comes from the testicles. In women, who have a small percent of the testosterone that men do, it comes from the adrenal glands.

This androgenic steroid has only a few mainstream applications, probably not enough to support a national television advertising budget. Just how many men are running around without testicles? And how many would admit it? To my knowledge no one is doing focus groups of eunuchs figuring out how to sell testosterone cream.

The whole reason for synthetic testosterone to exist is off-label use, which is using a medication for some other condition than it is approved for by the DEA. There is nothing illegal about this and it’s very common for many drugs. It also has been problematic for a few medications.

Testosterone gradually decreases in men as they age. This is a normal finding, or at least it used to be. But in our youth-crazed society this is now a “testosterone deficiency.” So virtually every middle-aged male is a potential customer. Now that’s a demographic worth an advertising budget.

Many of the issues of middle-aged men look like they are made for testosterone replacement. Loss of muscle mass and strength – check. Loss of libido – check. Loss of energy, erection and general manliness – check on all three. Kind of makes you want to stop reading this and find a doctor and a pharmacy.

Not so fast – this is an anabolic steroid we are talking about. And steroids are among the strongest medications made. Lance Armstrong and Marion Jones, among many other known steroid users, can attest to that.

Testosterone does increase protein production and adds to lean-muscle mass. It will speed maturation in young males and makes bones stronger. Certain types of anemia are also improved with testosterone treatment.

On the other side, anabolic steroids have many side effects if received in higher than physiologic doses. If someone is taking a physiologic dose (a normal dose that mimics what their testes would produce), there is really no point.

Anabolic steroids like testosterone commonly elevate blood pressure. Combine that with extreme physical exercise and you have a great one-two combination for a stroke.

Steroids also change the lipid ratio in the blood in the exact wrong direction (opposite of what Lipitor or your favorite statin does). The “bad cholesterol” rises and the “good cholesterol” goes down.

This increases the risk of heart attack, kidney disease and just about anything else that needs blood (meaning everything). And if that isn’t enough fun, steroids accelerate baldness and can make the testes atrophy.

A good case can be made for bringing males to normal testosterone levels for their age. Push it further in some effort for eternal youth and you might get just the opposite.

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

photo credit: Linden Tea via photopin cc

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Thinking of Your Heart as Valentine’s Day Nears

Posted on February 5, 2013 by ushealthworks| Leave a comment


Valentine’s Day brings hearts and chocolates, romantic thoughts and perhaps the bittersweet memory of young love lost.

Heartache is a pain like no other, utterly indescribable to one untouched by romantic catastrophe. The heart has been the center of the human intellect and our very soul for 99 percent of human history.

No less than Aristotle taught reason and love emanated from the heart. Makes sense, that’s where you feel the pain of heartbreak.

The familiar red heart symbol dates back at least 3,000 years and is believed to originate from the shape of mating swans necks, or more colorfully, women’s buttocks. The color red is assumed to come from the color of blood.

We know a lot more about curing heartache from clogged arteries than, unfortunately, unrequited love.

The physical side of the heart is simply a pump, weighing just over half a pound and making blood go round and round. It is built like the energizer bunny and is good for 2, 3, occasionally even 3.5 billion beats.

The heart, perhaps unfortunately, doesn’t get its oxygen from the blood in the heart, but rather from coronary arteries outside the heart. Blood and oxygen to the heart muscle go from the outside in, not, as commonly believed, the inside out. A somewhat precarious arrangement, as these coronary arteries tend to clog.

Making the heart last a long time is all about the quality of the heart you are born with, and maintenance, like so many other things in life. Hard to change build-quality without picking your parents. (If we get to pick our parents I want to be taller, smarter and better looking). Maintenance however, is at least as important as what you get to start with.

Avoiding a “broken heart” is a worthwhile exercise, as heart disease is the leading cause of death in America. Speaking of exercise … yes, exercise is one of the most important things you can do to keep your heart in good working condition.

Exercise is actually a “three-fer.” Exercise lowers your blood pressure, helps you lose weight and raises your good cholesterol. If blood pressure and cholesterol are still out of sorts despite exercise, they can be lowered with medication.

It is probably occurring to you that how you live has a lot to do with your risk of heart disease. Blood pressure, cholesterol, body weight and diabetes are all worsened by the typical high fat/high calorie American diet. Until recently, a lot of heavy meals were finished off with coffee and a cigarette or two. Smoking is rapidly dying out. Fortunately coffee isn’t bad for you.

Despite so much negativity, life still needs to be a little fun – especially on Valentine’s Day. Alcohol and dark chocolate are good for your heart. A glass of wine with a healthy dinner should help you not miss the double cheeseburger quite as much; and a piece of chocolate for dessert should satisfy the sweet tooth of your sweetheart.

So flowers, red wine and chocolate are romantic and heart-healthy Valentine’s Day gifts. And remember, a little romance also counts as exercise.

Take Care and Happy Valentine’s Day.

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona

 

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Super Bowl XLVII: Man vs. Alcohol

Posted on January 31, 2013 by ushealthworks| Leave a comment

On Super Bowl Sunday, American football fans are expected to consume approximately 50 million cases of beer while watching the game.

For many people, this will result in feeling worse than the players the next morning. The difference – the players use prescription medication for their pain!

There is more myth about alcohol than about any other single food group (except perhaps oysters). This should not be surprising because alcohol was already ancient when the Vikings (the Nordic ones, not the NFL Vikings) celebrated their adventures.

People learned to ferment alcohol about five minutes after learning to grow grain. Mankind has at least a 9,000-year-old relationship with alcohol. This relationship is more deeply entrenched than even human history would suggest.

The ability to metabolize alcohol is present in almost all animals. That’s curious, because I don’t ever remember seeing any pink elephants on bar stools, at least not until much later in the evening!

Alcohol is so easy to make; your body actually ferments a little alcohol on its own. To make it more conventionally in a brewery requires only some carbohydrate (sugar), water, and a pinch of yeast. The carbohydrate can be almost anything from grains for most commercial production to bread crusts, which reportedly work well in prison stills.

The yeast is a little one-celled organism that can be found in the environment (blowing in the wind and on raw foods). You can simply leave a pot of sugar water open and yeast will find its way into the batch.

Yeasts are clever little organisms that eat carbohydrates and excrete alcohol and carbon dioxide (bubbles). The cereal you ate this morning is fermenting in your intestines right this minute. It has everything it needs (yeast, carbs and water) to produce an average of 3 grams of alcohol per day. That’s about a quarter bottle of beer.

What happens to all this beer, or at least the water portion? Ultimately, you could be making a lot of bathroom runs this Sunday and perhaps missing some entertaining Super Bowl commercials. Everyone thinks it’s the water in the beer, but alcohol is a diuretic.

Then there is the alcohol. As far as your body is concerned, alcohol is alcohol. A beer is the same as a 2-ounce shot of liquor or a glass of wine. Any of these will cause your blood alcohol to go up about 0.02. Have four drinks and the average person will be legally drunk and 0.08.

Thankfully, our livers help sober us up. A liver will be busy getting rid of a drink every hour or so, decreasing your blood alcohol by 0.02. Simple math, yet so many are surprised.

What is it about drinking that makes for that special brand of misery the next day? People will tell you it’s toxins in the liquor or tannins in the wine. Drinking clear liquor – like white wine – surely makes a difference, right? If only that were true.

It’s the alcohol in the beverage that’s the problem. Ethanol is all good fun, but the liver oxidizes it into an aldehyde, which is 30 times as toxic as ethanol. It causes a headache, nausea and light sensitivity, with a little diarrhea thrown in.

Since alcohol is a diuretic, you are dehydrated and less able to tolerate the aldehyde. One of the liver’s many jobs is keeping the glucose level in your blood very even. Since the brain runs on blood glucose, this is a pretty important function.

Drink enough and your liver is too busy to babysit your blood glucose and your brain stops working. If that happens too early on Sunday, it’s doubtful this will be a memorable Super Bowl.

It pains me to tell you that there is no good medical evidence for any treatment that prevents or cures a hangover. The alcohol simply must be metabolized (to that nasty aldehyde).

Coffee doesn’t speed up recovery from a hangover and “hair of the dog” just delays the inevitable. However, there are a number of imaginative treatment suggestions. Among those that seem almost reasonable are hydration, aspirin, and B6, which can be combined with supplemental oxygen if desired.

Of course, you could be one of the lucky ones who “chose” your parents well. Approximately 25 percent of people don’t get hangovers – and it’s genetic!

For the other 75 percent of us, there is a very good strategy to avoid a Super Bowl hangover – it’s called moderate drinking.

Take care, and enjoy the game.

Dr B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona

 

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Healthy Habits Top 10 List

Posted on January 29, 2013 by ushealthworks| Leave a comment

Every time we turn on the TV or pick up a magazine, we’re told to do this or don’t do that. And if we follow the guidance, it will greatly decrease our risk of getting some horrible disease.

If I added up all the reductions in risk I would live to be 143! Kind of puts a whole new spin on the Social Security solvency issue. At the risk of ruffling a few feathers, I would like to suggest some order to the risk hierarchy. A logical starting place, if you plan to live a long time and are actually doing something to facilitate it, should begin here.

1. Stop smoking (or don’t start). This is the most researched topic and has absolute consensus in the medical community. Smoking cuts 5 to 10 years off your life. If you do only one thing to help you live longer, do this one.

2. Diet. I am reserving the No. 2 slot for what you eat, not how much you eat.

If you want to live a long time, eat grains, fruits and vegetables and avoid meats of all kinds, especially red meat. This is also very well researched and results in a dramatic decrease in cancer and heart disease – the No. 1 and No. 2 killers in this country. Your life expectancy will increase by five or more years from this.

3. Exercise every day. Do some form of exercise 20 minutes every day and that will get you the most life for your time investment. Your life will be a few years longer, and perhaps more importantly, you will be able to do more things and feel better. The cancer and heart disease rates are lower in exercisers.

4. Treat lifestyle disease. We are talking hypertension, Type 2 diabetes, and high cholesterol. Some of these are a result of excessive living and some just genetic roulette – blame your parents. Treating these illnesses almost completely neutralizes the dramatic decrease in lifespan that they can cause. Treating these diseases can easily add a decade to you life.

5. Weight Control. It’s not what you eat, but how much. Excessive body weight contributes to hypertension, heart disease and cancer. This can easily take a decade off your life, and make the rest of it pretty unhappy.

6. Seat Belts. Protect yourself from an untimely death in a motor vehicle. There are about 40,000 deaths per year in theUnited Statesfrom motor vehicle accidents. Seat belts have added a bunch more years than Vitamin C and the rest of the alphabet combined.

7. Deal with your depression. Depression measurably shortens life, but makes it feel way too long. The solution can be regular exercise, good friends or medications. The important thing is do something about it. Living a long life takes the will to live – that means treat the depression.

8. Stay married or get married. Married people have a measurably lower mortality rate then unmarried people. Sounds curious, but this is a well researched and a reproducible fact. However, a good marriage helps you live longer and bad marriages don’t. Make sure you know the difference (hint – if your spouse is your closest friend, you have a good one).

9. Sleep well. Insomnia and poor sleeping contribute to accidents, cardiovascular disease and poor health. Sleep apnea is one treatable culprit and can add years to your life.

10. Take vitamins. This is No. 10 because vitamins have precious little good scientific evidence of extending your life. There are a couple of exceptions (like Niacin) but 98 percent of vitamins are unproven.

The recommendation here is start at No. 1 and go as far down the list as you can.

Take care

Dr B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

Image courtesy of photostock / FreeDigitalPhotos.net

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Bout With Flu Nearly a Fatal Encounter

Posted on January 22, 2013 by ushealthworks| 1 Comment

Starve a cold, feed a fever: Do I have a cold or the flu, that’s the question.

That is more of an academic question until you actually tangle with the beast that is known as the flu. Then there is no question.

I once taught aerobics five days a week; picture me in leg warmers (or don’t). A man of steel was I.

On this particular Monday, the 5:30 a.m. class was tough to get through because I was a little off. I thought about the night before and blamed it on the one Cinco de Mayo strawberry margarita I’d had at a friend’s house.

No worries for a man of steel. After the morning aerobics class, I went to the office and saw patients. Little did I know that I was 48 hours away from intensive care, going from doctor to critically ill patient.

I went to the gym again the next morning, but was so weak I didn’t even consider teaching my class. I struggled through the day at work, and by afternoon a staff member had to take me home because she didn’t think I could drive.

She was right. But neither of us could have envisioned that I was 24 hours away from respiratory failure. Funny thing about being really sick; my medical mind was too scrambled to even diagnose myself.

The real fun started with a severe headache, the worst I’ve ever had. I couldn’t even bend down to pick up a $100 bill if I had seen one on the ground; I was feeling that bad.

My fever was so high that I was hallucinating. Fever delirium invariably produces nightmares. You are half out of your mind and the images are truly terrifying.

About this time the muscle pain started. Ache isn’t really a very good word for it. Remember when you were a kid and watched Star Trek and one of your friends tried the Dr. Spock grip on you (at the base of your neck). All my muscles felt just like that. When I weakly said – “just shoot me” – I wasn’t trying to be funny.

Later that day I’m told that I turned blue. A friend who was taking care of me asked if that was normal, but I was too sick to answer.

I don’t remember the rest of that day, but I know I was rushed to the emergency room. I was intubated and put in ICU. It wasn’t until 10 days later that I left the hospital at a meager 112 pounds.

That took place at age 24, when I exercised two hours a day, took my vitamins, watched my weight, and made 1,300 skydives. I was immortal, or at least I thought so. What did I have to fear from some respiratory virus? I didn’t even usually stop running when I had a virus.

But this time was different. They had the ventilator settings turned all the way up. As a doctor, I haven’t seen anyone survive an illness that needed maximal ventilator settings.

They actually called my parents and told them to fly in that day if they wanted to see me before I died. I was getting the best of care in an ICU that I actually trained in. Yet I was much closer to death than I ever was as a skydiver.

So how many flu shots do you think I have missed in the last 20 years? If I had to climb Mount McKinley to get a flu shot I would be looking for my ice axe and climbing boots.

Stay well,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

Image courtesy of Sura Nualpradid / FreeDigitalPhotos.net

 

 

 

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What’s Behind Those Winter Blues

Posted on January 21, 2013 by ushealthworks| Leave a comment

The season got you down? Struggling with the motivation to get moving, even though you know it will help? Do you find the color red mildly depressing?

You may have a serious case of righteous indignation with the superficiality of life, or perhaps just the winter blues. While we don’t specialize in existential funks, we know something about depression and its cousin, colorfully named Seasonal Affective Disorder (SAD).

Our brains are immersed in a neurochemical and hormonal stew that is dauntingly complex, but a lot of work in the last decade has given us understanding of at least the broad strokes. It’s pretty complicated up in the head.

It is completely normal to slow down some in the fall; your body is conserving energy to get you through the cold winter.

For up to 10% of people, this is much more than simply banking the fires; it is a life changing and unwelcome annual ordeal. An affective disorder is a fancy way of saying a mood problem. The namesake symptom of SAD is depression.

Depression is usually associated with varying degrees of fatigue, increased need for food and sleep, weight gain and difficulty concentrating.
This occurring during the holidays is particularly irksome – when the need for energy is greater than normal. The increased appetite when the house is full of Christmas cookies is torture to anyone trying to maintain an ideal body weight.

An additional 10% of people have a milder form of the condition that may only have fatigue as a symptom.

The scientists tell us that the decrease in daylight triggers a decrease in brain serotonin and increase in daytime melatonin levels. You probably remember serotonin; that is the brain chemical that Prozac increases. Serotonin is good.

You would be right in deciding that medications like Prozac would be helpful in Seasonal Affective Disorder.

For those inclined toward more natural cures, we just need to trick your body into thinking it’s summer.

Your body mostly wants a sunbeam, like a cat. That is something we know how to do. Light therapy is essentially a portable sunbeam. The UV light is filtered out so you won’t get skin cancer, or unfortunately, a suntan. Light therapy with the intensity of 10,000 Lux seems to work the best, with 30 minutes every morning commonly recommended. Sitting in your sunbeam after work can also help, but occasionally causes insomnia. This treatment actually can work in as little as a week. That is three times faster than is usually seen with medical pill treatment.

Melatonin is also commonly used to treat Seasonal Affective Disorder. Melatonin is a hormone that is produced by your body in dim light. Taking supplemental melatonin in the afternoon can reset the hormonal clock.

Light therapy isn’t the only unusual treatment for SAD. Use of a negative ion generator in the bedroom at night shows a 50% response in patients with SAD.

Medications of the SSRI class work well but take a few weeks to become effective. Prozac is the best known SSRI, but any of them are effective.

The seasonal nature of Seasonal Affective Disorder favors the non-drug approach to the disorder. In people with SAD it usually returns each winter. Light therapy can be started in the fall before symptoms occur and can be useful in preventing the onset of SAD. Many find this more palatable than starting and stopping medications every year.

Seasonal affective disorder is often the cause of winter blues. A variety of treatments are usually well tolerated and effective. In the meantime, have a Christmas Cookie, can’t hurt.

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic. 

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Getting Flu Shot a Great Investment in Your Health

Posted on January 14, 2013 by ushealthworks| 1 Comment
Dr. Donald Bucklin

Dr. Donald Bucklin

When discussing the flu, “same old-same old” means over 40,000 people will die in this country of the flu this winter.

That’s as many people as will likely get killed on U.S. highways this year. It would be nice to vaccinate against getting killed in a car crash, wouldn’t it?

This influenza season is a particularly severe one, if present trends hold out. Most of the deaths will occur in the very old or very young, both of which are not easily vaccinated, because they can‘t drive or ask for the vaccine. They depend on us able-bodied people, known as “the herd” in public health vernacular.

The herd can dramatically influence the spread of disease like influenza. Part of this herd is the workers at an institution that care for the elderly, the sick or the very young. They pass in and out of the institution every day, sometimes bringing and sometimes taking home unwanted viral baggage.

The flu depends on finding its next susceptible victim to continue its relentless winter march.

We all briefly consider getting a flu shot each winter, according to our own private equation. We consider the media headlines, our health, our experience with the flu vaccine or the flu, and weigh in the cost of the vaccine in time and money.

This may all be largely subconscious, but ultimately pushes us toward or away from the vaccination opportunities. You either stop and do it or drive by. The health care providers of the world are grinding their teeth in frustration trying to influence your decision.

Medical types like to place every illness under the microscope. The Canadians, common sense people that they are, tried a different approach, looking at flu from across the street. Their study didn’t even limit itself to influenza alone; they looked at winter respiratory illness in general.

The Canadian study included everything from the mildest chest cold to pneumonia, and everything in between. Influenza was part of that group.

During the study they gave the influenza vaccine to a large group and carefully observed for any respiratory illness. A more compulsive approach would be to count only lab-proven influenza, but that was not the Canadian way. Still, they generated some very interesting results.

Those who were vaccinated had 25 percent fewer respiratory illnesses than people who weren’t. The vaccinated group had 43 percent fewer sick days that winter, 44 percent fewer doctor visits, and saved almost $47 per patient.

Those are some impressive numbers and being a doctor, I very much want to do influenza antibody tests of all those Canadians. But that isn’t the point. The point is there seems to be a larger spectrum of influenza than we realize. Looking at doctor visits and sick days and all of that, a flu shot has measurable benefit for most people.

So you can get vaccinated because you are trying to keep the family healthy this winter, or because it’s the right thing to do. You can also get vaccinated simply because it’s a good investment in your health.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

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