Dr. Jane Explains

Open This Book & Say "Ahhh"

If you plan to live longer then plan to live better with these 5 steps

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Coming clean on my obsession with the dog’s health, I brush their teeth and exercise them outdoors daily. Weekly, I bathe them indoors and I restrict their diets to dog-healthy snacks in limited quantities. Dogs with good dental health and maintained within normal weight limits have less joint arthritis, heart conditions and have improved quality of life.

If it were that easy to manage our own health. Alas, we are not hand-fed healthy habits and therefore need to keep more strict with our own lifestyle choices. If we are going to live longer, we should live better. Based on a recent medical article in The Lancet(July 11, 2019) there are five lifestyle behaviors that could positively impact both quantity and quality of life

  1. Calorie restrictionand healthy diet choices (with adequate nutrition): The Lancetsummarized both short and long-term effects of a nutritionally balanced calorie diet on risk factors for healthy, lean, or slightly overweight young and middle-aged people. The study found that there was a potential for 2 years of moderate calorie restriction to significantly reduce multiple heart risk factors. These benefits could be applied to “long-term population health benefits” by reducing blood sugar, blood pressure, cholesterol and inflammation levels.

In addition, there are several studies demonstrating that fresh foods such as vegetables, nuts, berries, whole grains, seafood, poultry and olive oil reduce the risk for Alzheimer’s disease. This form of dementia negatively impacts quality of life of the patient and family members.

  • Exercise: The recommended dose of exercise is 150 minutes a week. Biking, walking, swimming, evening gardening or yard work counts. Work daily to close the rings on your IWatch or meet your steps. While 10,000 steps a day is generally recommended, another study suggests that the actual goal is closer to 8000 steps a day. You choose! 
  • Don’t smoke…anything(enough said). 
  • Limit alcohol: the study recommended one glass of wine daily as a reasonably healthy choice. Most medical experts recommend under 10 ounces of wine daily for men and 5 ounces for women
  • Regularly meet with friends and engage in mentally stimulating activities: Reading books and playing board games 3-4 times weekly can be socially stimulating and help to decrease brain-aging. Alternatively, watching TV is a passive activity that requires significantly less brain power. In addition, an NIH-AARP* study found that geriatric participants who watched 5 or more hours of TV daily were 65% more likely to have a walking disability within 10 years compared to similar age individuals who watched less than 2 hours daily.

Review numbers 1-5 above and adjust lifestyle to better accommodate a more graceful aging experience. Researchers found that individuals who pursued 4 or 5 healthy behaviors were 60 % less likely to develop Alzheimer’s compared with participants who scored 0 or 1.  The average age of the group was 73 years old.

If you plan to live longer, you should plan to live better.

*NIH-AARP: National Institute of Health and American Association of Retired Persons (combined study)

Five Signs Your Cellular Device is Hurting You

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Weekly notifications pop up on my mobile device with the number of hours I spend working (browsing, reading, etc.) on my iPhone. Time that I spend both wisely and unwisely. Approximately 3 hours and 35 minutes a day on cellular devices (emarketer.com) and up to 11 hours a day are spent on screens (Nielson.com) in the U.S. After a review of the medical literature, it is important I share the top five ramifications of electronic device overuse:

  1. Texting thumb:  This term usually refers to one of two conditions, either ‘trigger thumb” or “thumb arthritis,” according to Dr Matthew Nevitt MD, Baylor Scott and White Orthopedic hand specialist. Inflammation of the thumb joint and its tendons may be due to repeated rapid motions of the thumbs with texting and can be quite painful. “Trigger thumb” refers to constriction of the tendon in the thumb. A result of over use, there may be painful popping or locking of the joint. These orthopedic problems may require rest and splinting. In more severe cases, a steroid injection or surgical intervention for relief of discomfort may be necessary
  2. Occipital horn: Extended time spent hunched over electronic devices may cause small bone spurs on the back of the neck. Sadly, these bony changes are now seen in young people age 18 thru 25 according to the University of the Sunshine Coast in Queensland, Australia.  The occipital horns may not cause pain, but they are a symptom of stress on the neck. Over time, prolonged poor posture (neck flexion) could lead to neck arthritis promoting further spinal bony changes. Study authors believe the changes stem from early use of texting devices in childhood.
  3. Computer Vision Syndrome (CVS): Between 50% and 90% of people who work at a computer screen will report a range of eye strain and pain. Focusing and refocusing along with rapid eye movements needed to adjust to screen changes can promote blurred vision, double vision, and dry irritated eyes. Decrease the brightness, add a glare filter, and adjust the contrast to a more comfortable level. Keep your monitor slightly below eye level and work 20 to 28 inches from your face (WebMD).
  4. Sleep disturbance: The blue light emitted from the screens can delay the release of melatonin and therefore interfere with sleep. Teens’ sleep rhythms (circadian patterns) are vitally important to pubertal hormone development and brain maturity.  Remove all screens from your children’s rooms at night and change the background screen thru your device settings: “Display and Brightness”.
  5. Distracted driving: Distracted driving was found to be responsible for up to 68.3% of motor vehicle crashes according to the Virginal Tech Transportation Institute. Researchers suggest that the emergence of texting and browsing online is the single greatest factor accounting for the increased numbers of US motor vehicle accidents. Encourage your family to put the phone down and (far) away from reach while behind the wheel.

Bottom line: Get away from your mobile device as often as possible. Your hands and neck will feel better, you will sleep better, look better, and drive better. Good luck!

Clearing up concerns on sunscreen product safety

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Topical sunscreens are good tools for preventing skin cancer, but it turns out many formulations may be harmful not helpful. Realizing this, the US Food and Drug Administration (FDA) updated regulatory requirements for sunscreen products by reclassifying them as drugs.  After testing several common topical sunscreen ingredients, the FDA discovered elevated serum (blood) levels of avobenzone, oxybenzone, ecamsule, and octocrylene. The American Medical Association (May 6, 2019) recently confirmed these findings. It turns out that these chemicals can enter the bloodstream after just one day of use and can remain in the body for at least 24 hours after application. 

The February 2019 FDA proposal ensures that sunscreen’s active ingredients are more closely regulated. The FDA study did not find the ingredients would cause health issues, but further studies are pending.

Not all products absorbed thru the skin are dangerous, however, at levels above the acceptable 0.5ng/mL (nanograms per milliliter) there are potential safety concerns.  Elevated blood levels of some ingredients could increase the risk for cancer and birth defects, while other chemicals could adversely affect hormone levels in adolescent boys and men. In some cases, pregnancy duration could be shortened resulting in low birth-weight babies. 

With over 12,000 sunscreen products on the market, regulation could have the FDA working in over-time. According to a sample analysis of more than 1300 products, the Environmental Working Group reported that over 60% of the sunscreen products do not offer enough sun protection or contain potentially harmful chemicals.  

Since the 1970’s there have been many scientific advances in sunscreen contents which has led to greater broad-spectrum protection against UVA and UVB rays. In addition, several products are more potent, and which could lead to greater levels of chemical absorption thru the skin. Others sunscreen products combine insect repellents which add more substances. These combination lotions, if highly absorbed thru the skin, could lead to additional health risks. 

The use of sunscreen sprays and powders should be avoided because the aerosolized particles could enter the lungs leading to chronic lung conditions. I do not recommend their use, especially in children.

This information should not deter you from using sunscreens. Recently, I published an article reviewing the necessity of sunscreen product to prevent skin cancer. Reducing numbers of skin cancer cases is most important as it is highly prevalent and the most common cancer in the US with rising numbers of cases due to excess sun exposure. Due to recent concerns, consider looking for products with zinc oxide and titanium dioxide which are not absorbed thru the skin. Don’t forget to wear protective clothing in addition to hats and sunglasses.

A Honduras Mission: We Helped Each other

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I recently traveled to Catacamas, Honduras with a Baylor Scott and White “brigade” of medical providers.  I learned so much.  Working with Predisan Health Ministries was both boldly informative and, at the same time, humbling.  A Christian based non-profit organization, Predisan’s intent is to “Proclaim Jesus and heal lives”.  Their efforts have engaged teams of medical providers and health advocates to fortify the physical, mental, and emotional health of the Honduran people.  There is no way I can adequately describe my experience. It was so powerful.  I would, however, love to share five “take-aways” that I learned while overseas:

  1. Honduras is Central America’s second poorest country and approximately 63% of the population live in poverty. The poor are vulnerable to disease (The Borgen Project), becoming ill and many dying due to lack of affordable health care, clean water and adequate sanitation methods..
  2. Diabetes is among the most common chronic disease and cause of death in Honduras. Approximately 5.7% of the population has been diagnosed with diabetes (compared to 7.4% of the Texas population). In Honduras, an estimated 53% of those with diabetes are undiagnosed(Central American Diabetes Initiative CAMDI). Common morbid complications of diabetes include kidney failure, blindness, lower extremity amputations, and heart disease.
  3. Honduran food tastes really good. I loved the fresh beans, chicken, tortillas, fruit, and rice. The traditional carneada (orange and spice-soaked meat dish) sounds delicious. I plan to try that next trip.  No medical information here, just good-food talk.
  4. Honduras has one of the highest rates of depression in the world with 7% of their population suffering significant depression according to the Washington Post.  Globally, depression is the second leading cause for disability.  Violent conflict and disease along with lack of social and medical resources make it more difficult to diagnose and treat patients. Interesting fact: The country with the lower rate of depression is Japan (2.5%).
  5. A stethoscope is a good device, but the IWatch and iPhone can be so helpful. A Honduran patient in the central clinic complained of shortness of breath, lower leg swelling, and cough. On exam, I found she was in heart failure. Without access to X-ray, electrocardiogram, or immediate blood test results, our diagnostic capabilities were limited. The cardiologist among us had an IWatch. We had the patient place her two fingers on the watch face and within seconds we had our diagnosis: Atrial fibrillation with rapid ventricular response. The treatment strategy became clear and we were able to better manage the patient. I also used several iPhone Apps for medication references and pill picture identification. Thank you, technology!

Predisan Health Ministries works with the government to empower the medical community to serve its people. If you are interested in donating or volunteering with Predisan, go to Predison.org for more information.

What you did not know back then may hurt you now (no fair!)

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Back in the days when coconut oil was the suntan lotion of choice, many of us experienced sunburns beyond “bad”.  I recall several of my high school friends fell asleep under at-home sun lamps. Their red and swollen faces were a painful reminder that too much ultraviolet exposure was never good for anyone.

Thank goodness most people are far more careful about sun exposure today.  It is widely known that cumulative sun exposure can cause skin cancer.   More dangerous are repeated episodes of severe sunburns, usually before age 18, as that can result in melanoma (the deadliest form of skin cancer) later in life.

The sun’s ultraviolet light (UV) has two main components that can damage skin cells and lead to skin cancer.  UVB rays are the primary the cause of sunburn and most responsible for skin cancer.  UVA rays also contribute to sunburn but generally cause skin damage that leads to tanning, skin-aging, and wrinkles. The best way to reduce the effect of sun exposure is the generous use of a broad-spectrum sunscreen.

Most commonly, sunscreens are rated by their sun protection factor (SPF) number which refers primarily to the amount of UVB protection it provides.  The SPF is an approximate measure of the length of time the sun’s UV radiation would take to begin reddening the skin versus the amount of time without sunscreen.  For example, if 10 min in the sun would normally redden your skin, a properly applied SPF15 sunscreen would allow you to stay in the sun without burning for approximately 150 minutes (15 times longer).  To note, not all skin tones are the same, so the SPF is not applicable to every skin type. 

The difference between sun protection factors is very little.  SPF 15 blocks 93% of the UVB rays, while an SPF of 30 (twice the factor) blocks 97% of the UVB rays, and an SPF of 50 (over 3 times the SPF15 factor) blocks 98% of the UVB rays.  Purchasing anything over 50 SPF offers very little extra protection.

The Skin Cancer Foundation recommends a water-resistant, broad-spectrum sunscreen with an SPF of 30 or higher.  Apply an ounce (two tablespoons) 30 minutes prior to sun exposure.  Take time to put it on correctly and cover all exposed skin.  Remember, no sunscreen is completely waterproof so re-apply every two hours or immediately after swimming or sweating.  

Broad spectrum sunscreen can protect you from both UVA and UVB rays.  In addition, barrier clothing such as a hat and shirt or a cover up can also provide sun protection.  However, not all clothing provide the same security.  It is important to choose outdoor clothing specifically designed to protect the skin. The ultraviolet protection factor (UPF) will appear on the label. Loose fitting clothing will have generally have a tighter weave over skin-tight stretch fabric and is generally a better choice for extended time in the sun.

Have fun in the sun this spring but protect yourself and those you love!  Skin cancers are the number one cause of cancer in the United States and are, also, the most preventable. Thankfully, parents today are more commonly seen applying generous amounts of sunscreen to their children than past generations. If we had known then what we know now, perhaps hunting for that deep-dark tan may not have been such a quest.

My Dry Skin is Cracking Me Up

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The seemingly incessant hand-washing between patients is a routine ritual that leaves my hands, and the hands of many healthcare workers, wanting for moisture.  The deep skin fissures that sometimes appear burn as though I had rubbed cayenne pepper-laced hand cream on them.  As irritating as this cycle is, my complaints pale in comparison to one of my patient battling a severe form of skin dryness known as ichthyosis. I have watched his skin flakes, like snow, fall to the exam room floor as I gently removed his socks.  While not painful for him, it is  terribly annoying and understandably embarrassing.  He needed an urgent solution.

So for the myriad of other unsung people also with this persistent dry skin, I am going write out a treatment strategy: “Skin Care 101”: a seven step-by-step approach to managing severe dry skin.

  1. Cool it down. Instead of hot showers and baths, use cool or warm water.  Limit shower and bath time to under 10 minutes. Blot your skin dry; do not rub the skin and use moisturizer generously immediately after drying the skin (while it is still moist) so it will better absorb the ointment.
  2. Lay off the lotions.Instead, use an ointment or cream. Lotions tend to contain additives that can irritate or dry the skin.  Olive oil, jojoba oil, and shea butter are fine. Severe dry skin may require lactic acid, urea, glycerin, lanolin, mineral oil, petroleum, or hyaluronic acid (per the American Academy of Dermatology). Discuss these options with your medical provider.
  3. Send away your scents.Avoid scented skin care products and consider avoiding deodorant soaps when dry skin conditions worsen. These products may contain alcohol or other irritants that are too harsh for dry, sensitive skin.  If you are using topical retinoids or alpha-hydroxy acids, hold treatment for a few days in order to allow your skin to retain its natural oils.
  4. Cover up.Consider moisturizing gloves and socks at night. I realize that this does not seems very glamorous for bedtime, but it really helps the skin retain the moisture. There are several brand on the market specifically for hand and feet dryness.
  5. Keep the cream close.Keep a hand cream and lip balm with you during the day so that are more likely to replenish your hands and lips regularly.
  6. Wash and wear your clothing with care. Consider hypoallergenic laundry detergent. Use silk underclothing; it will glide over your skin more easily and be less likely to rub against dry and irritated skin.
  7. Watch the flame.Avoid sitting close to high temperatures such as a heater or furnace. Instead, consider bundling up and using a humidifier to maintain air moisture.

You should consult your medical provider to be certain that you have no medical conditions causing the severe dry skin. Low thyroid, autoimmune diseases, and inflammatory skin conditions such as psoriasis or eczema are among other causes that need to be considered and treated.

For my patient, the prescription of urea cream along with his written list of instructions should help lessen discomfort and soothe his dry skin. While there is no definitive cure for the scaling and dryness, we can keep ahead of the condition by keeping his skin healthier.  As for my embattled hands, “cracking me up” really is no laughing matter and I choose to fight! My weapon of choice is an unsurmountable supply of Cerave moisturizing cream and an iron will to win!  I got this.

A “Shot” of Humility

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A doctor’s first lesson in the treatment of patients is learning to live with humility.  It was Friday clinic and I was counseling a patient about his Shingrix vaccine. “You will be fine,” I reassured him. “The vaccine is safe and effective.”  I also let him know that I would be receiving my shot the same day.  “Perhaps you will feel a little bit achy tomorrow, but otherwise, you should be able to go about your usual activities this weekend”.  The next morning I called him to deeply apologize in case I had not properly prepared him for its side effects.  I know I was not prepared!  Statistically speaking, I found out that I was the one in six person who will experience the vaccine’s full side effects and I was miserable.

Thankfully, he suffered little of the side-effects the vaccine manufacturers described.  I, on the other hand, had pronounced fatigue and achiness that had left me napping and uncomfortable for most of the weekend.  After a couple of miserable, disgruntled, self-pity filled days I was quickly back to normal and back to work on Monday.  I have no regrets about receiving my vaccine.  My temporary symptoms were far-better than alternatively suffering from the burning pain of a shingles outbreak or, even worse, a post-herpetic neuralgia, a lingering chronic pain complication from a shingles viral infection. 

This newer Shingrix vaccine is over 90% effective in preventing the disease while It’s predecessor, “Zostavax” was found to be only marginally effective over time and is no longer considered effective a preventative vaccination.

Shingles is caused by the reactivated chicken pox virus.  It lays dormant in our body for years after a childhood infection.  Surprisingly, there are some people who have had chicken pox but never experienced its classic red-blistery rash.  According to the Centers for Disease Control and Prevention (CDC), approximately 99% of Americans over 40 have had chicken pox even if they do not remember an infection.

The CDC recommends all healthy adults 50 years and older receive at least two doses of Shingrix two to six months apart.  If you have had shingles, received less effective Zostavax, or are not sure if you had the chickenpox, you should receive the two doses of Shingrix.

Anyone who has had a severe allergic reaction to any components of the Shingrix vaccine should avoid the immunization. Your medical provider will screen you prior to your vaccination. Example of when you should postpone the vaccination include, but are not limited to, situations such as you currently have active shingles, a fever, a severe respiratory infection, or if you are pregnant or breastfeeding.  Be sure to let your medical provider know if you are on any anti-viral drugs such as acyclovir or valacyclovir as you may need to hold your medication for a few weeks prior to receiving the vaccine.  

Currently, I am planning ahead for “Shingrix – the Sequel” (round #2).  It will be Ibuprofen, hot baths, and no weekend plans for me.  My lesson was a good one.  As a medical professional, humility is a great teacher and constant companion.  It enables me to communicate both sides of the vaccination experience.  

Go ahead: Put some fat in it!

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My family always makes a fuss when it comes to our grocer’s yogurt isle. There are so many different brands of yogurt and we are all individually selective when it comes to our favorite morning food. To make matters more difficult, my family members have each opted to customize their yogurt selection based on fat content. When it comes to yogurt, my daughter is non-fat, my husband is low-fat, and I am full-fat. The question boils down to: Who has the healthiest breakfast diet? It would seem that lessdairy fat would be the best answer; however, that is not necessarily true.

Without doubt, dairy products with greater percentages of fat contain more calories which most people will want to avoid if they choose a calorie-restricted diet. However, studies found that when people purposefully reduce fat in their diets, they tend to replacethose calories with sugar and/or carbohydrates. The compensatory increase in both sugars and carbohydrate could lead to worsening effects on circulating insulin levels and lead to an increased risk for developing diabetes. A 2016 study published in the journal Circulation, Dr Dariush  Mozaffarian and colleagues studied dietary fat intake in 3,333 adults over 15 years. The researchers found that people who had higher levels of three different types of full-fat dairy had, on average, a 46% lowerrisk of developing diabetes compared to people who tended toward lower fat dairy products. But what about the weight gain with full fat diets?

My family is always concerned that full-fat diet may cause them to “pinch-an-inch”.  Contradictory! A study published in the American Journal of Nutritionanalyzed the effects of full-fat versus low-fat dairy on obesity. Researchers discovered that among 18,438 women, those who consumed the most high-fatdairy products lowered their risk of being overweight or obese by 8%. 

According to my taste buds, the full-fat flavor of yogurt is far better than the 0% fat yogurt chosen by my daughter (let’s not even get into my whole milk habit!). By cutting back on dairy fat, you may not only be cutting back on the deliciousness but focusing on one nutrient in the diet may be less beneficial overall. So now what do I tell my daughter when she reaches for the 0% yogurt? Back away, I am going for the 5% Fage*!

*pronounced “fa-yeh” yogurt

Circulation, Volume 133, Issue 17, April 2016

The American Journal of Clinical Nutrition, Volume 103, Issue 4, 1 April 2016

Vitamin D: When too much is toxic

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“Sally’s” mother called me in a panic. My young patient had misunderstood her Vitamin D instructions and had  been taking her weeklyprescribed 50,000IU Vitamin D capsule instead daily for the last fifteen days. She was experiencing nausea, headaches and mild dizziness. My first thought was, “it is just a vitamin and she is young and healthy and should be fine”. However, to be sure, I contacted Poison Control. I am so glad I did.

My Poison Control representative informed me she needed an immediate Emergency Room evaluation for electrolytes and an ECG. The Baylor Scott and White Plano emergency room doctor quickly agreed to accept Sally for immediate evaluation.

Vitamin D hypervitaminosis (vitamin D toxicity)is a potentially serious condition.  It may be more common than we think. More recently medical providers are recognizing that patients have Vitamin D deficiencies. For patient with exceptionally low levels,  large doses of prescribed vitamin Dmay be necessary in order to help prevent bone loss, fatigue, and muscle weakness among other complications. , Because it is a natural vitamin, many people may feel it is a benign drug. But it is not.

Vitamin D toxicity can cause a buildup of calcium in the bloodstream which can lead to nausea, vomiting and weakness, such as my patient was experiencing. If the calcium levels become too high, a patient may experience dehydration from urinary frequency, along with bone pain, and (over time) kidney stones.

Elevated calcium may even lead to electrical changes of the heart resulting in  abnormal heart rhythms .  Thus, necessitating the need for an ECG (electrocardiogram) for my patient in the emergency room.

I was reassured after reviewing Sally’s labs and ECG on-line. The emergency room doctor released her to home. My recommendation is to place Sally’s vitamin D on hold until February, then to place her on a daily dose of over the counter Vitamin D supplement. 

My patient learned that following both verbal and written prescribing instructions is very important. I was reminded that Vitamin D weekly prescribing should be clearly understood by the patient and that Poison Control is always a great resource for all medical providers and their patients. While vitamin D replacement has several advantages, too much of a good thing can be disastrous. Always check with your medical provider if you are taking beyond your prescribed dose of any medication, including vitamins.

*Sally is used in place of patient’s name in order to protect her privacy