January 2011

Are You SAD?

I used to live in Portland, Oregon, which is one of the most beautiful cities in the world. That is, when the sun is shining. Unfortunately, the average rainfall in Portland is 37.5 inches a year and by the end of October until the end of May it can be very gray. I noticed that many of my patients would get the blues during these months.

It did not surprise me when Dr. Norman Rosenthal described the condition known as Seasonal Affective Disorder in 1987. It is a condition that most commonly starts in September when the light starts to change. It can continue until the light returns in the spring and summer. Those who suffer from SAD often complain of fatigue, loss of self-esteem, moodiness, and a craving for carbohydrates. Interestingly, SAD can occur for some people in the summer and seems to be related to heat.

Light therapy, exercise, and antidepressants can help alleviate these symptoms. If a light box is used, it should be done in the morning with a special light that mimics daylight outside. There is some suggestion that blue light may be preferable. Regardless, it is important to research the lights or ask your doctor for a suggestion.

If antidepressants work best for you, it is important to start them in late August before the light starts to change. Exercise is essential for general health and will help especially during the gray months. If you were able to get away and go somewhere sunny, that would be great.

SAD occurs in one in fifty people so it is very common. If you think that you may have seasonal effective disorder, talk to your doctor. He or she can help to give you a sunny disposition even when the sky is gray.

When In Doubt Just Dance!

I started learning how to do ballroom dancing about a year ago. I found that it helped me to lose weight, walk taller, and it improved my balance. In addition, I noticed that my thinking was clearer and I had more energy. The observation caused me to look into the therapeutic benefits of dance.

Both the Mayo clinic and the National Institutes of Health have found that social dancing helps to reduce stress, improve energy and coordination, improve overall strength and it strengthens the bones of the hips and legs. In addition it lowers blood pressure and improves cardiovascular health.

A recent study of 75 year olds discovered that those who did activities such as dancing, playing music, board games and reading at least 11 days a month reduced their risk of dementia by 63%. Recent studies of Parkinson’s disease patients who were taught tango determined that when compared to regular exercise, tango-dancing patients had improved balance and functionality. When they were taught waltz and fox trot, locomotion and balance improved but the tango dancers showed the most improvements.

Many of us have a hard time exercising, because sometimes it just isn’t a lot of fun. However, dancing is great fun and is a wonderful form of exercise. The best thing about it is that it doesn’t feel like exercise it just feels great. If you are trying to figure out how to get more movement into your life, find a dance class and get started. It is good for your body and your brain!


If you’ve read our book, you know that we strongly believe in the maintenance of good health and the prevention of disease by regular screening exams. Of course, maintaining good health also depends on being aware of our bodies, noticing new symptoms, and seeking help for them. But, many people have no trouble doing the latter, but just can’t make themselves do the regular screening.

I never really understood that attitude until this past year.  In 2010, I managed to get every one of the recommended screening tests done.  How do I feel about having done that? Proud of myself, sure, but more than that – utterly exhausted. From my routine mammogram and physician-performed breast exam to my annual pelvic exam to my yearly full eye exam to my twice yearly dental cleanings and exams to a colonoscopy to my regular labwork to my first ever full skin exam. All throughout 2010, it felt like I was always either making a medical appointment or going to one.

Add to those, several acute problems – all orthopedic that necessitated not only several doctor visits but also 8 weeks of twice weekly physical therapy – and I had little to no time for anything else besides work, eating and sleeping! I can certainly see why some people would be reluctant to buy into the whole health maintenance idea from a time standpoint, if for no other reason. No wonder some of my patients’ eyes glaze over when I start talking about the yearly screening schedule.

The truth is though, that, in spite of my compaining, my strongest feeling about my health maintenance schedule in 2010, coming in far ahead of the fatigue, is appreciation. I’m very grateful and glad that 1) I have such easy access to all of these tests; 2) most are covered by my insurance; and 3) they all had good results. There are many people, here and in other countries, who cannot say even one of those things.

Take A Break: Doctor’s Orders!

A recent study done in Australia has found that those who take frequent breaks at work to stretch and walk around have smaller waistlines and smaller waistlines translate into a lower risk of heart disease.

They studied over 2700 people 20 years or older by monitoring their activity with an accelerometer. They wore the device while awake and it measured the amount and intensity of physical activity. Those who took an average of 1258 breaks in a week were two pant sizes smaller than those who took an average of 99 breaks in a week. A marker of inflammation called the C-reactive protein was also lower in the active group. The average break time was around 4 minutes. The range of sedentary times of those in the whole group was between 1.8 up to 21.2 hours a day.

Physical activity is very important. Getting up and walking around engages the core muscles, which are generally at rest with sitting. Taking breaks and walking around has also been found to help people be more productive on the job.

If you are sedentary at work, it is time to schedule frequent breaks. Bring good walking shoes and just walk around the block or up and down the stairs or even around the halls. Your heart will thank you.


Remember how easy the resuscitation part of CPR was to learn? You just had to memorize A-B-C which stood for AIRWAY-BREATHING-COMPRESSION. (Some people taught that the “C” actually stood for CIRCULATION, but same thing in terms of the goal.) No matter how much the medications changed for the various arrhythmias in the advanced portion of life support, ACLS, you could always count on the ABCs to get you started when someone suddenly became unresponsive. And this was true for years and years.

Until now. The 2010 American Heart Association Guidelines for CPR* state that compressions should be the first step in initiating CPR, therefore changing the prior ABCs to CAB (COMPRESSION-AIRWAY-BREATHING). This isn’t really all that new; it was recommended, based on a review of the most current resuscitation literature, in the various cardiology journals over two years ago. But now it will be talked about more in the mainstream media.

Based on research that confirms the superiority of performing CPR this way, the idea behind it is that there is already oxygen present in the lungs and bloodstream within the first few minutes of an arrest. Therefore, beginning with compressions will push that lifesaving oxygen to the brain and heart immediately, rather than having the thirty second delay caused by first establishing an airway as dictated by the old way of doing CPR.  In addition, the new guidelines recommend that the speed of compressions be increased to a rate of at least 100 times per minute, and that the compressions be made more deeply, to a depth of at least 2 inches in children and adults, and 1.5 inches in infants.

Another important change is that the guidelines advocate that even bystanders untrained in CPR be instructed to perform “Hands Only” CPR, which means that they do only chest compressions for adults who are unresponsive with abnormal or no breathing. You can already hear the sighs of relief from those potential rescuers who were always at best wary, at worst terrified, of having to do mouth-to-mouth resuscitation (and potentially catching a dread disease) should someone arrest in their vicinity. Now everyone can save a life – or at least, begin the process of saving a life, without fear.

So, even though the traditional ABCs will hopefully always remain the same, there’s now a new and better way to perform CPR. Repeat after me…C-A-B (100 per minute/depth 2 inches).


* Circulation. 2010;122[suppl 3]:S640-S656.(November 2, 2010 supplement)


Surprise! Fried Fish Increases the Risk for Stroke

There is a particular area in the South that has a very high incidence of stroke. A recent study done through Emory University has found the possible reason for this phenomenon may be the increased consumption of fried fish. This area known as the stroke belt includes the states of North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas and Louisiana. The buckle of the belt includes the coastal plains of North Carolina, South Carolina and Georgia.

Researchers studied the fish consumption of over 21,000 people in this area. Although they ate a fair amount of fish, only 23% of those in the belt and 17% of those in the buckle ate non-fried fish. Consequently, those living in the belt were 20% more likely to die from stroke and those living in the buckle were 40% more likely to die from stroke.

Eating fish and/or using fish oil is commonly recommended to reduce the risk for stroke and heart attack. However, frying the fish not only seems to negate the benefit but also seems to increase the risk. My guess is it has to do with not only consuming fried food but also eating increased calories as a result of the frying. If you look at Burger King you will find that one of the foods with the highest calories is the fish sandwich at 680 calories. The fish may be healthy but all the stuff around it may not be good for you or your waistline.

America has gotten the message that fish is healthy. However, the way it is cooked is important. In order to benefit from fish and decrease your risk of stroke put away the frying pan, add some vegetables and get out there and exercise.


A longtime friend of mine died last week. She was three months short of her 98th birthday, and had never been in the hospital until this final illness which began about a month before. She had few illnesses throughout her life and, other than vitamins, took no regular medications. Her only disability in the last five years of her life was blindness secondary to macular degeneration. And even this didn’t impact her daily activities that much.

Her good health continuing into a ripe old age is indeed remarkable. But there was something else about her that was even more remarkable – her attitude and her beliefs, and how she maintained and practiced these every day of her life. That last line would seem to be an opening to discuss her faith or religion or spirituality, and although she did in fact have a very strong faith, that’s not where I’m going with this.


What was truly remarkable about this lady was that she set daily goals for herself – not necessarily huge lifetime goals either – and actually carried them out on a day by day basis.  She strongly believed that she must accomplish something every single day; and she did. Whether she began a new drawing (she was an artist), or learned a new song (she was a musician), or went through old magazines and cut out photos that she liked for a scrapbook, she always accomplished something new each day. When she became blind, she immediately started getting books on tape; her first project was to listen to the Old Testament of the Bible from start to finish. When she had done that TWICE, she then began to learn French and practiced every single day. And, when she was 89, she wrote her memoirs.


These small accomplishments did not stop her from her activities of daily living. She got up every morning, got dressed – complete with pearls and stockings –

straightened her apartment, spoke on the phone to her sister, and went about her regular activities in addition to doing something new. We once were talking about the new year, and she could not understand why people made resolutions.  If they would just get up in the morning and do what they needed to – without fighting it, without thinking too much about it – then there would be no need for resolutions, she told me.


I will miss her. But, her friendship has left me with many gifts, one of which is that I will no longer make New Year’s resolutions. I will simply do as she told me.


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