We have a commitment in our office to help improve the health and fitness of our patients, and I think this is an opportunity to join with them in reaching that goal.  So, I would like to invite all of our patients to join us in the Son Run again this year.  It will take place the morning of Saturday, April 17 at the church.  If you would like to register as part of our team, contact our office and let us know by March 19th.  (Or, you can register individually here)  It doesn’t matter if you’re a serious runner interested in posting your best time or just getting started and wanting just to finish.  It’s a great opportunity get healthy and to help out your community.  All the proceeds of this event will go to Stop Hunger Now.

Typically the flu hits us hard here in Texas in late January and through February, but I have had hardly any positive flu tests, and almost all of the activity seen throughout the country has been H1N1.  So where is all of the typical flu?  I would like to think that the heightened awareness of swine flu led to more people getting vaccinated against seasonal flu and therefore less cases.  But, in my opinion, that alone could not explain the lack of flu activity.  Unfortunately, I’m expecting that we still have another outbreak of flu waiting in the wings.  This concern was strengthened this week when I saw my first positive flu test for Influenza B.  All of the previous H1N1 cases were testing positive for Influenza A, if positive at all.  So, I would consider this my first case of season flu all year.  Now, we just have to wait and see where this leads.

With all of this being said, it is definitely not too late to get you flu shot.   However, we are out of flu vaccine (ironically, we have plenty of H1N1) and will not be getting any more in.  Most of the local pharmacies and grocery stores still have flu vaccine available.

Take Care

Here is the final resolution for our list.

5.  Exercise – What is that?  You’d love to exercise, but you can’t find the time?  You’re too busy?  It’s too cold?  It’s too hot?  If you’re looking for an excuse to NOT exercise, then you won’t have to look far to find one, they are everywhere.  But, if you’re serious about making exercise a part of your life, then you have to find one motivating factor that will trump all of those available excuses.  Everyone, whether overweight or not, should be getting at least 30 minutes of cardiovascular exercise a day, more days a week than not.  If you’re trying to lose weight, then you’ll need to increase those numbers over time.  Most people who have been successful at losing weight, and keeping it off, typicaly workout 45 minutes to an hour, 5 days a week.  I know that sounds like a lot, but that’s what it takes.  You should always get medical clearance before beginning a new exercise regimen and you’ll want to build up slowly.  Once you’ve started, you have to continue to push yourself and not be static.

So, there you have it, five resolutions to living a healthier life.  If you have any others you would like to add to the list, feel free to leave those thoughts below.

We started with quit smoking and get a check-up, now here’s #3.

3.  Eat healthy – Well, this is a huge topic, but let’s hit some high points.  First, you should view food as fuel for your body, not a primary source of pleasure or as therapy.  If the purpose of eating is to fuel your body efficiently, then you need to supply your body with the needed nutrients in a timely manner.  Eating more frequently is key.  That means eat breakfast, snack often and don’t skip meals.  Don’t eat meals that are high in sugar (including complex carbs in the form of starchy foods) and lacking in protein and fat.  Your typical diet should be composed of about 50% of your calories from carbs, 30% from fat and 20% from protein.  Include a variety of fresh foods and whole grains every day.  Eating a variety of brightly colored fruits and vegetables is ideal.  Increase your daily fiber intake, typically 25-30 grams per day.  Drink water.  There is no substitute for water.  No, not even Diet Dr. Pepper.  Finally, you can never go wrong with the Food Guide Pyramid.  They’ve been teaching this since we were kids, and it still holds true.

Three resolutions down and two to go.  Today we tackle one of the most commonly made resolutions.

4.  Lose weight – With only one of every three people in our country considered “normal weight,” obesity has indeed become an epidemic.  It’s association with many other cardiovascular risk factors, such as diabetess and hypertension, makes it even more problematic.  Most Americans want to lose weight, but as each year closes, we typically find ourselves 3-5 pounds heavier than the last.  So, what to do?  First, make a reasonable goal.  From a health standpoint, a 10-15% weight loss is medically significant, so start there.  You could also choose a goal based on Body Mass Index, or other body composition analysis.  Then, set a reasonable pace, typically 1-2 pounds per week.  Make sure the methods you choose to lose weight are safe and sustainable.  Finally, create accountability, either with yourself or an outside person, to keep you on track.

Check back tomorrow as we wrap-up our heart-healthy resolutions.

2.  Get a check-up – Many adults have not needed to see a doctor for several years, but without someone to check for risk factors like high blood pressure, high cholesterol or diabetes, you could have more health problems than you know.  This is a situation where ignorance is not bliss.  These three conditions can go without significant symptoms for some time, but may be doing damage to your blood vessels all the while.  This is why high blood pressure has been dubbed the “silent killer.”  I would estimate that I see at least one person on a daily basis that is found to have one of these three problems without any previous knowledge.  If you’re healthy and under 40, you don’t necessarily need a physical every year, but at least every 2-3 years.

Ahh, New Year’s Day.  A time to reflect on the year that just passed and prepare for the one to come.  It comes with a unique tradition, the New Year’s resolution.  Almost everyone makes one and almost everyone fails to keep it.  But, the idea of riding the motivation that comes from a new beginning is too inspirational to pass up for most.  Resolutions to end this year in better health than the last are among the most popular, so over the next few days we’ll focus on 5 heart-healthy resolutions that anyone could benefit from.

If you’ve ever been in my office for a physical, then you’ve undoubtedly heard me belabor the importance monitoring and controlling cardiovascular risk factors.  Heart disease and stroke are two of the top three causes of death in our country, and although some of the risk factors are beyond our control (male gender, African-American heritage, age, family history), these 5 things are definitely controllable.  And, if preventing early death and disability from a heart attack or stroke is not motivation enough to make it stick this year, I’m not sure what will.

1.  Quit smoking – Hopefully, you don’t smoke, but if you do, you have to quit.  There are endless reasons to quit:  Smoking is the #1 true cause of death in our country, we have more options available now than ever before to assist with quitting, the cost of cigarettes is going to continue to rise, the accessibilty to places that allow smoking is going to continue to fall and it’s the most common cause of erectile dysfunction.  If there’s not something in that list that motivates you to quit, then ask yourself “What would it take?”  Perhaps the death or illness of a loved one from smoking, the illness of a loved one due to your own smoking (such as asthma or ear infections in your kids), your own personal smoking-related illness or some other reason.  But, whatever you do, find the right reason, find the right way and quit.

Tune in tomorrow for Resolution #2. . .

“Humanity has but 3 great enemies: fever, famine, and war; of these, by far the greatest, by far the most terrible, is fever”  -  Sir William Osler, Professor and Physician-in-Chief at Johns Hopkins Hospital, 1896

Fever is one of the most recognized signs of illness, and subsequently one of the most common causes for physician office visits.  But, despite it’s ubiquity, it is still poorly understood by most parents (and many healthcare providers) and is often feared.  So, after waking up this morning to a febrile son, his temp was 101.6 under his arm, I thought I would share my thoughts on this common, and unnecessarily frightening, symptom.

Much confusion exists about what defines fever and how best to measure temperature.  As a general rule, fever would be an oral temperature greater than 100.4F or a degree less under the arm.  Rectal temperatures are still considered the most accurate, but are rarely necessary.  Simply feeling a child for fever is actually a fairly accurate way of determining whether or not they have fever, particularly in kids older than two.

Fever is produced typically by the release of certain chemicals from infecting agents (viruses or bacteria) and the cascade of events that follow.  The hypothalamus is responsible for setting the thermostat for your body temperature, and it increases that setting to several degrees above normal.  Then, in an attempt to increase your body’s temperature to that setting, your blood vessels constrict, you start shivering and you get chills which drive you to wrap up in blankets or put on a coat.  These changes persist until your body reaches its new set temperature. 

The fever will persist around that temperature until the thermostat is reset, either naturally or by taking fever-reducing medicines like Tylenol or Advil.  When the fever “breaks,” then you get vasodilation (causing flushing), sweating and a feeling of being hot which leads to removal of clothing and blankets.  These symptoms typically last until the temperature returns back to its normal set-point. 

As I mentioned before, fever is typically not thought of as only a part of being sick, but as a danger to the person or child with fever.  However, fever is actually fairly harmless.  Other than discomfort, and perhaps dehydration, fever has few other consequences.  Many people have a fear of seizures or brain damage related to fever, but these are very uncommon.  In fact, the risk of brain damage from fever only becomes a concern when temperatures exceed 107F. 

Most people believe that without medication fever will continue to rise to a dangerous level.  But, temperature will only rise to the new internal thermometer set-point as discussed above.  This number rarely exceeds 103-104F in children and 101-102F in adults.  Treatment of fever is common, and definitely helps with patient comfort, but it is rarely truly necessary.  Persistence of fever is a sign of continuing infection, but not necessarily of worsening illness.  A common occurrence is a parent waking a child up to treat his fever.  But, if the child is sleeping comfortably, let him sleep and treat the fever when he wakes up.  Many experts believe that fever is itself a mechanism by which your body fights infection.  Many organisms can only survive and reproduce within a certain range of temperatures, and are inactivated by higher body temperature.

So here are a few points to sum up fever

• Fever is a sign of your body fighting infection
• Fever itself is not particularly dangerous
• Fever does not have to be treated
• Fever can be associated with viral or bacterial infections
• Antibiotics do not reduce fever
• Fever in otherwise healthy kids can be treated at home with close observation, and should prompt a doctor’s visit if it is associated with other worrisome symptoms such as worsening cough, irritability, lethargy, difficulty breathing or signs of dehydration
• Fever in children under 3 months needs to be evaluated immediately

H1N1 vaccine availability is continuing to increase, and we are now able to offer vaccines to patients outside of the top priority group.  Those eligible to get vaccines are all children 18 and under, adults with chronic health problems under age 65, parents of children less than 6 months and healthcare workers.  I still recommend vaccination because I suspect we will see another resurgence of H1N1 activity in the next few months. 

It is also a good time to get your seasonal flu vaccine.  They are recommended for anyone between 6 months and 18 years or over 50, plus anyone with a chronic illness.  We have vaccine available for anyone over 4.  For some reason, we have not been able to get our supply of vaccine for kids 6 months to 4 years.

Cajun Fried Turkey

Thanksgiving is a wonderful time to relax and reflect, but it is also a time of over-indulgence.  For the last two months, any time I mention to someone the idea of eating healthy, losing weight or exercising more, they immediately say “That’s going to be hard with the holidays coming up.”  Thanksgiving and Christmas are only two days out of an entire year, but they seem to have a much greater impact than that.  So here are some helpful hints for the upcoming holidays.

1.  Remember, a holiday is only one day.  Enjoy yourself and enjoy the time with your family over good food, but don’t make a week or a month or a season out of it.

2.  Be active.  All of the excuses you typically use to not exercise are gone when you’re off for a four day weekend, so get and get some exercise.  Maybe you can even convince some relatives to join in, they likely need it, too.

3.  Limit snacking.  For some reason, people typically eat a late Thanksgiving lunch, which leads to hours of mid-morning snacking.  Eat a healthy breakfast and one healthy snack to help curb those cravings.

4.  Eat wisely at the big meal.  Now, this is the tough one, but here a few thoughts.  Choose turkey over ham and save a few calories per serving, plus you’ll avoid a lot of unnecessary sodium.  Deep-fried turkey is the hottest thing now, and the good news is that it’s not significantly different from oven-roasted turkey when it comes to calories.  Stick to white meat and lose the skin.  Choose mashed potatoes with turkey gravy over stuffing and save 50-70 calories per serving.  Limit your dinner rolls, they’re about 100 calories each with butter.  Check out the nutritional information of other foods at mypyramid.gov.

5.  Enjoy dessert, a little.  There is no substitute for staples like pumpkin or pecan pie, but they are calorie killers.  Try the three bite rule – take three enjoyable bites and throw the rest away.  We all know that your grandmother made way too much pie, anyways.  A typical slice of pecan pie is almost 500 calories, so just taking a few bites can easily cut 300-400 calories.  Also, don’t take any pie home, leave that for someone else.

I hope this helps make your holiday a little healthier.  If you have any other good tips, let us know.  I wish all of you a happy, healthy holiday.  We have many things to be thankful for, and our health is one of them.

Darin Charles, MD