November 2015

Time To Manage Your Stress! By Robin Miller, MD MHS

Global warming with crazy weather happenings, ISIS and domestic terrorism, the upcoming elections and the ranting of politicians, trying to help patients get well when they cannot afford the medications that will heal them, these are just a few things that have led me to write once again about ….STRESS!

Stress is one of those things that is a natural part of life, and one of those things that can show up physically with new, or worsening, symptoms. Some of us handle it better than others. There are various types of stress. There is acute stress that you feel when you are in danger and that provokes a “fight or flight” response, otherwise known as an adrenaline rush. There is intermittent acute stress that is a hallmark of those with the type A personality. These are people who are stress junkies and thrive on deadlines and rushing around. Finally, there is continuous or chronic stress. This can be seen in people who are oppressed either by a job, relationship or a government.

The most dangerous form is chronic stress. After time, those with this type of stress get so used to it they don’t even notice it. The continuous outpouring of stress hormones can lead to obesity, diabetes, heart disease, stroke and even cancer.

It is important that you recognize stress in your life and that you do something about it, especially since there are so many ways to relieve stress. I advise starting with a healthy diet (avoid the urge to devour carbs), exercise is key, and then find ways to relax: read a lighthearted book; watch a funny movie; listen to soothing music; lay on the sofa holding your dog, and pet her nonstop. Turn off the news. Find ways to help so you can make a difference in improving the lives of others.

There are also complementary medical therapies (CAM) such as massage and acupuncture that can help. Meditation and yoga are great ways to relax and manage the stress response. Some may need the help of a therapist.

Regardless of which route you choose, it is important to pay attention to your body and if you are chronically or even intermittently stressed get help and stay healthy.

Make Sure All You Stuff is The Turkey on Thanksgiving

Every year there are blogs about how to avoid weight during the holidays. So, here we go again. I have some quick tips that I think will help:

  • Make sure to eat a good breakfast on Thanksgiving Day so you aren’t ready to eat the turkey all by yourself.
  • Go for a walk and relax before your dinner.
  • Choose a small plate and take small amounts of food. Talking can distract you and cause you to eat faster. Fast music and being surrounding by fast eaters can do it as well. . So, chew slowly and enjoy every bite.
  • Fill yourself up with veggies.
  • Dessert is OK but take small amounts and bites.
  • Watch the alcohol. Many drinks are loaded with calories and those who drink tend to eat more.
  • Fill up by drinking plenty of water and staying hydrated.
  • Finally, move around and socialize rather than hang out on the couch after dinner.

Thanksgiving means different things to different people. For most it is a time to express gratitude for our freedom, and to enjoy family and friends. It is important not to get so involved in the food and festivities that we forget the true meaning.

The More Things Change The More They Stay The Same-Revisited By Robin Miller, MD

As a physician with conventional medical training, I often used to look at home remedies with skepticism. I have had several patients who have sworn that apple cider vinegar was good for whatever ailed them. Apple cider vinegar has been around for ages. Hippocrates used it to treat wounds; soldiers in the civil war used it for digestive problems and to prevent pneumonia and scurvy. Apparently Cleopatra used it to dissolve her pearls to make a love potion for Mark Antony.

Studies Showing Benefit

There have been recent studies done at the University of Arizona that have caused me to take a second look at apple cider vinegar. One study looked at 29 patients with either insulin resistance (prediabetes) or type 2 diabetes. They were given either a drink of vinegar, water and saccharine or placebo followed by a meal with 87 grams of carbohydrate. Compared to placebo, blood sugar decreased by 64% in the prediabetes group and 19% in the diabetes group.

Another study looked at weight loss in healthy women. The women were given a morning drink of vinegar or placebo followed by a bagel breakfast. Not only did the vinegar group have a 54% lower blood sugar one hour later, but they also consumed 11-16% fewer calories throughout the day.

Yet, another study found that taking a drink containing two tablespoons of apple cider vinegar along with eating one ounce of cheese before bedtime significantly lowered fasting blood sugars in the morning.

Some Cautions

There are potential safety and side effect issues. Obviously those allergic to apples need to avoid apple cider vinegar. Raw apple cider vinegar can contain bacteria, so it would be better to use the pasteurized form. Apple cider vinegar capsules can cause burning in the esophagus if they get lodged there. Apple cider vinegar can also irritate the stomach. There are potential drug interactions if a patient is taking digoxin, insulin or diuretics. Vinegar can lower potassium levels.


Of course, as with everything, moderation is the key. Taking a mixture of apple cider vinegar in juice or water in the morning may help with both blood sugar and weight control. It is important to discuss this with your doctor before you do it.

I Disagree! By Robin Miller, MD MHS

The American Cancer Society has come out with new recommendations regarding screening mammography for breast cancer. They recommend starting regular screening at age 45, yearly screening from 45 to 54, and screening every 2 years after that. They also discourage self and in-office breast exams. I have to strongly disagree. I understand their concerns about the stress and distress of false positives. However, as a clinician who has cared form women for the last 30 years, I don’t get it. I also don’t understand their recommendations when it comes to eliminating the in-office breast exam.

Starting mammography at the age of 45 years means that we will be missing the aggressive cancers found in younger women. I have diagnosed many in this group. They were not the kind that would lay dormant either. These were inflammatory cancers that had a high likelihood of metastasizing. I am happy with screening yearly between the ages of 45 and 54. But, why would we screen every two years in older women. The chance of breast cancer goes up, not down as we age. As far as the exam, I have picked up many cancers that were quite large that patients did not notice.

Unfortunately, insurance companies will seize on the recommendations and stop paying for mammograms that are recommended for good reason by conscientious primary care providers everywhere. Patients will not want to go to any extra trouble to have an exam that they are afraid of having in the first place, even if they have symptoms or feel a lump.

We have done such a great job with screening. The survival of those with breast cancer continues to improve, in part from early detection. Mammography also continues to improve. We now have the 3D mammogram machine, which promises to improve detection rates of invasive cancer by 40% and decrease false positives by at least 15%.

The American College of Obstetrics and Gynecology (ACOG) have a similar opinion to mine. I believe they feel the same way as I do, because those who belong to the organization have most likely saved many lives as a result of examination and screening.

“ACOG maintains its current advice that women starting at age 40 continue mammography screening every year and recommends a clinical breast exam. ACOG recommendations differ from the American Cancer Society’s because of different interpretation of data and the weight assigned to the harms versus the benefits.”

I am hoping that medical providers can prevail when it comes to common sense and concern for the women we care for and about. I am going to continue doing what I have always done, because I have seen the positive results of prevention and screening. I treat my patients as individuals.

Current global recommendations are just that. They do not take into account each person. They look at averages and base them on the whole not the parts. The recommendations will work for you if you are in the middle of the pack. If you are on the outskirts you will suffer. How do you know if you are on the outskirts? You don’t until it is too late.

The REAL weapons of mass destruction

November is diabetes awareness month. Why is this important? Because, diabetes (specifically type 2 diabetes) is a HUGE problem.

Here are some quick facts:

• Of those Americans over 65 years of age, close to a third (26.9%) had diabetes in

• Almost 30 million children and adults in the United States have diabetes.

• 86 million Americans have prediabetes.

• 1.7 million Americans are diagnosed with diabetes every year.

Why is it such a problem? Diabetes is a major cause of kidney failure, limb amputation and blindness. It is also a risk factor for stroke and heart attack.

Overweight and obese individuals are most prone to developing type 2 diabetes. Weight gain decreases the body’s sensitivity to its own insulin. This causes the body to kick out more insulin, but eventually insulin stores run down. This whole process results in inflammation, and that is how diabetes causes serious damage to the body.

Type 2 diabetes, also known as adult onset diabetes in the past, is no longer a disease of adults. As a result of our obesity epidemic it is becoming a disease of children. Unfortunately all the complications that follow as a result are being seen in children including stroke.

The symptoms of diabetes can be subtle. When it becomes more pronounced with increasing blood sugars the symptoms that occur include excessive thirst, urination and an increased appetite. Some people may lose weight. Others may also note fatigue and tingling of the hands and feet.

Fortunately, type 2 diabetes is preventable. A recent study found that small amounts of weight loss (5-10%) could delay or prevent diabetes in those who are at risk. In fact, it was pretty dramatic. Diabetes was reduced by 40 to 60% over the 3 to 6 years that the study was conducted. The solution to this growing problem sounds easy. But, it is not, because achieving significant weight loss is tough.

Obesity continues to grow as an epidemic that threatens to kill our children, crush our medical system and ultimately our economy. We worry about terrorism and weapons of mass destruction or WMD, but perhaps what we should fear most are the ultimate WMD, the knife and the fork.


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