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Thursday, June 19, 2014

White House Conversation: Why Breakfast Is Important

By Hansa Bhargava, MD

white house

This morning as I was rushing around to get ready for work and getting the kids ready for camp, my daughter asked: “Do I have to eat breakfast? Can’t I just skip it today?”

As a working mom of twins, l confess that the thought of skipping breakfast to make the morning easier has crossed my mind. But as a pediatrician, I know that breakfast really does make a difference.

So yesterday, when I sat at the White House roundtable discussion with the first lady about the School Meal Program, I was not surprised when the topic of breakfast came up. Mrs. Obama admitted she didn’t realize the importance of breakfast until she became a mom, when she spoke to her pediatrician. James M. Perrin, MD, FAAP, president of the American Academy of Pediatrics, talked about the importance of healthy meals to the brain, as well as the importance of fueling the brain first thing in the morning. The Healthy Hunger-Free Kids Act of 2010 not only provides qualified children with a healthy lunch (according to the standards set by the USDA), but also breakfast.

Most research shows that the school breakfasts have made a difference. Sam Kass, former White House chef and executive director of Let’s Move, reported that test scores are up in schools participating in the healthy meals program. Although a recent study had mixed results on the importance of breakfast, most experts support the idea that good food in the morning helps kids’ brains work better. As a pediatrician, I fully believe that giving your kids a meal with protein and healthy carbs will sustain their energy and help them concentrate.

And as a mom of two 8-year-olds, I absolutely understand the obstacles that stand in the way as you try to get the kids ready, prepare school lunches, get yourself ready, and head out the door. Here are a few tricks that I’ve used to make it easier:

  1. Stock up your pantry and refrigerator. Keep protein bars, yogurt, hard boiled eggs, and cheese sticks handy. Any of these with an apple or banana make a great grab-and-go breakfast.
  2. Do some work the night before. I will often put 2 days’ worth of sandwiches in the fridge along with cut-up veggies in plastic bags.
  3. Have healthy cereal options available at your fingertips. This is an easy go-to for older kids. If you have fresh blueberries in the fridge, throw a handful in their cereal along with low-fat milk.
  4. Give them a glass of milk to chug down and bring a granola bar and a piece of fruit to eat in the car.

 
That old saying about breakfast being the most important meal of the day is true. Let’s make it happen for our kids so that they can do better at tests, at soccer games, and most importantly, at life.

Posted by: Hansa Bhargava, MD at 5:43 pm

Monday, June 16, 2014

Lyme Disease QA: Prevention and Testing

 Each year, about 30,000 cases of Lyme disease are reported to the CDC, although health officials believe the actual case number is higher. To learn more about prevention and testing for the disease, WebMD Senior News Health Editor Ashley Hayes talked to CDC Lyme disease expert Paul Mead, MD, MPH, and to Beth Daley of the The New England Center for Investigative Reporting. The center today  published a report that looks at issues around Lyme disease testing.  Please return  here at noon on Wednesday, June 18 for a live chat with Mead, Daley and Dr. Arefa Cassoobhoy of WebMD about Lyme disease.

Warmer weather, from spring to early fall, means ticks are at their most active. That increases your chances of a tick bite and your risk of Lyme disease.

Lyme disease is spread through the bite of a blacklegged tick.  Most U.S. infections happen in the Northeast and mid-Atlantic states, from northeastern Virginia to Maine; North-Central states, mostly Wisconsin and Minnesota; and on the West Coast, particularly Northern California.

Here’s what you need to know:

What are the symptoms?

The “classic symptom” of early Lyme disease is a red, expanding rash, says Paul Mead, MD,  medical officer with the CDC. The rash, which can have a bulls-eye appearance, isn’t always present; it’s seen in 60% to 80% of cases, he says.

The rash develops at the site of a tick bite, although a person may not be aware they’ve been bitten. Lyme disease is usually transmitted by nymph ticks, and those are very small, Mead says.

Also, flu-like symptoms — muscle aches and pains, a fever of about 101 degrees or so, headaches, and “that kind of yucky feeling” — are common, with or without a rash, Mead says. If you live in an area where Lyme disease is common and have these symptoms, you and your doctor should consider it a possible culprit.

In later stages of the disease (usually starting a couple of weeks after a bite) people can have Bell’s palsy, a type of partial facial paralysis. The disease can also spread to the joints, causing arthritis. In rare cases, complications such as inflammation of the heart, leading to an irregular heartbeat, are seen, Mead says.

What do I do if I find a tick on my body?

Ticks can attach to any part of the body, but may often be found in hard-to-see areas such as the groin, armpits, or scalp, the CDC says. It’s important to remove a tick as soon as possible, as it has to remain attached for at least 24 hours to transmit Lyme disease.

Remove an embedded tick with fine-tipped tweezers, Mead says. “Grab it as close as you can to the skin, and simply sort of pull directly away from the skin” using a slow and steady motion.

In some cases, a bit of the tick’s head or mouth parts may remain, he says. Clean the site of the bite and “typically, those will fall out.”

If you develop a rash or fever within several weeks, see your doctor — and be sure to mention the bite.

 A tick bit me. Do I have Lyme disease?

It depends on the type of tick, where you acquired it, and how long it was attached, the CDC says. Always remove ticks promptly and, if you live in a high-risk area, check your body daily.

“It’s not true that every single tick bite is going to pose a risk, but you don’t really know, so you have to remove the tick,” Mead says.

Remember, too, that ticks can carry other diseases besides Lyme disease.

How can I prevent tick bites?

Ticks tend to live in wooded and bushy areas with high grass and leaf litter, so take steps to clear your yard. Blacklegged ticks “like cool, dark, moist areas like leaf litter — they don’t like sunny, dry, open areas,” Mead says. Gravel or wood-chip barriers between patios and kids’ play areas and forested areas can also help.

Use repellents on skin (use a product with 20% to 30% DEET) and on clothing and gear (use products containing 0.5% permethrin).

Bathe or shower within 2 hours of coming indoors, if possible, to easily find and wash off ticks — research has shown it may lessen your risk of infection, Mead says. Do full-body checks using a hand-held or full-length mirror. Parents should check children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in the hair.

Don’t forget to check your gear (such as coats or backpacks) and pets. “Pets can be vehicles for ticks to come into the house,” Mead says. Using pet tick control can help.

How do I get tested for Lyme disease?

You must visit your doctor to be tested.

The CDC recommends that only FDA-approved tests be used to diagnose Lyme disease.  Reporter Beth Daley recommends asking your doctor what test he or she uses to diagnose Lyme disease and whether it’s FDA-approved. If you have a bulls-eye rash, your doctor may diagnose you without testing, she says.

Some alternative tests have been developed, but can lead to misdiagnoses, Mead says.

“I think patients get information from those and have difficulty understanding the limitations of those tests,” he says. “Patients are eager to get answers, but a misleading answer is not really helpful.”

The CDC says on its web site that before it recommends new tests, “their performance must be demonstrated to be equal to or better than the results of the existing procedure, and they must be FDA-approved.”

What tests for Lyme disease are valid?

An FDA-approved test uses a two-step method. The first test looks for increased disease-fighting antibodies in the blood that react to Lyme disease bacteria, according to Daley. If that test is positive (meaning you have the increased antibodies), a second test called a “Western Blot” is used to more accurately identify antibodies specific to the Lyme disease bacteria. Results are considered positive only if both tests are positive, according to the CDC. The tests need to be done together.

A person can test negative and still have Lyme disease. That’s because antibodies take a few weeks to develop, and the test can be done too early, the CDC says. The test will likely pick up Lyme disease after 4-6 weeks; if you test negative but still are having symptoms, you can be retested.

Posted by: WebMD Blogs at 1:20 pm

Friday, May 30, 2014

Concussions and Kids: Cause for Concern

By Hansa Bhargava, MD

football player

You may have heard a lot about concussions lately in the news or even through your kids’ school. And as a parent, you may be wondering: If my kid hits his or her head in a game, is it a big deal?

As a pediatrician, I can tell you: Yes, it really is a big deal. A concussion is a brain injury that can stop the normal function of a child’s brain for a short while, sometimes even permanently. No one knows how many concussions will cause permanent damage, but here’s a very concerning issue: Getting on the field again before the brain is ready can not only lead to another concussion, but can even be fatal.

As a mom of 8-year-old twins who play sports, I’m concerned about safety on the playing field. And I know I’m not the only one – teachers, coaches and even President Obama have expressed concern.  In his remarks at the Healthy Kids and Safe Sports Concussion Summit this week, the president noted it’s not just youth football players who suffer concussions. “Every season, you’ve got boys and girls who are getting concussions in lacrosse and soccer and wrestling and ice hockey, as well as football,” he said.

The Obama administration has committed to increase public awareness through a CDC campaign called “Heads Up.” The campaign aims to educate parents, athletes, coaches, and school staff about preventing, recognizing, and responding to concussions.

So, does concern about concussions mean you should pull your kids from sports altogether? I say absolutely not. Participation in sports not only fosters good physical health, but good emotional health, too. Being on a sports team can enrich your child with good friendships, teamwork skills, and deeper self-esteem. But I do think that as parents, we need to take an active role in ensuring our kids’ safety and, especially, preventing the possible long-lasting effects of concussions. Here are a few actions you can take as a parent:

  1. Be your child’s advocate on the field. Make sure you talk to the coaches about protocols when a kid hits his or her head. Is there a sideline assessment? When does the child get put back in the game? When does he or she get pulled out? Are the coaches trained in sideline assessments?
  2. Be an advocate at school. Talk to your child’s school about school sports and even gym class. Are they aware of the impact of concussions? What do they do if a kid hits his or her head in basketball?
  3. Be vigilant. Your kids should absolutely play sports, but make sure they wear helmets when appropriate. And if they do hit their head, make sure they are properly evaluated. If concussion symptoms are not immediately present, call your doctor for guidance on what to watch for. If your child does have symptoms – such as loss of consciousness, headaches, vomiting, nausea, dizziness, and vision problems — see your doctor right away.

 
We want our kids to continue participating in the sports they enjoy. As parents, we need to be educated and prepared so that we can be strong guardians of their health when they’re on the field.

Posted by: Hansa Bhargava, MD at 3:49 pm

Thursday, February 27, 2014

How to Survive in Rare Disease-ville

By Amy Nadel

Image of Amy Nadel

Amy Nadel is the executive director of partnerships at Medscape and editor of Medscape Rare Diseases. Her 27-year-old daughter has glycogen storage disease type 1A (GSD1A) and ankylosing spondylitis (a type of spinal arthritis). Her 22-year-old son is a special-needs young adult.

Last year I wrote about living the “rare disease” life — going from crisis to complication, dealing with new challenges and health issues as a matter of course. We are now in the midst of a serious health crisis. My daughter, 27, is waiting for a liver transplant, due to complications from her rare disease GSD1A.

We got the call in late June, after one of our routine visits to our “rare disease” home away from home, a hospital 500 miles away. An MRI showed “suspicious lesions” in my daughter’s liver that were growing rapidly.  Our doctor recommended strongly that we be evaluated for a transplant and do something about the lesions in the meantime. I know what “suspicious lesions” is code for, and I felt just like I did when she was an infant and we got the GSD1A diagnosis.  Shock … panic … speechlessness … this is not something I ever thought would happen.

I fell back on my crisis management routine. I called the doctor myself to talk through everything. I worked my Medscape network of colleagues to find out as much as I could about the best place to go. I talked to the transplant teams at four academic centers. I reassured my daughter and our family that “Everything will be OK, We will get through this, we always do.”  But I knew this was something quite different than anything we’d had to deal with in rare disease land.

Picture of Rachel

No matter how much you’ve prepared, no matter how many crises you’ve been through, you may still not be prepared for the “what’s next.” Unexpected reactions and rare occurrences seem to happen to us. Yet you have to function, you have to support your child to ensure they feel safe. You have to be an advocate and stay calm and rational, or at least appear that way. (Believe me, I’m ready for my Oscar by now!)

This summer, we entered an alternate universe.  Let me take you on a tour.

1. Was the tumor cancer, or not? It was a bit like a Rodney Dangerfield routine. “It could be cancer … it’s NOT cancer … it probably IS cancer …  it’s definitely NOT cancer … we won’t KNOW if it’s cancer until we take it out.”  Wow. What to do with this information?

2. The surgery to deactivate the tumor goes fine, but my daughter’s recovery is much slower than expected. Eventually she is released from the hospital despite not feeling well. One day later we were called and advised to take her to our local hospital immediately. Routine blood tests showed that she was in kidney failure. We rush to our local suburban hospital ER. Despite my advocacy, no one seems to know how to deal with the issue or why it is happening. Eventually, we learn that she had a “rare” reaction to the contrast agent used for the testing and surgery.

3. My daughter receives dialysis and is in intensive care. Ten days later, she recovered enough to go home. They pulled the dialysis catheter out, and suddenly my daughter started talking strangely (very nasally) and had difficulty swallowing. When she drank, the liquid came out her nose. After several days of panicked calls with different specialists, she was diagnosed with a blood clot resting on a nerve, another rare condition.

Two more weeks, three emergency rooms plus another admission later, we had been in four hospitals in two months. And after all of that, we are on the waiting list for a liver transplant, hoping to get a call soon.

The point is: we recovered, and we’re prepared for what’s next. I’d like to share what I have learned along the way. Being able to plan and rehearse for an emergency (even if you don’t know what it will be yet) will make you feel less “at sea” if (or when) something happens.

  • A team approach is essential.  Keep all members on the team informed of all issues and treatment plans.  Make sure every team member knows the others, their  roles in managing the patient, and how to contact each other in case of emergency (beyond the “on-call” protocol).
  • Role of the primary care doctor:  If your specialist is also a generalist, you are very lucky – but also get your local primary care doctor trained and part of the treatment team.
  • Plan for unplanned scary events.  Know where the local hospital is when you go on vacation. Keep a days’ worth of meds in the car or in your bag, testing equipment, bottled water and whatever else you need for a day in case you have car trouble.
  • Get an emergency protocol from your rare disease specialist that gives guidance for emergency treatment for the patient with the rare disease. It should be very specific and include on-call numbers, case numbers, and any tests that need to be ordered to inform further treatment.  Put copies of it everywhere, including your car, handbag, on your phone, with your primary care physician, at the school, in your child’s backpack.
  • Have an updated medication list on hand at all times (put it on your phone and update it).
  • Have a medical alert bracelet and keep the file up-to-date.
  • Consider writing the history of your child’s disease as well as all relevant details in case you are not with them all the time (I did this each year when my daughter was in elementary school).  The nurse had a copy, one was in her backpack, and the babysitter had one too. Update as necessary.
  • When you’re in a crisis, plan on being the communicator and coordinator of care. Advocate in a calm, informed way without ruffling feathers. (Remember, you’ll probably know more than the doctor about your child’s disease.) Encourage collaboration with others who know you or your child’s condition well.  Practice with a good friend or family member to step through the process if needed. This is the best way to get things moving in the right direction.

When you’re not in a crisis:

  • Routinely email your team (including all specialists and primary care) about yourself or your child. Keep them in the loop. Update medication list as necessary.
  • Keep the team list current.
  • Work with your child to help them understand what to do in an emergency, and help them participate as they get older so they feel  empowered.

Most of all, know that however rare each of the diseases is, collectively, rare diseases aren’t so very rare. If you speak about this to almost anyone, you’ll find that their lives have been touched by something “rare” too.  Keep advocating personally but also to increase funding for research.  Join or start a parents group for rare-disease persons because finding someone in your town with the same condition is unlikely. I am thinking of all of you out there with rare diseases today, and I know you are thinking of my daughter and us as we wait for the phone to ring.

Posted by: WebMD Blogs at 4:26 pm

Thursday, February 13, 2014

Dementia: Is Gluten to Blame?

davidperlmutter

In his new book, Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar — Your Brain’s Silent Killers, Dr. David Perlmutter, associate professor at the University of Miami School of Medicine, advocates that lifestyle modifications, starting with a high-fat, nearly carbohydrate-free diet, can prevent or greatly lower dementia risk and progression — and he’s armed with plenty of data to back up the claim. But detractors say the evidence isn’t quite there. With Grain Brain about to hit its 15th straight week on the New York Times best-seller list (including a stint at the top spot) Medscape’s Dr. Bret Stetka spoke with Dr. Perlmutter about his thoughts on the impact of carbohydrates and gluten on the brain.

Medscape: For those unfamiliar with your ideas, can you summarize the thesis behind your new book and how you arrived at it?

Dr. Perlmutter: Certainly. I’m a board-certified neurologist and a fellow of the American College of Nutrition. I’ve been very frustrated with neurology over the past 20 years, because we’re trained in residency and practice to basically treat symptoms of neurologic disorders. I found that not to be satisfying and thought it was important to delve into causality as opposed to just focus on treating the smoke and ignoring the fire.

That said, with time we began seeing wonderful research citations that were drawing a link between risk for dementia, for example, and blood sugar levels appearing in our most well-respected journals. For example, a study published in Neurology in 2005 pointed a finger squarely at the most powerful metric being glycated hemoglobin. Even back then, it was becoming clearer that there was something going on with blood sugar correlating with rate of brain atrophy, specifically hippocampal atrophy, and cognitive decline. When you now retrospectively evaluate that study, you begin to appreciate that glycated hemoglobin is more than just a metric of average blood sugar, which is typically how it’s looked upon even today.

Glycated hemoglobin is a glycated protein. This is a marker not just of average blood sugar, but more important, it’s a marker of the degree of glycation that’s going on in human physiology — a process that increases inflammation and dramatically increases the production of free radicals and oxidative stress. So the idea that even subtle elevations of sugar, which is a dietary lifestyle choice, are related to risk for brain degeneration really began to crystallize.

This notion has gained traction and, I think, is profoundly supported by a couple of more recent studies. A study published in August 2013 in the New England Journal of Medicine (NEJM)  was very supportive, indicating that even subtle elevations of fasting blood sugar translates to dramatically increased risk for dementia. This was a prospective analysis that measured fasting blood sugar and followed 839 men and 1228 women for a mean of 6.8 years. I’ll quote the conclusion: “Our results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes.”

Why? These are levels of 105 and 110 mg/dL — levels that most doctors are going to be satisfied with. However, according to the study, these numbers translated into a significantly increased risk for dementia in individuals who were not demented.

Medscape: That is striking. However, I think it’s important to point out that many of the studies you cite report associations between glucose and risk for dementia and don’t necessarily prove causality, correct?

Dr. Perlmutter: You are 100% correct. I’ll stand and take my lumps from those individuals who want to make the argument that there’s no smoking gun here. But when a prestigious journal like NEJM calls our attention to this relationship effect in glucose and cognitive decline, we’ve got to take notice, especially at a time when we have no other choice. It’s the best thing that we have going.

We know that a lower-carbohydrate diet is the right choice for the heart and the immune system. There’s no downside to it. I offer it up as being supported by the current peer-reviewed literature. If that’s as good as it gets, that’s the best we have right now.

You can wage criticism that the NEJM study was not interventional. It wasn’t a double-blind study testing some sort of pharmaceutical intervention. It was a prospective study that basically asked who’s going to get dementia on the basis of fasting blood sugar levels.

Some people criticize prospective or even retrospective studies because they’re not interventional. I tend to think that they can provide very, very valuable information. There’s never been an interventional trial that’s demonstrated that seatbelts are effective in reducing injuries in a car accident.

The Dementia Diet

Medscape: What type of diet or interventions do you recommend to prevent or slow dementia?

Dr. Perlmutter: The data show that individuals with lower blood sugar levels have a lower risk for dementia. Therefore, we’ve got to keep blood sugar low. We do so by using the time-honored dietary intervention of a lower-carbohydrate, higher-fat diet.

This is what the scientists have told us for years is the best way to lower blood sugar. If you look at the A TO Z trial, which was published in JAMA in 2007,  dramatic reductions in blood sugar were seen in participants on a lower-carb, higher-fat diet.

A similar article was published in NEJM in 2008. This was an interventional trial demonstrating both weight loss and reduction of fasting blood sugar in individuals eating a higher-fat, lower-carbohydrate diet.

The Mayo Clinic published a study in the Journal of Alzheimer’s Disease in 2012 demonstrating that in individuals favoring a high-carb diet, risk for mild cognitive impairment was increased by 89%, contrasted to those who ate a high-fat diet, whose risk was decreased by 44%. Drs. Barnes and Yaffe from the University of California, San Francisco, published a study in Lancet Neurology in 2011  indicating that about 54% of cases of Alzheimer disease in the United States could have been prevented with attention to lifestyle changes, such as exercise, weight loss, and controlling hypertension.

This province of lifestyle modification in neurologic diseases has not been one of comfort for neurology in general. We neurologists are acting in an essentially reactionary manner. In other words, we are responding to illnesses by hoping that there are medications to treat symptoms, whereas we really ought to embrace the notion of preventive medicine, because the science is staring us in the face.

Medscape: One of the points in your book I found interesting is that you’re not just talking about processed carbohydrates or sugars here, right? You believe that whole grains — typically presumed healthy — also increase dementia risk?

Dr. Perlmutter: Yes, they do. There’s a lot of very good information provided on the glycemic index of these foods. That is a metric of not only just the elevation of blood sugar and the consequence of consuming a particular food, but actually it’s also a measurement of how long the blood sugar remains elevated.

The glycemic index measures what the blood sugar is between 90 and 120 minutes after consuming a particular food. When you look at the glycemic index of whole-grain bread, for example, it’s extremely high: 72-74. It’s higher than that of white bread. It’s much higher than that of many candy bars. It becomes a huge issue in terms of how long your blood sugar remains elevated — that is, how long you have increased risk for glycation of proteins. It becomes a big issue that we have to reconsider these recommendations about whole grains in terms of the simple fact of looking just at the glycemic index.

Medscape: Does the same go for other grains common in health foods these days, such as flax and quinoa?

Dr. Perlmutter: Flax and quinoa (which by definition is actually not a grain) are gluten-free foods rich in fiber and healthful fat. However, they do contain modest amounts of carbohydrate, and assessing these foods by evaluating their glycemic indices will help decide how healthful they really are.

Giving Up Gluten, and the Paleo Diet Fad

Medscape: Why do you feel that gluten is particularly detrimental to our brain health?

Dr. Perlmutter: Gluten-containing foods stimulate inflammatory reactions in a significant number of individuals, well beyond the 1.8% of the population that has celiac disease. This may lead to increased bowel permeability and even increased blood/brain barrier permeability, as described by Dr. Alessio Fasano (formerly at the University of Maryland, now at Harvard).  The mechanism deals with the expression of the protein zonulin brought on by gluten exposure. What is so compelling about this newer research is the fact that this reaction to gluten may occur in all humans.

This may explain to some degree the array of neurologic issues now correlated with gluten sensitivity in nonceliac patients, as described by Dr. Anna Sapone and colleagues. So we have to look at gluten sensitivity in a new light, recognizing that its manifestations may extend well beyond the gut. Writing in the Journal of Neurology, Neurosurgery & Psychiatry,  Dr. Marios Hadjivassilou stated, “That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception. Gluten sensitivity can be primarily and at times exclusively a neurological disease.”

That said, many people shop the gluten-free aisle of the grocery store, thinking that those gluten-free breads, pastas, pizza doughs, crackers, and so on are much better because they’re gluten-free. The bottom line is these are still powerful sources of carbohydrates.

Even fruit is a source of aggressive carbohydrate in the human diet. Take a simple 12-ounce glass of freshly squeezed orange juice — what could be better, right? As a matter of fact, that’s about 34-36 grams of pure carbohydrates. That’s 9 teaspoons of pure sugar with breakfast before your breakfast cereal has even arrived.

My recommendation is to try to keep the total carbohydrates per day to 60-80 grams. If you have 2 glasses of orange juice, you’ve already consumed 72 grams of pure carbohydrate.

It’s really fundamentally important that we address this mechanism of glycation of proteins as being a cornerstone of brain degeneration pathology, and recognize that beta-amyloid itself is a protein that can become glycated and as such can become a powerful nexus for the production of free radicals in inflammation.

We have watched with dismay over the past several years the failure of the drugs designed to rid the brain of beta-amyloid. Most recently, as published in NEJM, a higher dosage of the experimental drug semagacestat was associated with increased cognitive decline of individuals compared with placebo.

Medscape: How does your diet compare with the paleo diet — the idea that we should be following the presumed diet of Paleolithic humans?

Dr. Perlmutter: They are very similar. It’s basically focused on very low carbohydrates and the aggressive addition of good fats: by all means, avoiding modified fats, trans fats, and hydrogenated modified fats, but welcoming back to the table such things as extra virgin olive oil, nuts, seeds, and grass-fed beef (not typical beef).

My diet is not a big beef, go out and eat a lot of meat, kind of diet. When Drs. Campbell and Campbell published The China Study about the possible health consequences of eating meat, their report was valid because by and large, the type of meat that people are eating is derived from animals that have been fed genetically modified corn and soy and high levels of omega-6 fatty acids, which are proinflammatory. Therefore, clearly the idea that there’s a relationship between that type of meat consumption and cardiovascular disease, and even cancer, is valid.

We’re talking about specifically small amounts of grass-fed beef and wild fish. We’re moving the meat, chicken, and fish away from being the centerpiece of the meal to being the side dish, the garnish. Lots of above-ground leafy green vegetables, colorful vegetables, and welcoming back good fats, because that’s what the brain is desperate for.

Medscape: So, it’s in line with a review published by the American Society for Nutrition  last year, as well as other recent data  suggesting that a little saturated fat, particularly from free-range red meat, might not be so bad for our brain health and may protect against anxiety and depression?

Dr. Perlmutter: Absolutely. And not just from grass-fed beef, but from the dreaded egg as well. There is no relationship in the current peer-reviewed literature between egg consumption and cardiovascular risk — none whatsoever. Yet, there is still the ubiquitous egg-white omelet on every restaurant menu that you can find.

Diet Isn’t Everything

Medscape: There are a lot of data on other lifestyle factors with benefits in dementia — physical activity and mental and social stimulation in particular. How much weight do you give these nondietary factors?

Dr. Perlmutter: We were all over exercise in Grain Brain. One of the notions that I think is very, very empowering and compelling is the idea of neurogenesis — that humans retain the ability to grow new neurons in the hippocampus throughout our entire lifetime. We can enhance our ability for this activity through the process of epigenetics.

A study published in Proceedings of the National Academy of Sciences in 2011 showed that we can actively modify the gene for the production of brain-derived neurotrophic factor (BDNF) with simple exercise. The investigators looked at 120 elderly nondemented individuals over a 1-year period who either stretched or did aerobics. They measured 3 variables: serum BDNF levels, memory function, and morphometric analysis of hippocampal size on MRI before and after the intervention period. After 1 year, the group that did the aerobic exercise had an increase in hippocampus size by about 1%, improvement of memory function, and higher levels of serum BDNF.

What is so incredible about that is there is no pharmaceutical that can do that. Believe me, you would have probably the world’s most valuable pharmaceutical if you could develop a drug that would do that. Plain old physical exercise, nonproprietary. No one owns it. That’s why you don’t hear about this on the evening news. It’s not advertised in our medical journals. Just aerobic exercise improved memory, grew the hippocampus, and raised BDNF levels — which beyond neurogenesis also stimulates neuroplasticity, which is fundamental for learning. How incredible that you can modify the growth of your brain today by engaging in aerobic exercise! All you need to go out and buy is a pair of sneakers.

The Obama administration just dedicated $33 million to help pharmaceutical companies develop an Alzheimer disease prevention pill, and yet this article has already been published showing preservation of hippocampal size and function — in fact, regeneration of hippocampal size and function.

Medscape: What do you say to the fact that many global diets proven to be healthy — particularly the Mediterranean diet, which is continually shown to be beneficial in numerous medical and mental conditions — include whole grains? And that many of the world’s so-called “blue zones” — regions in which residents have notably long lifespans — also include grains in their diets?

Dr. Perlmutter: I think people do tolerate some amount of grains, and that the classic Mediterranean diet is one that has added fat and lower carbs. Of note, an April 2013 article in NEJM  compared a standard U.S. diet with a Mediterranean diet supplemented with extra-virgin olive oil and a Mediterranean diet supplemented with mixed nuts. The investigators looked at 3 endpoints: myocardial infarction, stroke, and death. They had to stop the study halfway through it, at 4.6 years, because the individuals with the highest fat consumption had a 30% lower risk for the endpoints. It was unfair to the rest of the participants.

Can people get away with having some whole grain products? I suspect so. But you have to understand that wheat products represent 20% of our caloric intake in the United States. That’s not the way it is around the rest of the world. The Mediterranean diet, for example, does not pound people over the head with soda.

Medscape: How would you respond to your detractors that there just isn’t enough evidence to support what could be considered a somewhat extreme change in our country’s dietary habits?

Dr. Perlmutter: My response is that the “extreme change in dietary habits,” to quote you, is actually what has happened to human nutrition in only the past several centuries. In the early 19th century, Americans consumed just over 6 pounds of sugar each year. That figure now exceeds 100 pounds. And there has been a dramatic reduction in the consumption of healthful fat. Beyond the mechanism of protein glycation, as well as the powerfully detrimental downstream effects of uncontrolled insulin signaling, we haven’t even begun to understand the epigenetic consequences related to the effects of these new dietary challenges in terms of maladaptive genetic expression.

So in reality, I am not suggesting a change. I am recommending that we end this grand experiment and return to a diet that isn’t evolutionarily discordant.

Photo: Courtesy Dr. David Perlmutter

Posted by: WebMD Blogs at 4:55 pm

Monday, February 10, 2014

3 Questions About Flu With Susan Rehm, MD

flu woman

 

WebMD Medical Editor Arefa Cassoobhoy, MD, MPH, sat down with Susan Rehm, MD, the medical director for the National Foundation for Infectious Diseases (NFID), for insights into this year’s flu season. Rehm also shared results of a recent NFID survey on the flu.

What are the highlights of the NFID survey?

Although Americans understand that the flu is a serious illness and the flu vaccine is very important to prevent it, 41% don’t realize that people can be contagious before symptoms start.  Symptoms of the flu can start between 1 to 4 days after you are exposed. During that window you could be spreading the virus to others around you. Hand-washing can help stop the flu from spreading person to person.

Remember flu symptoms using the word FACTS:

FACTS

  • fever
  • aches
  • chills
  • tiredness
  • sudden onset

Who’s at risk this season?

Everyone is at risk.  Nearly all the virus this season circulating is a strain called pH1N1. It’s also known as swine flu. It first started circulating in 2009 and became a pandemic strain that young adults and children are particularly vulnerable to.  It may be that older adults may have partial immunity from exposure to a related virus years ago.

Last year 169 children died, most of whom were healthy to start.   This has led CDC to recommend everyone 6 months and older, including pregnant women, get vaccinated for the flu.

If you do get sick, call your doctor.  You may benefit from antiviral medicines like Tamiflu (oseltamivir) and Relenza (zanamivir), especially if you start it within 48 hours of feeling ill. Surprisingly, 59% of Americans do not realize there are prescription medicines available.

How long am I contagious?

When you are sick with the flu it’s very important to stay home.  It is no good to expose people in the office or at school.  You can return to work after you are fever-free for 24 hours.

Posted by: WebMD Blogs at 10:32 am

Thursday, February 6, 2014

Expert Q&A: Heart Health

heart beat

 

Last year brought about a lot of changes in how we think about heart health. We heard about new guidelines on cholesterol and blood pressure. We heard more about the dangers of salt and sugar to our hearts.

With so much attention focused on heart health this month, we thought it would be a perfect time to get more insight into these and other changes. To do that, WebMD writer Kathleen Doheny talked to Mariell Jessup, MD, president of the American Heart Association. Here’s what  Jessup, a professor of medicine at the University of Pennsylvania  Perelman School of Medicine, had to say.

Last  year, the American Heart Association and the American College of Cardiology changed the guidelines about cholesterol and who should take the cholesterol-lowering drugs known as statins. Can you explain what the changes are and why they were made?

The new guidelines take the emphasis away from focusing only on a specific number for so-called ”bad” cholesterol, or LDL, and focus instead on the patient’s risks. “Previously, doctors were told they had to have their patient’s LDL cholesterol lowered to a certain value, depending on risks. If a patient had had a heart attack, the LDL should be below 70. If they had a risk score that predicted a higher risk of cardiovascular disease in a 10-year period, their LDL should be under 100. For others, under 130.”

The new guidelines advise not treating a lab test number. Instead, they evaluate a person’s risk of having a heart attack or stroke and then suggesting statins, if appropriate.

For instance, a patient who has had a heart attack should be on high-intensity statins. Others may not need a statin but may need to lose weight or make other lifestyle changes.

Some doctors have challenged these new guidelines. Why? And will the AHA and the ACC continue to evaluate the guidelines?

“They are challenging them because it’s a big change. Change is hard, even if it’s change for the good. Many clinicians feel strongly that the lower the LDL is, the better it is for the patient. Unfortunately, there are not a lot of randomized controlled trials [the ''gold standard''] that support that view right now.”

New data is constantly being reviewed and added into the guidelines when needed.  “We are just saying, ‘This is what the facts are now.’”

If someone who was not on statins under the previous guidelines now is prescribed them due to their risk or history of heart attack, can they try lifestyle measures first?

Yes. “The prevention guidelines are a tool to begin a conversation between providers and their patients.  The first task is to assess risk, then consider lifestyle therapy in everyone. For patients at higher risk, [doctors would] consider adding a statin. Of course, lifestyle changes are critically important. Indeed, that is why we published a separate guideline on lifestyle.”

The lifestyle guidelines cover diet, exercise and other measures.

Q: Although people can often improve their heart health through lifestyle changes, many have a difficult time doing so. Why is that?

When it comes to a healthy lifestyle, our culture is far from encouraging.  “Many Americans don’t have access to fresh fruits and vegetables, or a safe place to exercise. The availability of unhealthy foods like sugar sweetened beverages or salty snacks is ubiquitous. This needs to change. Lifestyle is a potent weapon against cardiovascular risk, and we need to make it easier for people to harness that power.”

If you were telling someone to adopt just one new, healthy habit, what would it be?

“Get regular exercise: walking instead of riding, taking the steps instead of the elevator. Just aim for at least 30 minutes of walking [daily] for the sake of walking–not as part of your job.”

More research is coming out about how bad sugar can be for your health.  Do you think excess sugar will be seen as bad as excess salt?

“No question about it. There is almost no nutritional value to this refined sugar glut that so many Americans are accustomed to. I think everyone agrees it contributes to excess obesity, to excess diabetes. There was just a paper that shows it actually contributes to cardiovascular death.”

Women should aim to eat less than 100 calories a day (6 teaspoons) from added sugars, she says. Men, under 150 calories (9 teaspoons).

Recently, an expert panel also issued new guidelines about blood pressure.  What do these new guidelines say and why?

The panel reviewed the evidence on blood pressure control for heart health. It suggested that ”the optimal targets for blood pressure be changed from the previous panel’s recommendation.”

For those age 60 and above, for instance, medication is advised if the pressure exceeds 150/90 instead of 140/90, under the new guidelines.

”They also suggest that every encounter with a physician should begin with a discussion about lifestyle–such as sodium intake, alcohol, weight and exercise.”

Doctors caring for patients with high blood pressure should also take into account the other medications a person is on, especially older persons, under the guidelines. “The older a patient gets, the potential adverse effects of drugs become more important. Clinicians have to take into consideration the age of the patient and their target [blood pressure] and the drugs they use to control the pressure.”

The emphasis on blood pressure control for reducing the risk of heart attack and stroke remains the same.

We hear a lot of talk about so-called ”super foods” for heart health. What are your favorite go-to foods for heart health?

“Plenty of fresh fruits and vegetables, and several servings of fish each week.”

Posted by: WebMD Blogs at 1:40 pm

Monday, December 30, 2013

New Year’s Resolutions: The Trick to Making Them Stick

By Michael Smith, MD

new year man

Health goals, I’m happy to say, often take the top spot on the list of New Year’s resolutions. About half of us tell ourselves we’re going to improve our health each year. But health resolutions are also some of the most frequently broken — only about 8% of us will reach our goal, according to research from the University of Scranton.

It’s time to change that.

Let’s look at the top 5 broken healthy New Year’s resolutions and how you can make your goal stick this time.

1.  Lose weight. No surprise here. In one survey, nearly half of people who tried to lose weight in the last 5 years didn’t make it. Here’s how to be part of the other half.

  • Set a realistic goal. Want to lose 50 pounds in the New Year? Great! But that’ll likely overwhelm you. Instead, use the 5-pound approach. Set your sights on something that’s achievable in the near future. Now that you can do! You could lose 5 pounds in a few weeks — maybe even faster. Once you’ve lost that first 5 pounds, then you can start thinking about the next 5.
  • Tweak your plan. As you lose weight, you will have to change things up. That means as you get smaller (and you will), you’ll need to tweak your plan. But tweaks are a lot easier to grasp than a complete overhaul.
  • Ease up on yourself. You will have setbacks. I guarantee it. You’ll have weeks where you lose no weight and even some where you gain. At this point, people often give up. Don’t fall victim to that excuse. Own the setback and make a commitment to yourself to keep moving forward.
  • Avoid people who don’t support you. Understand that not everyone wants you to lose weight. Some may even unknowingly sabotage your goal. Avoid them. It’s about you at this point.

2.  Work out more. I hear more excuses about why people can’t get in shape than any other health goal. No time, too tired, exercise is boring … excuses. I can guarantee you’re not alone. There are others with the same reasons to not move more. The difference is they found solutions. You can, too. Eventually exercise will become a habit — one that you don’t want to miss.

  • Go slow.  Going too hard, too early is one of the main reasons people fail. You have my permission to start with 1 minute of exercise a day. Once you got that, step it up to 2 minutes. It’s more than you do now, so consider that a success.
  • Reward successes, no matter how small. Just reward yourself with something that’ll make you feel even better. A piece of cake will likely backfire in multiple ways. Instead, buy yourself a new pair of running shoes.
  • Seek support: Want some extra motivation? Post your move-more goal on Facebook. A little extra nudge from friends never hurt anyone. Maybe you’ll influence others to do the same.

3.  Eat healthier. This might be the most overwhelming of all! The most common problem? A complete overhaul. Change what you eat, when you eat, how you eat, why you eat … need I say more? Let’s go small with this one, too. If you try to change too much all at once, you will probably fail.

  • Change just one thing. Eat one more vegetable at lunch. Sound silly? It’s not. You have plenty of time to build on it. But make that habit stick first.
  • Don’t eliminate anything! If you do, that’s all you’ll think about. Follow the 80/20 rule. Be good 80% of the time. Then, be bad the other 20% and eat whatever you want. You have my permission. Just be honest with yourself.
  • Write down your eating plan each week. You’re more likely to stick with it.

Think you don’t have the willpower? You do. You just need to exercise that, too. As you practice making healthier decisions, “no thanks” truly gets easier. You’ll be patting yourself on the back like crazy in no time.

4.  Quit smoking. Tried to quit before? You know the drill. Six out of 10 smokers have to try and try again to stop smoking.

  • Ditch the triggers. Don’t make it even harder on yourself by leaving ashtrays and lighters around.
  • Make a new habit. Admit to yourself that smoking is a habit. And yes, habits are hard to break. So make a new one. As a personal trainer, I’d love to see you replace that morning smoke with a brisk walk. But do it for yourself, not for me.
  • Don’t stop trying. Remember, each time you try, your chance for success goes up. Let failure motivate you. You can kick its butt!

5.  Reduce stress. Just saying the word gets you riled up. Over 40% of workers say they’re stressed out during the workday. The reality is, stress isn’t going away. And the right amount of stress helps motivate us. But you have to actively manage it unless you want it to manage you. There are two simple things that will send stress running (and yes, they are about as simple as getting healthy gets).

  • Deep breathing exercises. Yes, literally taking slow, deep breaths not only eases stress but lowers blood pressure and heart rate. The mind and body are wonderful things.
  • Meditation. I’m not talking about contorting yourself into lotus pose (if you can, more power to ya!). Meditation is about freeing the mind from the chaos of the day. It’s simple, but I didn’t say it was easy. Thankfully, there’s an app (actually many) for that. Plenty of online, free programs too. If you’re looking for a way to overhaul your health, meditation has that much power.

So pick one resolution. And let’s do this together. And remember, even if you missed the Jan. 1 deadline, you can start today.

When it comes to self-improvement, there is nothing magical about the first day of the year. There is something magical about today though.  Let’s get to changin’.

 

Posted by: Michael Smith, MD at 8:33 am

Friday, October 18, 2013

Expert Q&A: What We Know About Concussions

football player

Recent news stories about brain injuries among former NFL players have renewed concerns about the possible risks posed by football and other contact sports for players of all ages. The attention has helped raise awareness about concussion — a type of traumatic brain injury that can cause behavior changes, blurred vision, loss of coordination, disorientation, dizziness, and headaches. As many as 3.8 million concussions happen in sports each year, and nearly 9% of all high school sports injuries involve concussion, according to the American Academy of Neurologists.The organization says that with prompt and proper treatment, most athletes recover fully.

To discuss the latest findings about concussions, WebMD writer Matt McMillen talked to University of Michigan sports neurologist Jeffrey Kutcher, MD. Kutcher recently worked with the NFL Players Association to create an informational pamphlet, “Concussion Questions and Answers.” Here, Kutcher walks us through what’s known about concussions, who’s at risk, and what parents need to do to be sure their child is playing it safe.

1. Are concussions always the result of a single, brutal blow or can they come from an accumulation of less severe hits?

You can have a sequence of not so dramatic hits that absolutely can lead to traumatic brain injury, so we do have to readjust what we think about. It’s not always that big Sports Center-type play. Especially in sports like football, where there is so much going on, we lose track of the fact that the majority of concussions are not obvious just from watching the play as a casual fan.

Hits in succession mean those that occur during a game, over the course of an hour. They result in the transient change in brain function that causes the syndrome we know as concussion. That’s distinct from the thousands of hits that a player can take over the course of a season or career, which may lead to other types of brain injury.

2. Is there any way to judge how many hits is a safe number of hits?

There is no answer to how much is too much. I don’t think we even have a vague idea of what that means. Until we do, we have to bring the medical observation up to the point where we are watching our athletes at all levels across the course of a game, a week, a season, a career, and ultimately a lifetime.

We need to be able to understand individual sports and what is required to play each sport safely. In football, at some point you have to teach players how to hit. If you delay that, are you doing more damage because when they are bigger and faster, will they have learned how to hit safely? What’s the least amount of hits that it takes to teach players how to hit correctly? That should be your ceiling. You should not go above that. Every hit after that is gratuitous. But there’s also the question of how many hits it takes to cause damage, and there’s conjecture across the spectrum on that. Some say only one hit can cause trouble down the road. Others say that can’t be because we have been doing this for a hundred years and our former contact sport athletes in general as a group are doing fine. Somewhere in the middle is the truth.

3. Is concussion and concussion risk variable from player to player?

Let’s say I took everybody on a football team or in an office and lined them up and gave them a blow to the head, somewhere in the sports realm of force between 20 g and  100 g. (Sneezing is around 3 g, jumping off a step is 8, car crash at 40mph is 35 g). When I measure physiologically the changes in the brains of these 20 people, I’m going to get 20 different levels of injury based on genetics and what’s going on with that person at the time. Many things, including dehydration and metabolic status, can affect the amount of injury that’s produced.

But here’s the bigger point: if I could somehow have a device that hit people in such a way that they had exactly the same level of brain injury, I am going to get 20 completely different clinical syndromes. That’s just what brains do. Brains are vastly different in their ability to produce symptoms. There will be differences in its duration, in the type of symptoms that people are describing, and in how significantly those symptoms interfere with their functioning and their life.

That becomes one of our biggest problems. We keep using this term “concussion,” and people think that it is well defined and that it’s the same from one person to the next. But there’s no objective diagnostic tool that can describe what injuries are present, let alone to what degree.

4. Are there ways of identifying particularly susceptible players?

To try to answer that, you use tried-and-true, comprehensive neurological evaluations based on personal history and family history. You look for history of migraine in the family, history of mood disorders, history of people having difficulties with head injuries. While we don’t have the genetics figured out where I can say, “You have this gene that gives you a risk for concussion or long term effects,” we can use family history as a general guide of genetics.

5. Do learning disabilities and disorders like ADHD play any role in concussion and recovery?

A reasonable amount of data suggest that patients with ADHD, or migraine headaches, or a mood disorder, or even a sleep disorder pre-concussion are at risk for a longer clinical syndrome. But what does that mean? If they have symptoms longer, does that mean they have a worse injury? We need to separate out symptoms that are produced by the underlying condition from those produced by the hit. The injury itself could be less in somebody who already has a setup of brain network dysfunction.

6. Does the age of player influence the likelihood or severity of concussion?

The jury is still out, but there is published data that shows the younger you are, the longer the clinical syndrome lasts. There are a few possible reasons for this. One might be that pediatric brains that are still wiring themselves can’t deal with injury as well, and so the injury produces symptoms that last longer. Others have argued the opposite, that the developing brain is better at absorbing injury without producing clinical effects, which would mean it would take a greater injury to produce the syndrome in the first place.

As far as the risk of being concussed, the risk goes up as you get older and move into high school or college, but that’s mostly due to the changing style of play. As for any other risk you want to describe, such as changing brain function over time or changing the arc of this person’s development, it’s completely unknown right now. There is so little data on concussion in the pediatric population. That’s one thing we are really focusing on, getting better data for kids down to 6, 7, 8 years old.

7. We hear a lot about boys sports. What about girls and women and the sports they play?

Girls may be more susceptible to concussion. They might incur more injuries than boys in the same sports, like basketball and soccer. It’s been shown in some research but not in other research. There are many factors that could lead to that effect. One possible reason that makes sense to us as neurologists is hormone levels. It makes sense that the brain’s ability to deal with a force and not produce injury or limit the level of injury could be affected by hormones, as could the symptoms that occur because of the injury. Girls do represent a difference for us as clinicians, but most of what we know is conjecture that’s not supported by data.

As for adult women, the data are not really there. The data for long term cognitive impairment are only there for male professional sports. To my knowledge there’s not a professional female data set that addresses that issue. And in college and high school sports and below, no clear pattern has been established.

8. Why are we hearing so much more about the degenerative disease chronic traumatic encephalopathy (CTE) now? Are we seeing an increase in cases? An improvement in recognizing and diagnosing it?

What is the incidence of CTE? We don’t know. We don’t have a real sense of that. We only have a case series of individuals. But the idea that repetitive hits to the head, repetitive brain trauma over the course of a lifetime is bad for your brain is not a new concept. What’s new is looking at our popular sports and asking, is this a problem for our popular sports right now? We don’t understand the numbers, the incidence rate, at all, but we do think it is relatively rare. However, it’s also reasonable to conclude that repetitive contact is at least a risk factor if not the determining factor of this degenerative disease.

9. What are the most pressing priorities in concussion research?

For me, the most important question that I would love to have answered with each of these cases is how to measure injury and not simply measure the clinical syndrome. If we could develop a reliable measure of injury that we could use across the population, that would allow us to change everything about our diagnosis and management of concussion.

The second thing: We need to have a clear understanding of the long term effects on brain health from hits over time, not just concussions. Let’s follow athletes through the course of a game, a season, a career. Let’s monitor their brain function clinically and, as much as possible, physiologically, and see what happens to them over time. That would be incredibly helpful.

10. What advice do you give parents whose kids want to play contact sports, football in particular?

For contact sport generally, I’d say, kids should just play one and then give the brain a chance to rest. I have patients who play football and then wrestle and then play lacrosse or rugby. They’re involved with contact sports 12 months out of the year. Don’t do that. Pick a contact sport, get good at it, then play another non-contact sport so that you give your brain a chance to recover from the hits it took.

For football, first you need to really understand the benefits of participation. You can’t make a good decision if you just talk about the risks. Talk to your kid and understand, why football. There are often plenty of reasons why football and not some other sport. Those reasons can be that as a team sport, it’s unique. You have 11 players working together and all trying for the same goal, you have the physicality of it. Those are just two reasons.

As far as the risk goes, I would say a few things. Make sure new helmets or recently re-certified helmets are used. Make sure the proper techniques are being taught. Understand the coaches’ approach to contact. Make sure they respect brain trauma, that they look for it and that they believe it is real. You definitely want to have a conversation with the coaches and get a sense of how serious they are about this. I would also talk to the athletic trainer. If your school does not have one, that may be a red flag. There has to be somebody looking out for these kids.

The next step is to ask, “What happens if my kid gets concussed? What’s your plan? What resources are there in the community? Is there a comprehensive concussion specialist or center?” Identifying that up front before injury is a smart thing to do.

Finally, if all these things line up –  if you have good support staff, if the coaches get it, if there are good athletic trainers and a good baseline testing program with good people who can take care of it, if you’re an involved parent, if your kid is at least somewhat up front and will tell you when they’re not feeling good, if when they’re injured, it’s recognized, and when it’s recognized, they are allowed to recover — when all that happens, I feel that our sports, including football, are safe.

Stepping back, though, it’s not just about concussion. If my kid just played a year of football, I would want him to see a specialist who can speak to his overall brain health when he’s not concussed, when he’s not injured, when he’s not playing, and to manage that aspect of things for his lifetime.

You need to have a specialist who looks at the big picture, not someone who is only concerned with when you were hit, what are your symptoms, are you back to baseline, when can you get back in the game. While all that’s important, it’s just the beginning of the story.

In my experience, you need to have a physician or neurologist who will step back and ask, “How is this affecting your brain health going forward?” If this is your third or fourth concussion, I would want to know about each of those concussions, how long they lasted and what the symptoms were and how long you were out of school. I would also want to know, when we deemed that injury to be over, how you were doing. How were you between the injuries? What’s happening to your brain function in a general way? That’s not something we can do with a one-time office visit and our tools for managing concussion. You have to step back and look at overall brain health.

 

Photo: Courtesy of NFLPA

Posted by: WebMD Blogs at 1:01 pm

Friday, October 11, 2013

To Vaccinate or Not to Vaccinate: Is That Really a Question?

By Hansa Bhargava, MD

Baby getting a vaccination

The other day I saw a 9-month-old baby in my clinic who came in with a high fever. The parents told me he had never received any vaccinations because they were concerned that his immune system could get ‘overloaded.’ The child was unprotected against some of the most deadly organisms, including those that cause pneumonia, meningitis, and measles. These diseases can lead to hospitalizations and even death.

Being a mother of two 7-year-olds, as well as a pediatrician, I understand the wish to protect our children. Many of my own friends and family members have worried about ‘overloading’ the immune system or whether vaccines cause autism. But what is the truth?  In fact, there is no medical evidence to date that the immune system can be ‘overwhelmed’. And the notion that the MMR vaccine causes autism has been proven untrue, in study after study.

Some parents say that because everyone else is vaccinated, their child is protected even without vaccines. But imagine the danger if every parent felt this way.  This is already happening in some areas of the United States. In some private schools in California, less than 20% of the kids have been vaccinated. The children at these schools are at huge risk of getting sick if an epidemic occurs. It is frightening to think about what would happen if one student got measles or another severe childhood illness.

And here’s a concerning trend: Recently, there have been more, and worse, outbreaks of childhood illnesses. In 2011 there were 220 cases of measles reported- a big jump from an average of 60 cases per year, previously. This year, 159 people have already been diagnosed. Most of these people got sick because they were unvaccinated and came into contact with someone who had traveled internationally. Don’t forget, we live in a small world. With the extent of airline travel, can you guarantee that when your child grows up, he will never go outside this country? Or meet someone who has traveled here from another country?

And then there is the recent outbreak of whooping cough, which killed several infants. In 2010, there were 9,210 youngsters infected with whooping cough in California. A study confirmed that  the large numbers of unvaccinated children helped spread the infection. In my office that day, the 9-month-old had to undergo a lot of tests because he was not protected. This included a lumbar puncture, to make sure he was not infected with a bacteria that could cause meningitis. The baby was also admitted to the hospital. Luckily, he was released a few days later. The child was given vaccinations not long after that.

Vaccinations are key protectors of our children’s health.  We have the luxury of living in a developed nation where we’ve been able to get rid of most of these illnesses through immunization efforts. But most of them are still lurking in the background. Do you want those illnesses to come back? And possibly affect your children and communities?

Posted by: Hansa Bhargava, MD at 11:22 am