Monthly Archives: February 2011

Where Are My Car Keys?

Who hasn’t asked themselves that question?

My car keysphoto © 2007 Reiner Schubert | more info (via: Wylio)

On an increasingly frequent basis, I find myself utterly at a loss for what movie I saw last week or where I put my cell phone. I’ve even accused my phone of teleportation – and then seriously questioned the health of my brain.

How is it I can remember some trivial and insignificant detail from 20 or 30 years ago and not what I had for dinner two days ago? Am I losing my mind – is this the first dreaded sign of Alzheimer’s?

Life is a challenge for most people because they have never been this age before, at least not that they remember. I am an expert at being 40 (and unfortunately at being 50), but 55 remains a mystery, although not for long.

The brain of most people weighs about three pounds – even Einstein’s. It is made of something like 100 billion neurons. Each neuron connects to hundreds of other nerve endings. The connections in your brain number roughly 1 quadrillion (that’s 1000 trillion or 10 to the 15th power). My brain hurts just thinking about that number.

A fatty substance called myelin insulates these connections and acts like the plastic coating on a wire. Short circuits are called seizures. Fortunately, you don’t need to understand the brain’s owner’s manual to operate one.

With aging, some neurons die. You start with all you get and go down from there. What a completely depressing thought. There is a tiny but measurable decrease in brain mass with increasing age. As these cells die, their connections are lost, resulting in some data loss. The brain continually rewires itself, constantly establishing new “work-around” for the lost cells. It is actually more remarkable what we remember, rather than what we forget. Remember this is a biological system, not a supercomputer.

Studies have shown that as brains age, long-term memories are maintained the best. Recent or new memory formation is the most affected. Several long philosophical ruminations occur at this point, but you may peruse that on you own.

Now it gets interesting. Everyone has heard we live in a small portion of our brain, something like 30 percent. There is a huge range of “normal” among adults with healthy brains. What feels like normal to me might feel like the mother of all hangovers to some master mathematician or particle physicist.

We have been collecting vast amounts of data our whole lives. Much of the data is meaningless. Do you really need to remember every parking space you selected in your life or every word you’ve spoken or heard? The data is there, somewhere. Since it is never used, it is given low priority by the brain. The less unique the memory, the harder it is to retrieve. The less a memory is used, the harder it is to recall. Use it or lose it (your mind that is).

The sheer mass of data makes us all feel like an Alzheimer’s candidate. Everyone forgets where he or she parks, but no one forgets the color of their car.

Brain health is a lot like body heath. The brain likes to be exercised (Sudoku anyone?). It’s utterly dependent on good blood flow and oxygen, so we want to keep atherosclerosis away. Everyone talks about classical music exposure in utero, but it’s hard to fix that now. Personally, I think rock works better – it makes mom move, which keeps the blood flowing.

These mental glitches are part of the human experience. One study of neurologists found 60 percent had what they considered real symptoms of brain disease – and these guys are pretty smart. They could lose a few neurons and miss them less than I would.

Fortunately, dementia is not hiding behind every lost car key or car. In fact, considering the complexity of the brain, it is perhaps more amazing that it works as well as it does.

Take care,

Dr. B

Diabetes Dangers

You may have heard that diabetes is one of the fasting-growing diseases in this country. Why the sudden popularity – is this the medical equivalent of a pet rock? Should we worry or invest?

Here we’re talking about Type 2 diabetes, more commonly called adult-onset diabetes. This is a whole different beast than Type 1 or juvenile diabetes (insulin dependent). It’s 10 times more common, and thankfully, a lot less serious than insulin dependent diabetes.

Why talk about Type 2 diabetes? Because it’s largely preventable.

A few basics: glucose is a particular type of sugar that your body runs on. It is the common fuel for everything that takes energy, from running and jumping to simply thinking. It’s the gas in your car. Your body is understandably particular about having enough circulating glucose; you may need some at any moment, like making the next heartbeat.

Sugarphoto © 2006 Uwe Hermann | more info (via: Wylio)

A large percentage of what you eat is simply to supply fuel for your body’s needs.

Glucose in the blood stream does you no good – it needs to get into your cells, which are the little engines of life. Insulin’s job is to make glucose go into cells where it provides energy for all of life’s processes.

When there is too much glucose in the blood stream, the kidneys try their hardest to retain it, but it leaks out in the urine. This leakage of glucose brings water with it, resulting in the usual symptoms of diabetes: thirst, frequent urination and weight loss.

Why weight loss? You are urinating sugar. On the surface this seems the ideal situation – eat and drink all you want, and get rid of the excess sugar. Where do I sign up?

Unfortunately, this is not the type of weight loss you need. You want to lose fat, not fuel. Also, the complications of diabetes make this a much less desirable diet plan. Think heart disease, kidney disease and stroke.

So why does being overweight lead to diabetes anyway?

Obesity causes resistance to insulin. It changes the cells so the insulin you have doesn’t work as well. Since the insulin doesn’t work as well, you transport less fuel into your cells. The cells are literally starving while the blood glucose level climbs.

An interesting segue: cyanide, the poison used in the gas chamber, is a drastic example of a similar mechanism. In the presence of cyanide, your cells can’t use the fuel you have. You starve to death in the land of plenty.

Kind of makes you think twice about that donut, doesn’t it? Sorry about that.

So if you are obese and you don’t want diabetes, you can make more insulin or eat less food (glucose). Unfortunately, there are limits to creating more insulin. The cells can become so resistant to insulin that you can’t make enough to do the job.

So why is diabetes such a bad thing anyway? To put it simply, high blood sugar wreaks complete havoc on your blood vessels. The tiniest blood vessels get the worst of it. They get inflamed and plug up (atherosclerosis). There are lots of tiny blood vessels in the kidneys, the brain and the heart. When these blood vessels plug, the cells they supply die. Some of those cells are my favorites – the ones in the brain, heart and kidneys. When these cells die, it’s called a stroke, a heart attack or kidney failure. There are also some tiny vessels in the eye, so your sight doesn’t fair too well either.

You probably have heard that this type of diabetes runs in families. There is an inherited tendency for Type 2 diabetes. If one of your parents is diabetic, you have a much higher risk of developing Type 2 diabetes. It is only a tendency – it is far from a certainty. Type 2 diabetes is unusual in normal weight adults, even with a family history of diabetes. It’s difficult to change your parents, but you can certainly do something about excess body weight.

So now you know enough about Type 2 diabetes to take charge of your fate. A little care about diet and exercise will keep you on friendly terms with your favorite cells.

Take care,

Dr. B

The Best Path to a Healthy Night’s Sleep

Do you feel refreshed and alert in the morning after a good night of sleep?

Maybe that doesn’t happen often enough. Perhaps, it has been so long since you’ve felt that way that you’ve forgotten how you’re supposed to feel in the morning.

Chronic sleep deprivation appears to be a growth industry in the U.S. where someone has said, “We are a country that is open for business 24/7.” As a modern society, we definitely sleep less than in decades past.

Numerous artificial factors have influenced our sleep patterns. Life is busier and more demanding. Innovation has created a vast array of opportunities in communication and information technology that profoundly affect our daily lives. And with round the clock news cycles and instant messaging to any place on the planet, demands on our time and stress have increased.

Angel Sleepsphoto © 2007 planetchopstick | more info (via: Wylio)

Further, more people than ever work around the clock on shifts that conflict with our normal circadian rhythm. The ubiquitous television, computer screens and artificial lighting are more stimulating than people realize.

In turn, this adversely affects our sense of fatigue and interferes with our ability to get to sleep and rest in a normal physiologic manner. We are no longer synchronized to the cycles of day and night in conjunction with our internal bio-rhythms.

Research has shown the large majority of adults require seven to eight hours of sleep each night. Younger children need considerably more, but teens are notorious for burning the candle at both ends. Science has shown that they too need an average of 8.5 to 9.25 hours of sleep to be adequately rested and recharged.

Adequate quality sleep is not a luxury or simple matter of convenience. Numerous studies have shown an inadequate amount of sleep in adults leads to serious metabolic and mental changes: greater risk of heart disease, stroke, high blood pressure, diabetes, compromised immune system, weight gain, car accidents and other injuries due to impaired judgment occur more with inadequate sleep.

Overall, less productivity in school and the workplace is connected to sleep deprivation. In teens who do not get enough sleep, there is a strong correlation with depression, suicidal thoughts, poor impulse control, substance abuse and violent behavior. These tendencies in all ages begin to come into play with less than seven hours of sleep on a regular basis.

Studies have demonstrated how these changes start happening in healthy volunteers when they are sleep deprived for as little as four days in a row. It is very difficult to compensate for a regular nightly sleep debt. You cannot overcome this without changing the regular pattern of sleep. You cannot just “catch up on the weekend.”

An interesting fact about modern society is the more people drive a car daily, the less likely they are to get enough sleep. There is direct correlation between driving more than a total of 40 minutes a day and getting less sleep.

Since sleep is so profoundly important, what can you do to ensure a restful night of restorative sleep? Here are a few tips:

•  Adopt a regular routine at night and make it a priority to stick to it.
•  Go to bed at the same time week nights and on weekends.
•  Don’t take naps during the day unless you are really desperate.
•  A short 30-minute power nap can be a resource if you are sleep deprived to recharge; however, regular daytime naps are counterproductive to a good night of quality sleep.
•  Avoid caffeine, alcohol, a big meal or vigorous exercise in the evening.
•  Minimize your fluid consumption for 2-3 hours prior to bedtime.
•  Regular daytime exercise is an excellent tool for general conditioning and contributes to good sleep hygiene.
•  Use the bedroom for only sleep and sex – do not eat or watch TV in bed.
•  If you cannot fall asleep after 30 minutes, get up and go to another room. Do something relaxing like reading or taking a warm bath. Do not check your email or watch TV.

Invest in rest! It will pay big dividends. As the Irish proverb goes, “A good laugh and a long sleep are the best cures in the doctor’s book.”

– Dr. Bruce Kaler

As the Peak of Flu Season Hits, Study Shows Importance of Hygiene

With the peak of flu season usually occurring this month, a recent study on the spreading of flu can teach us an important lesson about hygiene.

The study, published by the National Academy of Sciences, looked carefully at the H1N1 flu season in 2009. They studied schoolchildren, classmates and their families as the epidemic was happening. They suspected that many children were spreading the flu to their classmates in school.

Their findings actually disproved that school was an important source of infection. They found instead that the close contact of friends who played together outside of school was a common source of illness. Typically, children who played together outside of school have more close contact with each other. They use little hygiene such as hand washing or covering a cough.

Hand Washingphoto © 2010 Anthony Albright | more info (via: Wylio)

It was striking that children did not get sick from just sitting next to a classmate in school who was sick. This went against the prevailing wisdom of closing schools to prevent the spread of flu.

In reviewing households with sick children, most of the time adults in the household did not get sick from their children. They were probably making a special effort to limit exposure to the obviously ill family member. Again, the study results suggest the more likely source of infection was in the community at large where efforts at hygiene were forgotten or non-existent.

Day 59, Project 365 - 12.18.09photo © 2009 William Brawley | more info (via: Wylio)

We know that the flu virus does not fly through the air attacking a person over the shoulder while they look the other way. If someone coughs or sneezes on you point-blank within a couple feet, mucus droplets are broadcast with the virus; however, the most common denominator is you. We are the last link to acquire the infection. By touching our own hands to our face and mouth, we’re most likely to get the illness. Hands touch so many public places and surfaces that we forget that our own hands are such germ-laden instruments. Washing hands before eating or food preparation remains one of the most important means of protecting yourself from illness.

The researchers noted that the flu virus spreads very rapidly among school age children. The results reinforce that it is not the classroom or seating arrangement that is the problem. It is more likely due to the fundamental lack of hygiene practices in children and adults in the community that facilitate spread of the disease.

We all can learn a lesson from this study, so be sure to wash up.

– Dr. Bruce Kaler

Santa Clarita Valley Signal Features U.S. HealthWorks

This week The Santa Clarita Valley Signal featured in great detail some of the services we provide our clients and patients.

Local medical provider helps injured employees
Health: HealthWorks treats workers that have job-related injuries

By Jana Adkins
Signal Business Editor
February 9, 2011

U.S. HealthWorks Medical Group provides medical care and claim management to companies whose employees have experienced work-related injuries.

The Valencia-based company, founded in 1995, has more than 130 medical centers in 13 states, 15 additional work-site centers and 2,000 employees, including nearly 350 affiliated physicians.

One of the largest private providers of occupational health care in the country, the medical organization manages lost work time and specializes in early return-to-work, injury prevention and wellness programs for employers.

Additionally, U.S. HealthWorks provides urgent-care service at many of its locations, including the Valencia office.

Read the rest of the article here.

U.S. HealthWorks Acquires 3 Ohio Medical Centers

After announcing yesterday that we’ve acquired 3 Ohio clinics, we’re thrilled to double our footprint and help more patients in Ohio. The Dayton Business Journal featured the news yesterday:

U.S. HealthWorks acquires three medical centers

February 7, 2011

U.S. HealthWorks, an operator of occupational health care centers nationwide, has acquired three Kettering Workers’ Care medical centers in the Dayton area.

The acquisition of the centers doubles the number of U.S. HealthWorks-operated medical centers in Ohio and increases its number of centers to 139 nationwide.

The newly acquired Dayton-area medical centers are in Moraine, Huber Heights and Franklin. The facilities offer occupational medicine services, including diagnosis and treatment for injury and illness, preventive services, pre-employment and post-offer exams and screening, and return-to-work rehabilitative care.

Read the rest of the article here.

Ginger: A Mysterious Cure for Motion Sickness

As old a remedy for nausea and motion sickness as ginger is, the exact mechanism of action is not known. It has been recommended for ages to alleviate the symptoms of motion sickness.

It has only been in the last few years that a number of good studies have shown clear benefit of ginger compared to placebo. These studies looked at a number of people before and during episodes of motion sickness at sea and on land. Nonetheless, the reason for a favorable outcome remains unclear.

Homemade ginger alephoto © 2010 305 Seahill | more info (via: Wylio)

For that matter, the exact mechanism of motion sickness itself is not understood. It is thought that the disparate signals to the brain of what feels like motion to the inner ear and what may or may not look like motion to the eye confuses and alarms a portion of the brain. Speculation about how this is sorted out has to do with which signal is stronger and how an individual can choose to ignore one signal over the other. For instance, trying to focus on the horizon or a fixed point to convince the brain there is stability, while ignoring the signal of motion, which is triggering the obligatory nausea, can alleviate the feeling.

Ginger has active compounds – speculation is that it promotes forward “gastrointestinal transport.” This means: it keeps things moving forward instead of coming back up. Anti-emetic drugs work in a similar manner. The drug increases the upper esophageal sphincter pressure to close off the lower esophagus at the top of the stomach, helping to prevent reflux, while enhancing forward movement through the stomach and gastric emptying in the correct direction. The mechanism of how the drug works may be how ginger creates a similar effect. Unfortunately, it’s all speculation about how ginger actually seems to help.

The benefit of ginger has not only stood the proverbial test of time but recent scientific studies as well. One common misconception is that ginger ale is helpful for nausea and vomiting. Unfortunately, the carbonation being mildly acidic and so gaseous actually makes the nausea worse. Moreover, there hasn’t been anything more than “ginger flavoring” in most of these beverages for more than 50 years. Your best bet is sucking on true candied ginger or powdered ginger in capsule form.

– Dr. Bruce Kaler

Energy Drinks – Boost or Bust?

The popularity of energy drinks over the last 15 years is astounding but not surprising. Targeted at a market segment of the young and on the go, the drinks promise increased alertness and stamina. A single major brand whose name is recognized by everyone recently announced that they sold more than 4 billion cans worldwide in over 150 countries. That was just one brand in one year!

Energy drinksphoto © 2008 Tambako The Jaguar | more info (via: Wylio)

Although their primary demographics are young adults and athletes, the average person on the go is often looking for a morning boost or mid-afternoon energy. So why not grab an energy drink? Is it really a good boost or a bad bust?

The active ingredient that provides energy is typically caffeine and lots of it. It is very common for an energy drink to contain 2 to 5 times the caffeine in a cup of coffee or an average soft drink. There is also a lot of sugar as well. The amount of sugar is equivalent to 4 to 8 teaspoons of sugar in a single 8-ounce serving. There are other ingredients that contribute to the energy effect including guarana, an herb that metabolizes to caffeine. Other herbs such as ginseng have an energizing effect in humans although somewhat inconsistently. Naturally occurring amino acids taurine and carnitine have variable effects in different people. Some of the B-vitamins can provide a pick-me-up in some individuals. The amounts and sensitivity to these effects vary a great deal across the population.

There is no argument that energy drinks provide “energy” – temporarily; however, it is short-lived and typically results in a rebound “lack of energy” from caffeine withdrawal and the blood sugar level plummeting following the ingestion of concentrated refined sugars such as high fructose corn syrup and sucrose. Too much caffeine can be very harmful, especially in selected individuals or under specific circumstances of strenuous exercise or relative dehydration. It has a direct effect on increasing blood pressure to dangerously high levels, rapid heart rate, anxiety and insomnia. This clearly puts people at risk for heart attack or stroke.

A disturbing trend is to mix energy drinks with alcohol. The combination has potentially dangerous side effects. Caffeine does not change the amount of impairment from alcohol. One may feel more alert and less sedated but remain as slow to react or make poor decisions due to the effects of alcohol.

tall drinksphoto © 2008 Melody Gutierrez | more info (via: Wylio)

There is little protection or warning for consumers about potential side effects. According to the Food and Drug Administration, energy drinks are supplements and not subject to the same regulations as medications, soft drinks or even food products. They are not obligated to disclose how much an active ingredient is contained in a single serving. Soft drinks are required to have no more than 71 mg of caffeine per serving and most contain much less.

As dangerous as the short-term effects are, there is no research regarding the long-term effects of regular use of energy drinks. It is very possible that regular consumption of high doses of sugar and stimulants leads to bigger problems. One has to doubt the wisdom and safety in the regular use of these products.

What is the alternative? There is no substitute for adequate sleep, regular exercise and a balanced diet. If you suffer from chronic fatigue, there may be an important metabolic reason, which needs evaluation by a medical professional.

Energy drinks are everywhere and seem seductive, even benign. It is still important to be aware. Is it worth the risk?

– Dr. Bruce Kaler