Category Archives: Health

Topics related to medicine and general health aspects.

Video

Answering The Door 1

Safety considerations when there is someone at your door.

Caffeine Effects

A couple of days ago I went to a picnic celebrating the Fourth of July and a friend’s daughter’s graduation.  While socializing with people of various ages I had the delightful opportunity to speak with the graduate’s grandmother. 

“If I could only sleep better, I’d be happy,” she said.  She was saying how well she felt otherwise, but needed to find a solution to sleep better.

Insomnia, or difficulty falling/staying asleep, was a relatively frequent complaint from some of my patients. Most ofter they sought a “sleeping pill” to solve the problem, but oftentimes that wasn’t necessary. Insomnia was also a challenge to students in my Smoke-Stoppers classes.  The stress of stopping smoking would seem to bring insomnia to the forefront and hence it was common to discuss it.

The physician-patient discussion would then focus around the characteristics  of the insomnia. Was it difficulty falling  asleep or staying asleep? Most often it was “staying” asleep or sleep maintenance. My next question was whether they were taking anything that would tend to keep them awake. Some antidepressant medications can do that as well as nasal congestion meds as in nasal sprays and tablets. Phenylephrine and pseudoephedrine are available over the counter (although you have to show your driver’s license due to their potential abuse). When these meds are present in “Sustained Release” tablets their effect can last quite a while.

But the most common non-medication cause of insomnia was caffeine.  I’ve had a number of stories of patients who seem to “suddenly” become caffeine sensitive.  And that’s not too surprising.  Our tolerance to caffeine often changes as we mature.  Three cups of large coffee daily as a “twenty-something” changes to caffeine scrutiny of all drink labels when we’re older. Remember, our body is a work in progress and we have to adapt appropriately.

According to what I’ve read, caffeine is  metabolized to its breakdown products within 12 hours.  However, those products can still affect your sleep! Characteristically caffeine and its by-products won’t keep you from falling asleep, however you won’t sleep as deeply, and you’ll have a harder time going back to sleep if you wake up for some reason.Such reasons include waking up to go to the bathroom,anxiety, hearing a noise, or even having “something on your mind.”

I recommend caffeine withdrawal in a gradual fashion, even from only one cup of coffee a day. People have had severe withdrawal headaches from going one cup per day to “cold turkey.” I suggest one half cup caffeine per day for 3 to 7 days before stopping.  Some coffee shops may even offer “half & half” caffeine for those days, then decaffeinated thereafter. Remember, decaf is really low-caf.  Decaffeinated coffee has one-sixth to one-tenth the amount of caffeine as regular coffee, depending on the brand.  It’s extremely rewarding to have the patient come back, off caffeine, sleeping soundly, on no new meds, and feeling great.

Caffeine traditionally has had a role to help our generally sleep-deprived population wake up each morning. There were also some studies that have claimed some anti-(pancreatic?) cancer effects, and delaying manifestations of Alzheimer’s disease. Although this may be true and work for some people, caffeine can be a problem.

Caffeine can cause gastroesophageal reflux (acid from the stomach shoots into the lower esophagus)during digestion. On a long term basis this can predispose to cancer in that area. On a short term basis it can cause discomfort of “acid indigestion,” or trigger asthma symptoms.  Approximately half of all asthma patients have this potential sensitivity which explains why they breathe better when they watch what, how, and when they eat! (I’ll make a note for my self to talk more about this in a future posting). Palpitations can be caused by caffeine and this can alter the effectiveness of some cardiac medications.

The acid indigestion segues into another hidden cause of insomnia. The earlier stages of reflux may not be perceived. But if one realizes that they ate just before going to bed, or had a fatty meal, or tomato-based food, or alcohol, then taking a Tums tablet may neutralize the acidity and allow sleep! Tums contain calcium and should be used cautiously by patients who have difficulty handling it. Check with your doctor if you have any questions about it!

One final note is where caffeine can be found. We all know that it is in the cola sodas. However, watch for it also in Mountain Dew, A&W Cream soda, Sunkist Orange,Moxie soda and Barq’s Root Beer. Watch for it in the teas, especially the Iced Teas which we frequently drinks on these hot, summer days!

The grandmother with whom I was speaking drank one cup of caffeinated coffee daily and will consider switching to decaf. 

Watching the amount of caffeine you consume should help with insomnia, palpitations, anxiety, gastroesophageal reflux, and asthma symptoms.

CERT Safety Fair and Safety Awareness

About three weeks ago I had the opportunity to participate in Bristol’s CERT Safety Expo.  The CERT (Citizens Emergency Response Team) program is comprised of civilian volunteers who prepare for and handle emergencies in our city and state region. The team, headed by  Harley Graime, played a pivotal role in our city’s response to the October 29, 2011 snowstorm. They manned one of the emergency shelters where people could seek warmth, electricity, and food. There were a lot fewer casualties because of them and I applaud Harley and his team on their accomplishments then, and on their motivation to keep the Bristol community informed and prepared for other emergencies, natural and man-made. That was the point of the Safety Expo for them and they allowed me to share some information from my Refuse To Be A Victim personal safety seminar with people who attended.

The “quiz” I used consisted of five questions to evaluate safety awareness.  How many can you answer?

1.What is “Condition Black?”         2. What is your Best Weapon?    3.  What is the “Rule of 21?”     4. What is Forced Teaming?”   5.  Should you answer the door if the doorbell  rings when you are doing something and don’t want to be bothered?

While you are thinking of the answers, let me tell you a true story.   A friend of mine and his wife were looking for their car in a parking garage about 3 blocks from a local concert theater in Waterbury. Although the garage was well lit, it was surprisingly deserted and it was night. As they started walking down one aisle, they were hailed by a stranger approaching them from the opposite direction.

“Hey there,”  the man said.

“Hi…,” answered my friend, noting that the man was about 20 years younger, about 30 pounds heavier, and six inches taller.

“Are you looking for your car too?” the stranger asked.

“Yes…,” replied by friend, somewhat cautiously.

“You know,” said the stranger, “we come to these concerts looking forward to a good time with the wife; kids are at home with a sitter; and we forget whether we parked on the north or south end, the right or left side, and even what floor we’re on.  It’s a good thing there are only three floors in this garage! What does you car look like; maybe I can help you find it so we can all get home sooner!”

“I found it; it’s over here,”  my friend’s wife just then announced.

“Thanks, but we’re all set,” my friend said to the stranger as he started to turn away.

“Before you go,” the stranger quickly retorted, “maybe you can help me out. Will you give me five bucks for gas; the pump wouldn’t accept my charge card?”

My friend said that at that second he felt like he was “frozen.” He wasn’t quite sure about how he should respond, he said afterward. “If I refused him would it escalate into violence ? Would it escalate anyway no matter how I responded? I wasn’t sure about what my choices were!”

I asked what happened. “I gave him five bucks, he went his way and I went mine. And that was it,” he said.

I call this an acceptable ending to a potentially dangerous situation.   It was a “teaching experience” for both me  and my friend. He had a number of choices with which to respond and he chose one he was most comfortable with at that time.  He had other options though. And the discussion points of this encounter contain answers to most of the Safety Awareness questions above.

The feeling of being “frozen” is often due to being in a state of denial. As a potential crime is unfolding thoughts run through your mind,”I can’t believe this is happening! It can’t be happening to me! This is surreal! This must be a dream! Things like this don’t happen to me!” And you a literally “frozen” in place not knowing how to answer the potential threat.  The danger is that you are losing valuable time with which to prepare for your defense! This is “Condition Black.” Make no mistake ; you must get past denial to survive!

Deliberate quickly what your options are, then take decisive action to handle the threat.  Mentally, and ideally physically, preparing  for such encounters ahead of time helps to partially or completely remove the time lost because of denial. And as a result, you have a better chance at surviving the encounter. Remember: Denial – Deliberation – Decisive Action.

The younger, taller, heavier stranger used Forced Teaming  strategy in getting my friend to part with his money. In Forced Teaming the criminal uses words like “we,” “us,” “our” to subconsciously suggest that he is like you.  And if you like yourself, you’ll like him too! This works to decrease alertness, awareness, and make the victim more vulnerable to crime. See his vocabulary when he first greeted my friend. There are seven other strategies listed by Gaven DeBecker in his book The Gift of Fear and we discuss them in the Refuse To Be A Victim (RTBAV) course!

Your Best Weapon is your mind, your brain!  Everything else, whether it is as simple as a pen to poke into the soft tissues of the face and neck, or as sophisticated as an electronic stun device or firearm, is a “tool.” The “tools” can help improve the effectiveness of your “weapon” when used properly.  We discuss rules for using your “tools” properly in the RTBAV course. Also note that my friend did not let “his mind be embarrassed  by his ego!” If five bucks circumvents a violent situation, the investment is worth it. How to use this “chump change” or “mugger money” is also discussed!

The “Rule of 21” refers to  the fact that the average criminal, of the average age, with the average ability, can cover 21 feet in 1 – 1.5 seconds.  Distance is safety and keeping your distance from a potential criminal will help defuse  the situation. Remember, now he doesn’t have the element of surprise.  Be aware, however, that if it takes you 2 seconds to take your pepper spray from your pocket or purse,  you want to keep 40 feet (on average) between you and the assailant. Otherwise you may find yourself not only unable to draw and use your tool, your hand many also be trapped in your pocket and unable to defend yourself!

These and literally hundreds of other crime-prevention suggestions are provided in the Refuse To Be A Victim seminar. I hope you’ll let me share them with you!  See the seminar schedule in this blog site.

Upper Respiratory Congestion

Upper respiratory congestion,due to inflammation of the nose (rhinitis), sinus (sinusitis), and throat (pharyngitis) can be felt as nasal/ sinus/ throat “fullness,” congestion or pain. It seems to be a complaint of patients felt throughout the year. And why not. The lining of our nose, sinuses and throat are sensitive to many irritants present in our everyday environment throughout the year.
Most often a patient sees their doctor in search of an antibiotic for a suspected bacterial infection causing the symptoms.  Actually, viral infections and allergy account for more of these bothersome symptoms, and recognition of this can provide symptom relief faster and less expensively by use of over the counter (OTC) medications. 
Viral infections by the rhinovirus is the most common cause of “cold” symptoms.  These occur most often in the late fall and winter, and consist of  the sensation of fullness in your head, around the eyes (where the sinuses are located), and in the ears and throat.  When the throat lining gets swollen, the throat opening of the Eustachian tube from the middle ear gets blocked and the pressure from it can’t be equilibrated easily. This is the same pressure you may feel in an elevator of a tall building or  in an airplane.  Also your eyes may tear and your nose may “sniffle.”
A rhinovirus infection is usually picked up when we casually touch our eyes, nose or mouth after picking up the virus from a non-absorbable surface after an infected individual sneezed or coughed on it.  This is why handwashing is so important in prevention of most viral and common bacterial infections.  We have no effective antiviral medication to treat the common cold virus yet.  Other general “good health” habits such as eating a balanced diet, getting enough sleep, exercising regularly, and effectively managing stress  will aid in the prevention and treatment of a “cold.”
OTC medications which may help, include guaiafenesin which helps loosen secretions and helps the body get rid of the virus particles. You want them to “flow out” of the body to keep them from multiplying and getting into your bloodstream   and thus compounding the symptoms.  Guaiafenesin is present in some liquid cough meds as well as in timed-released and regular tablets.  Although it carries the warning of possible stomach upset, it is usually well-tolerated by most people and should be used whenever there is mucus that you want to get rid of.
Sometimes guaiafenesin is partnered with an antitussive (anti-cough) medication.  This is mostly for the purpose of patient comfort, for example to allow them to sleep.  Using the antitussive all the time is counterproductive; you’re loosening the secretions/mucus but stifling the cough to get rid of them!   In addition the cough suppressant medication can upset the stomach and cause constipation. So maybe taking the anti-tussive/guaiafenesin during the night, and the plain guaiafenesin during the day would make sense.
Decongestant medications are available OTC but you may have to show your ID card in order to purchase them since they may be abused.   Phenylephrine and pseudoephedrine  come in pill form, both timed-release and regular release. Patients with hypertension should exercise caution with these meds; they may elevate the blood pressure.  They can also cause insomnia and increased pulse rate so the afternoon/evening dose may need to be modified or skipped.  Your doctor will be able to advise you on this.  
Nasal decongestant sprays/gels are also available, may work faster, and you may be able to modify the dose.  But follow the instructions carefully since some decongestants can worsen symptoms if used for more than a few days.
One caveat: Although most viral infections clear up eventually,  they can sometimes linger, weaken your immunity and open  the door  to a bacterial infection.  It should be recognized  that bacteria exist normally in the throat and nose, but are kept “under control” by good health.
Allergic rhinitis, on the other hand, causes similar symptoms  as rhinovirus infection but in addition there are histamine-related symptoms of itchy eyes, itchy nose, itchy throat and multiple sneezing (4-5-6 times in a row).  Any one of these histamine signs, expecially when there are more than one, should make you think “probable allergy” as the cause.  The importance of this is that anti-histamines are available OTC and are effective  in relieving symptoms and, more importantly, preventing development of a secondary bacterial infection.
Loratadine is the generic of Claritin, cetirizine is the generic of Zyrtec, and fexofenadine is the generic of Allegra.  The generics are all available OTC and generally do not have the side-effects of diphenhydramine (Benadryl). These are sleepiness, dry mouth, and prostate congestion in men.  However, if you have to take the antihistamines regularly, you may eventually experience some side-effects .  If you have a history of asthma consider using guaiafenesin while on antihistamines to help prevent bronchial plugging from dried mucus secretions.

Some patients have reported decreased effectiveness of the antihistamines after prolonged use.  When this effect has been seen, another one is chosen.  
Although we commonly think of allergic rhinitis  as occurring in the springtime, these histamine symptoms can also happen in the middle of winter!  If you get those itchy histamine symptoms in January, you may be reacting to indoor allergens  such as animal danders, dust mites, or allergens on your clothes from walking outside.  One study suggests that if you have a history of allergic rhinitis in the spring, you are more susceptible to allergic sensitivity in the winter.  So watch for it; use the antihistamines as directed.  Having had the “opportunity” of experiencing allergic rhinitis in the winter, I can appreciate how insidiously it can appear in the middle of winter, make you think you have a bad cold or bacterial sinus infection, and make you think you need an antibiotic. But check your history carefully; antihistamines may help and antibiotics can be saved for when you really have a bacterial infection.
Your physician will help you with any further questions about rhinitis, sinusitis or pharyngitis, including other, less frequent causes for it. His/her experience may even contribute further insights to help  maintain your good health!

Essentials of Personal Safety

Essentials of Personal Safety  provides an information  foundation on which to build increased safety into your life and thereby prevent crime. Criminal psychology is discussed,along with Pre-Incident Indicators which are “red flags” that tip a potential crime victim that “something may be about to happen!”  A  number of cases will be discussed. Most of them are local to Connecticut. We will talk about What happened, Why it happened, and Options the victim may have to avoid / handle the crime.  Through this discussion we build up our self-confidence that we need not be “bullied” by criminals; that staying safe is not an impossible task in our world today. Essentials of Personal Safety is a “preview” of the Refuse To Be A Victim Program which discusses safety and crime prevention in the various areas of your life: Home, Auto, Shopping and Travel, Work, Technological  and Medical. Knowledge IS Power when you use it.  When you use this knowledge, you will be able to Deter, Delay, Detect and Deny crime!!  I look  forward to meeting you!!!

RTBAV – “Don’t worry; you’re safe with me!”

He was leaving the popular bookstore and crossing the parking lot. The early evening light was still  enough for my buddy to see out of the corner of his eye the car coming toward him . He jumped one way; the car pulled the other way and screeched to a sudden stop. He walked over to the rolled down, passenger window, expecting an explanation.

The driver was  younger, muscular, potentially intimidating. “Don’t worry, sir; I wasn’t going to hit you,” he said. My buddy was still awaiting an explanation.

“Don’t worry, you’re safe with me driving,” he continued.  Still no explanation. “I wasn’t going to hit you.”  And then, finally, “You know, my credit card didn’t work when I went for gas.  Can you spare me $5?”

As the hairs stood up on the back of his neck, my friend realized this was a scam!  “I’m sorry,” he said. “I don’t carry cash.”

Radiating intimidation the driver came back,”Well, are you sure??

My friend is a Viet Nam veteran with a concealed carry permit. That explains why the intimidation was not received, as my buddy put his hand under the edge of his untucked shirt, on the handle of his concealed Glock. He was confident; he didn’t have to say another word. “The scammer knew I was not going to be a victim,” he related afterward. Without another word he drove away, rather quickly.

Walking to his car, perturbed with the attempted scam , my friend heard another screech of brakes not 30 seconds later. Looking back to the store, he saw the driver attempting the same scam, on an older lady, who was talking to the driver through the driver’s window!

Same lines…”Don’t worry, ma’am; I wasn’t going to hit you. You’re safe with me driving.”

He approached the car from the left rear.  He was angry. He met the drivers eyes in the left side view mirror, the serious look on his face telegraphing what he felt.

That’s all it took. Almost instantly the scammer drove away, again very quickly.  And the older woman was at first perplexed.  “What happened here,” she thought? “This nice man who saved my life was talking to me, and he suddenly drives away when this other man  came up. And he looks concerned…”  Then it hit her. The explanation. “I could have been scammed, robbed.  The driver could have taken my pocketbook even if it was around my neck. I could have been badly hurt .”

I use this story for a number of reasons. First reason is that it is true. There is no denying that crime can still happen! And not just in sleazy, inner city neighborhoods at night.

Second reason is that it shows the criminal’s strategy to lower the intended victim’s awareness. Gavin DeBecker in his book The Gift of Fear lists Pre-Incident Indicators which are warning signs, red flags that warn you something criminal may be occurring.  This maneuver, called “loan-sharking,” has the criminal making you feel like he had “done you a favor” and now it is your turn to “pay him back.” We discuss the eight Pre-Incident Indicators as well as the psychology of the criminal mind in the Refuse To Be A Victim program.

You can appreciate how my friend was in a Level Orange of awareness. Familiar surroundings, unfamiliar people.  We talk about the White, Yellow, Orange, Red and Black levels of awareness and function in the RTBAV program.

Lastly, one can appreciate his different “layers” of response. He didn’t just run up to the driver’s door, open it, grab the guy and confront him. Rather, he responded to the level that he needed, ultimately even keeping his firearm holstered. And then he prevented the woman from getting ripped off. That’s my buddy. He’s what Lt. Col. Dave Grossman labels a “sheepdog,” watching over people who are prone to being victims.

The information provided in Refuse To Be A Victim gives citizens those “layers” of protection and safety which translate into crime prevention. There is no “hands on” training nor firearm shooting, although I provide some resources if one would want to pursue this.  I invite you to join me at one of my upcoming programs.  Refer to a previous blog for details. I know you’ll find it worthwhile in every respect!!

Nuts and Weight Management

A few days ago a radio personality was talking about New Year’s resolutions, dieting, etc. and one of his listeners suggested that weight can be controlled “by drinking water and eating nuts.” The question arose, “How does that help?  Aren’t nuts fat and isn’t fat to be avoided?” And how does drinking water help keep weight off? I can share with you some of the information I used in my past Smoke Stoppers classes.  Some of this information was updated  with the South Beach Diet movement.

As we eat and fill the stomach, a message gets sent to the brain that “I’m starting to get satisfied, so decrease the appetite and slow down the eating.” By filling the stomach with a glass of water (no calories there) or a broth/ onion soup (few calories there) , we can decrease the amount of craving hunger that leads to rapid food intake and weight gain. You might even be able to take half the meal home with you to enjoy at a later time!

The second answer is that yes, nuts are mostly fats. But they’re the “good,” monounsaturated fats that help decrease cholesterol damage to the blood vessels throughout your body. Although nuts are  better for you than either the saturated or polyunsaturated fats, they are still fats and the amount one consumes should thus be limited. The South Beach recommendation is to eat about 10 unshelled peanuts (therefore 20 nuts), or about 15 pistachio nuts or almonds, or 5 walnuts with a meal. Their slower breakdown slows down digestion and prolongs stomach-emptying. Fats, like proteins, create a sensation of fullness more efficiently than ingestion of refined carbohydrates does. This leads to a more gradual  release of calories over the few hours following the meal. We thereby avoid the hunger between meals which often leads us to the fat food-filled, vending machine.

The South Beach Diet book also has a dessert recipe with low-fat ricotta cheese  that, as a fat, should help slow down stomach (gastric) emptying.  I urge anyone interested in trying this diet to read the book by Arthur Agatston, MD, and consult with their physician with any questions. In the event that more guidance/motivation is needed, one should call the New England Integrative Health Associates (NEIHA) in West Hartford, CT.  They have a number of dedicated physicians and dieticians who promote weight management and good overall health through healthy eating!