Post Vacation Blues

Posted on July 17, 2012 by ushealthworks| Leave a comment

Are you kidding me? Darned if you do and darned if you don’t.

Vacation is more precious than life itself. You saved, stood on your head to make the schedule work, studiously avoided anyone that sniffled, and wiped off the grocery cart handle, every time.

You went to the near perfect place, found entertaining diversions for 2 or 3 generations, ate like Vikings, and slept in.

And now you’re home in one piece, rested, renewed and depressed. Depressed?

You just got a case of the “post vacation blues.” If it’s any consolation, even though it probably isn’t, you are not alone. Studies show that a third of all adults are affected by post vacation depression (PV blues).

This funk tends to last a week or two, about 1.5 times the length of the vacation. One has to wonder, if only from a mathematical standpoint, if vacation is worth it.

The symptoms are usually limited to a melancholy affect or feeling blue. The more common type of depression is often associated with loss of appetite, which might not be such a bad thing after vacation.

Sleeplessness is also usually associated with depression, which would at least let you get caught up on email.

Post vacation blues, perhaps unfortunately, usually lacks these symptoms and you are left with mere sadness.

Medicine has few answers for you, at least in the short run. Most antidepressants (SSRIs) take 3 or 4 weeks before they kick in, and PV blues have usually passed by then.

Sleeping medications may help with jet lag, but are of little use when dealing with depression. There just hasn’t been an invention that offers immediately effective “happiness in a bottle.” We’re working on it …

Where we lack well researched, scientifically grounded answers, we are good at making it up as we go.

The internet is full of sensible sounding advice on the subject. Suggestions to relive your vacation memories are often tossed about as useful for post vacation blues.

Gather up the family to see the slides, but best keep it to family as vacation slide shows are deadly to friendships. A little mental imagery of idyllic vacation moments can give a measurable boost to your mood. Do something in your everyday life to remind you of your adventures. Hawaiian shirt to work? Flip flops with your three piece?

Overall, be reassured that this is a normal part of reintegration into our chosen lives. The post vacation funk is brief, self-limiting, and the price you pay to play.

Take care, and start planning your next trip!

Dr. B

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USHW Washington: Smiling and the Grim Reaper

Posted on June 22, 2012 by ushealthworks| Leave a comment

It seems your chosen world view has a lot do with how long you get to keep this view.

A curious little study out of Wayne State University looked at old pictures of baseball players and rated their smiles. They were sorted into groups with nonexistent smiles, a little smile, or a full 100-watt display of their pearly whites.

Being scientists, they spent a lot of time looking these people up and finding out everything they could about their health, starting with making sure they were alive. Most of the well-known risk factors for early death, like obesity, hypertension and smoking, were standardized. That means they fiddled with the groups until they all looked alike for common risk factors, and only differed by smile factors.

So far this sounds scientifically reasonable.

And the researchers found good stuff, at least for the smilers. No smile got you an average of 73 years, a little smile 75 years, and a big smile 80 years. The average life expectancy for people born at this time was 78 years. So in effect, a frown robs you of five years of normal life, and a smile gives you two bonus years.

Now how much fun can the years 79 and 80 be anyway? This used to be my response when well-meaning people criticized my “Halloween Cigar”. Of course, you would have to ask a 79-year-old, but you could easily spend 2 years doing all the bad things you had to stop to get there.

This smile study was not an outlier. Some pretty good research has been done on attitude and health, attitude and marriage, and even attitude and cancer survival. People with good attitudes simply do better; it’s a scientific fact.

Interestingly, these pictures in the Wayne State study were posed, not candid shots.

Presumably someone said, “Smile for the camera” or “Say ‘cheese’” – or something like that. These young players picked “the look” they wanted to show the world. We don’t know if the smilers actually were people who smiled a lot, or were just better at following directions.

So the million dollar question is: do you get the bonus if you make yourself smile? Fake it until you make it? That’s what we all wonder when we read this kind of stuff.

That is a surprisingly hard question to answer. How might you make yourself a smiling person? Perhaps medicine has an answer; better living through pharmacology, smiles from Prozac.

There is precious little evidence that Prozac and its friends will statistically make you live longer. However, untreated depression dramatically shortens your life.

How about psychotherapy, a little head adjustment until you smile? Talking to someone often helps when you are feeling blue. There just isn’t good evidence that people utilizing psychotherapy live longer.

And this is not to pooh-pooh anti-depressants or psychotherapy because both are life-saving therapy for many people.

A lot of thinking has gone into the question of why that single photographic smile makes you live longer. That’s a difficult area to study with hard science. People have suggested that smilers have more friends, a better social support system, and better marriages. But smiling for a picture may just be a short-hand way of asking if someone’s basically OK.

The problem ultimately is a lot of us don’t consider ourselves smilers, but we’re otherwise pretty normal and getting along OK. We certainly don’t feel the acute need for Prozac or psychotherapy.

If asked, we would probably smile for a picture. So, who knows, that may get us the bonus years after all.

Take care.

Dr. B.

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Brain Power: Mind and Body Together

Posted on May 24, 2012 by ushealthworks| Leave a comment

New research emphasizes what has generally been accepted for a long time – keeping the brain active and well tuned is best achieved by a combination of both intellectual stimulation and physical exercise.

The aging mind and body has a certain amount of inevitable decline. The only certainty in life remains change, and change we must. How we change and how much we can slow our decline or renew our mental and physical capacity is the challenge we all confront.

Extensive experience and research has demonstrated the advantages of regular exercise and continuing mental stimulation throughout a lifetime. Anecdotal experiences abound of recovery from illness, injury and staving off the effects of aging.

Although the myriad of brain function remains mostly a mystery, we are bit by bit getting glimpses into how it works, grows and recovers.

After brain injury from trauma or stroke, we have long engaged the benefits of providing stimulating intellectual challenges to advance the recovery process. This has also included regular exercise. Clearly, exercise has increased the recovery rate after brain injury, as long as it’s included appropriately for an individual’s level of conditioning.

Recent studies in both animals and humans provide some small insight as to why and how this works. Exercise appears to stimulate growth of new brain cells and even helps them integrate with existing parts of the brain to improve brain function. The entire mechanism remains unclear.

Through high-tech scans of the brain and sophisticated tests that determine increased levels of hormones known to encourage growth and regeneration of brain cells, we are able to measure a response in healthy people and animals when they exercise regularly.

A distinct difference was seen in brain structure and ability to function at a higher intellectual level in those who exercise and those who do not. Even when gender, diet and other variables were considered, exercise created increased brain activity and increased levels of chemical messengers that influence the creation of new brain cells.

A more recent finding indicates that the brain is able to grow new brain cells. Moreover, the new cells have to be trained to work in concert with cells that are already functioning and sometimes even specialized.

How this all happens remains a somewhat mysterious process. The latest research confirms neurogenesis (process by which new nerve cells are generated) and that physical exercise enhances the process and integration of new brain cells.

Some have referred to the brain as the muscle between your ears. The message is clear even though we have yet to illuminate all the intricacies of this elegant computer. Regular exercise and continued intellectual challenges keep the mind and body fresh and in good condition.

Dr. Bruce Kaler

U.S. HealthWorks is one of the nation’s largest workplace healthcare providers with nearly 170 urgent care clinics (including Spokane and Seattle Washington) and worksite centers in 15 states and more than 2,000 health care professionals. Please visit www.USHealthWorks.com. For more information or to find the U.S. HealthWorks location nearest you, please visit www.ushealthworks.com.


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Coffee: The Natural Wonder

Posted on May 16, 2012 by ushealthworks| Leave a comment

Coffee: I think they should put it in the water.

This much maligned beverage has again made headlines for being – surprise – a healthy beverage. Now this is no huge revelation to me as I feel positively suicidal before I have my first morning cup-a-joe. Coffee extends my life every morning.

Coffee got its bad reputation from associating with undesirables. People are natural multi-taskers. They like to do something while they smoke, sometimes combining smoking, drinking, and talking all at once.

Coffee, or whiskey, was perhaps used to wash down the bad taste of the smoke. The result was coffee was considered a co-conspirator with cigarettes in research showing increased mouth, throat and lung cancer. It turns out it was all the cigarettes. Combine cigarettes with the most innocent of beverages (dandelion wine, mint tea, mother’s milk), and the results will be the same. The coffee was simply an innocent bystander.

The latest research on coffee is the result of a “Mega- study.” Mega-anything sounds impressive, but a mega- study is a powerful statistical technique to combine dozens of smaller, weaker studies and get a big strong study – and hopefully some bullet- proof answers.

This time the analysis showed stroke risk was significantly lower among coffee drinkers. When all the usual suspects for stroke (hypertension, high cholesterol, diabetes), were accounted for, coffee drinkers came out ahead.

But cutting down on the stroke risk is only the puff of steam in the volcano of coffee benefits. Coffee is low-cal. If you like it black, it’s like celery, takes more calories to digest than it contains. Even with sugar and a splash of cream, it’s less than 50 calories. That is half the calories of most soda, juices or margaritas.

Perhaps coffee can save us from the obesity epidemic, venti mocha with whip notwithstanding.

Coffee has antioxidants, those magical molecules that are believed to help everything, including aging. No guarantees that coffee will make you any younger, but the risk of heart disease is lower in coffee drinkers. Colon cancer, gall bladder disease and Parkinson’s are all less frequent in roasted bean enthusiasts. Even the risk of diabetes is lower.

But coffee is not for the faint of stomach. The acid level in the stomach is measurably increased by coffee, as any college student up late for finals will attest. There are also better beverages for insomniacs. Caffeine when taken in excess can turn you into a jittery mess, again channeling my undergraduate years.

But strokes are nasty things and any way to avoid one is a blessing.

Also good to not sleep through your life.

As always,

Take care.

Dr. B.

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Surgery vs. The Medicine Man

Posted on May 10, 2012 by ushealthworks| Leave a comment

There is an eternal struggle in healthcare, that of the surgeon vs. the medicine man.

This is not obvious from outside the professions, but the evidence is all around us. The surgeon is a much more glamorous specialty; life and death sometimes literally rest in a surgeon’s hands. The surgeon is richly rewarded for sometimes heroic efforts, and is among the highest paid and most respected of any specialist.

The medicine man (internist) spends time in the much less dramatic pursuit of disease prevention and cure through medications. This is a quiet and thoughtful profession, but much like the tortoise and hare, the medicine man is winning.

This struggle was highlighted last week by studies showing that antibiotic treatment is as safe and effective as surgery for acute appendicitis (and a whole lot less miserable for the patient).

That is the exact opposite to the training surgeons received for the last 50 years. We believed that antibiotics never cured an appendicitis, it just made it harder to diagnose, thus delaying surgical treatment until after it burst (peritonitis).

So we will see a lot less appendectomies in the future. Score: Medicine 1,
Surgery 0.

Thinking about life and death surgery, the cardiovascular (heart) surgeon has no equal.

But the triple bypass is steadily losing ground to prevention and alternative treatments. Medications like statins to reduce cholesterol and blood pressure medications are keeping the vast number of patients from even getting coronary artery disease. Even if you get coronary artery disease, the chances are that your treatment will be an angioplasty/stent rather that having your “chest cracked.”

There is a reason they call it chest cracking! That’s 2/0, in the Medicine Man’s favor – if you are keeping score.

Ulcer surgery used to be one of the most commonly performed operations. Then came the invention of Tagamet, a class of acid reducers light years ahead of antacids (acid neutralizers). Then came the proton pump inhibitors (Prilosec), which was the knockout blow that virtually eliminated ulcer surgery.

Cancer has always been first and foremost a surgical disease. What is more appealing than cutting the cancer out? These days, the answer is a lot of things. Prostate cancer was always treated with prostate removal, and a frequent complication was impotence.

Now oral medications like anti-androgens, or alternative treatments like radiation, have dramatically decreased the number of prostates we remove, and the number of people needing Viagra is also reduced.

Breast cancer was first treated with the big operation: radical mastectomy. This evolved into simple mastectomy, now lumpectomy, or even just needle biopsy. Medical treatment for breast cancer does a better and less traumatic job of curing many of these unfortunate problems for women.

In fact, just about pick your cancer, and the treatment has dramatically moved from surgical to medical in the last 30 years.

But never fear, orthopedics can be a safe haven for underemployed surgeons. A pill for a broken bone is still a while away. But I wouldn’t quite classify it with teleportation; we may come up with something.

Having trained in general surgery, and then practiced occupational medicine, and urgent care for the last 30 years, the sweep of change I’ve seen has been dramatic. Every year we find new magic pills that retire another scalpel.

Call me a wimp, but I’ll take my Lipitor and Tenormin; and eat walnuts if I want to hear a cracking sound.

Take care.

Dr. B.

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10 Things Not To Do When Drunk

Posted on May 3, 2012 by ushealthworks| Leave a comment

Summer is coming and with it, the first taste of freedom for a few of us. The rest of us settle for wistful memories; assuming we were lucky enough to have survived our youth.

Assuming the world keeps spinning, alcohol will be consumed by many and there will be ill-advised forays into the land of inebriation.

Perhaps we can mitigate the damage with some timely advice – things you never want to do while drunk.

1. Get a tattoo. Tattoos are the leading cause of Hepatitis C in this country. More Americans die of Hepatitis C than AIDS. The Hep C virus is in blood and is difficult to kill. It is easily transmitted while getting a tattoo if absolute sterility isn’t maintained. Get your tattoo when you are sober enough to judge the cleanliness of the tattoo parlor, or settle for a piercing – earrings rarely cause major complications.

2. Get pregnant. Alcohol impairs your higher cortical functions. This is your rational self, the place where reasoning, judgment and “the brakes” reside. Evolutionarily older brain is less affected by alcohol. It is your inner cave man/woman. This version of you is only concerned with the more basic emotions, like hunger and lust. You don’t want to get dragged off by the hair to a cave.

3. Get married. Someone once said “questions of marriage and divorce should be made in cold blood.” You need your rational self to consider such decisions. Getting married is easy and fun; putting up with each other for the rest of your life is a little more challenging.

4. Mix Chemicals. Alcohol is a respiratory depressant. Narcotics are also respiratory depressants. Moderate drinking chased with a couple of oxys or Vicodin can be a deadly combination.

5. Mix Chemicals, Part 2- Stimulants. Cocaine, methamphetamine and ecstasy are all stimulants. Take any of these and you are now a “drunk in motion.” Not more coordinated or a better driver or rational decision maker; just in motion. Think of this as looking for trouble; you are now a human pinball.

6. Drink more. If you are awake and feeling pleasant, this is as good as it gets. More alcohol will seem like a very fine idea, but it isn’t. Trust me on this. Vomiting on your shoes, or your date, does very little to improve your social life. On second thought, it may prevent 1, 2 or 3, which are all worse.

7. Sign legal documents. We already discussed marriage licenses; but car loan documents, mortgages or wireless contracts are equally ill advised when drunk. Save these things for when your brain is working at its best.

8. Be profound.

9. Break-up, make up or significantly change an ongoing relationship.

10. Drive. Almost half of the serious and fatal car crashes involve alcohol. Over 20,000 people die each year. You have a better chance of surviving an encounter with a Great White shark than staying out of trouble in a car. A designated driver or cab fare is an absolute necessity.

Take care and stay safe.

Dr. B

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Pertussis: The Preventable Epidemic

Posted on April 23, 2012 by ushealthworks| Leave a comment

If you thought pertussis was history, think again. Since 1980 the number of cases in the U.S. has risen to more than 3 million a year. Pertussis, also known as whooping cough, is the only vaccine-preventable disease that is on the rise.

The Pertussis vaccine became available in 1940 and there was a steady decline of this deadly childhood disease in the U.S. until 1980. More cases are now being reported among adults and adolescents who experience a milder, but just as stubborn form of the disease as infants. Since pertussis initially resembles other common colds, the disease is probably under reported.

Babies under the age of 1 get the infection from those who are closest to them. Family members, friends and caregivers are usually the source. We have only recognized in recent years the role of adults around an infant to be a potentially dangerous reservoir of the disease. Adults are susceptible to pertussis because the vaccine they received as children wanes over five to 10 years. If one member of a household has whooping cough, there’s a 90 to 100 percent chance that other susceptible household members will also catch it.

The vaccine is administered at 2, 4 and 6 months of age. A fourth dose is administered between 12 and 18 months, and a fifth after age 4. Teens need another booster shot between 11 and 18. All adults should have a single adult booster of Tdap (tetanus, diphtheria, and acellular pertussis) vaccine.

Even when a baby is vaccinated, they may not be fully protected until they have received at least three doses of the infant pertussis vaccine. In order to create a “cocoon of safety” around an infant, those in close contact with the baby should receive a single dose of Tdap.

Whooping cough is spread easily through mucus droplets, broadcast by profound coughing and sneezing. It can take three weeks or more to develop symptoms after exposure to the infection. Individuals can give whooping cough to others until they’ve been treated with antibiotics for five days, or until coughing for 21 days.

The swelling and inflammation to airways is actually caused by toxins secreted by the bacteria. After 21 days of the infection the bacteria will die off, but has already released damaging toxins.

Early recognition and treatment is important to minimizing the effects and preventing spread of the acute infection to others. Pertussis causes spells of coughing that makes it hard for a child to eat, drink, or breathe. The cough is often followed by a “whooping” sound as the person gasps for air, which is how the condition got its name. Some historians referred to the disease as the “100-day cough.”

Serious side effects from the coughing fits are common in children. The choking and gasping can be fatal in children under the age of 1. The disease is most serious in infants, especially those too young to get the vaccine or not fully protected. Babies with whooping cough are often hospitalized. With older kids and adults, the disease is milder and can cause several weeks of exhausting coughs. Although rarely fatal in adults and older children, time lost from school and work is substantial.

Early detection is important in limiting the spread of whooping cough. Appropriate antibiotic therapy for the person suffering from the condition and their close contacts needs to be started as soon as possible. Late recognition and treatment fails to change the course of the disease. Many weeks of coughing by the affected individual will continue even if the spread is limited.

Testing specimens from a nasal swab can be helpful in identifying pertussis only in the first couple weeks. Many patients don’t seek medical evaluation until later and the results of testing also causes further delay. Precise recognition can be difficult. Treatment is often started in the context of clinical symptoms and known outbreak in the community.

This punctuates the importance of prevention and a proactive approach to immunizations of both children and adults in the community. The best way to help protect babies against pertussis is to get infant vaccinations in a timely fashion. Adolescents and adults should have a single dose of Tdap booster.

By Dr. Bruce Kaler

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Sushi: More Than Just Raw Fish

Posted on April 6, 2012 by ushealthworks| Leave a comment

Japanese cuisine has worldwide popularity and nothing is more synonymous with Japanese food than sushi.
The term sushi is associated with raw fish dishes that we see as healthy culinary art forms that many people feel taste great. The forms and traditional types vary greatly. Raw seafood is the foundation for dishes that are consumed and stand on their own merit. Many presentations also include rice, nori and numerous other ingredients, such as vegetables and some seafood that may already be cooked.

However, sushi isn’t limited to raw fish and rice. Condiments such as soy sauce, wasabi paste (a distinctive cousin to horseradish), tofu, soy beans, eggs and mayonnaise are often components to some dishes.

Fish is a wonderful source of high quality lean protein. It is low in saturated fats, cholesterol, and carbohydrates. Salmon, mackerel, herring and tuna are rich in omega-3 fatty acids, which are linked to many health benefits.

Tofu, soy beans, nori, the dried seaweed wrapper commonly used in “rolls,” are all excellent nutrient sources of minerals, calcium, vitamin D, folic acid and antioxidants. Not all ingredients are limited to raw fish. Shrimp, eel, geoduck and crab are often cooked before they are featured in a roll.

The wide array of creative rolls and styles seems endless with something to suit any taste. One must be thoughtful about some of the ingredients in some contemporary rolls, like cream cheese, fried foods, mayonnaise, and soy sauce that greatly increase the calories, sodium and fat contained in your dish. Overall, the benefits of enjoying sushi and sashimi are diverse and outstanding.

The risks of eating sushi are very low, but are worthy of consideration. The general contamination of seafood with mercury is virtually unavoidable. Unfortunately, this neurotoxin contaminates all open waters of rivers, lakes and oceans. Some caution should be exercised in choices of fish variety and quantities consumed by those who are at greatest risk of mercury consumption.

Women who are pregnant, nursing or planning to get pregnant, young children, elderly or people who have a compromised immune system, should limit their consumption of seafood to only 12 ounces per week.

Some species of seafood are likely to have higher mercury levels, such as tuna, swordfish, shark and mackerel. This doesn’t mean that they need to be avoided entirely. They just need to be consumed in limited quantities, emphasizing variety with other kinds of seafood that may be lower in mercury content, such as salmon, trout, crab and shrimp.

There are additional risks with undercooked or raw seafood that remain low if products are handled and stored properly. There are FDA guidelines for the industry that include freezing fish for precise amount of time to kill parasites.

Still, poor handling or dishonest vendors can provide tainted food that is contaminated with bacteria or parasites. The most common symptoms from eating contaminated raw fish are nausea, vomiting, diarrhea, abdominal pain, headache and fever. One must rely on a reputable dealer and trust your restaurateur to provide sanitary products of high quality. Although eating raw seafood is simply a greater risk than cooked fish, experts agree the health benefits outweigh the risks.

Enjoy the nutritional benefits of a wonderful culinary art with thoughtfulness and peace of mind. Also keep in mind to strive for variety and eat sensible portions.

By Dr. Bruce Kaler

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Lawnmower Safety: Most injuries are very preventable

Posted on March 26, 2012 by ushealthworks| Leave a comment

Has that time of year arrived already? Could it really be time to start cutting and trimming the lawn again? With that in mind, it’s also time to consider some safety tips for lawn care.

Lawnmowers are very powerful and needless to say an almost indispensable tool. They not only gobble up the lawn, but often the people operating them. More than 100,000 people a year are injured mowing the lawn. It is usually an adult, but children become victims as well. Most of these injuries are preventable with a small amount of effort and common sense precautions.

The power and danger of a lawnmower can’t be taken for granted. A mower is able to spit out a rock, piece of wood or metal at a speed of 100 miles per hour. The force of a small object striking a person after ejection from a mower is comparable to being shot with a handgun.

The mower blade is able to mangle part of an extremity in literally the blink of an eye. Power or push, ride or walk, they all contribute to an enormous number of serious injuries. Lawnmower injuries most often involve the hand, fingers, wrist, foot, ankle, or toes and account for the large percentage of partial or complete amputations.

A number of simple precautions will go a long way in preventing injury to yourself or your family. Only adults should operate mowers and supervise young people about the dangers and proper use.

In order to maintain adequate control of a mower, no one younger than age 12 should operate a walk-behind mower because a certain amount of growth, strength and coordination is necessary.

A riding mower should not be operated by anyone younger than 14. Again, maturity, exercising good judgment and instruction on how to operate safely is important. Proper footwear and eye protection for the operator is always a must. Since flying objects are a big potential problem, others should be kept away from the area being mowed.

A bag that catches the clippings or a flap plate that covers the opening where the grass is ejected should be in place and in good working order. Mower adjustments and refueling should be done by an adult when the mower is off, cool, and with the ignition off.

Regular maintenance and simple inspection before or between regular use will be a great aid in preventing dangerous malfunctions. Many safety features are built in to mowers, but are overlooked and neglected. They can’t help unless the mower is in proper working order. Working on a hot mower or inadvertent charge from a spark plug that is not disconnected can lead to burns or accidental ignition.

A few simple steps can prevent a life-changing injury. Please treat these tools with the respect and care they deserve.

By Dr. Bruce Kaler

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Qnexa – Better Mousetrap or Hype?

Posted on March 21, 2012 by ushealthworks| Leave a comment

Obesity is a huge problem in this country (sorry). One third of Americans are significantly overweight, and overweight people have a whole Pandora’s Box of health problems.

Obesity causes elevated blood pressure, heart attacks, strokes and kidney failure. The extra weight wears out the joints in the legs so total knee and hip replacements are performed more frequently, and at a younger age, in the obese. Reassemble this box and the price tag adds up to $150 billion per year for obesity-caused disease, just in this country.

Think a few people are looking for an answer? We may have found one.

Qnexa is a combination of two older medications that appears to have somewhat magical and unexpected properties when put together in just the right amount.

The two medications that make up Qnexa are Phentermine (of fen-phen fame) and Topamax. Phentermine is an older diet medication, which is in the family of stimulants. Don’t worry, the heart problems in Fen-phen were all because of the Fenfluramine, which is no longer available.

Topamax is an anti-convulsant (anti-epileptic) that has been around a while and is used to treat migraines and chronic pain, as well as epilepsy. So you add these two medications, experiment with the right amount, and duration of each, and almost like magic, people start losing weight.

The magic seems to be in the details. The phentermine-to-Topamax ratio that is used is roughly 1 to 6. The actual dosages studied are anywhere from roughly 50% of maximum doses of each to merely 10%.

They have also adjusted the release of the medications to prolong the effect in the body (also allows once daily dosing).

Now, more than a few people will be thinking of making “do it yourself” Qnexa by getting a prescription for both medications – that would be a very bad idea.

The actual medication has been approved by the FDA advisory panel; but it took two times through to get that. The full FDA hasn’t approval this (necessary to allow your doctor to prescribe it). Approval is anticipated later this year. In the meantime, do-it-yourself pharmaceutical research is dicey at best.

Probably worth remembering that one of these medications has seen trouble before (fen-phen). There have also been a good dozen drugs taken off the market in the last 10 years for safety reasons, and they had been fully approved by the FDA.

Qnexa isn’t there yet.

But does it really work? Three large studies have looked into the safety and effectiveness of this medication. The FDA’s minimum “bar” for effectiveness (in a weight loss medication) is 5% weight loss after one year of therapy. Qnexa had no problem meeting that, and in fact had closer to 15% weight loss after a year’s therapy.

The mechanism of action is appetite suppression; you don’t get hungry.

There were no surprising side effects, most were mild and did not limit treatment. Side effects tended to be gastro-intestinal; some nausea, constipation and numbness and tingling in a rare patient.

Keep in mind that new medications and combinations are tested on a few thousand people, not the millions of people that a hot new prescription drug will see. Statistically rare occurrences require big numbers to identify. It is reassuring however, that there are no serious scientific concerns about this new combination medication.

Will Qnexa be the next big pharmaceutical wonder drug, the billion dollar pill? Will it undo some of the damage the fast food nation has done on our heart health? Or will having a good answer for weight loss just make us eat even less carefully?

I think next year’s New Year’s Resolution is going to be a lot easier to keep.

Take Care.

Dr B.

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