Insomnia and Anxiety

Sleeping pills are not always the best solution.

More information on Insomnia

Nearly one third of older people in the U.S. take sleeping pills. These drugs are called “sedative- hypnotics” or “tranquilizers.” They affect the brain and spinal cord.

Doctors prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.

Usually older adults should try non-drug treatments first. According to the American Geriatrics Society, there are safer and better ways to improve sleep or reduce anxiety. Here’s why:

Sleeping pills may not help much.

Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who don’t take a drug.

Sleeping pills can have serious, or even deadly side effects.

All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults.

And these drugs may stay in their bodies longer.

The drugs can cause confusion and memory problems that:

  • More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
  • Increase the risk of car accidents.

Try non-drug treatments first.

Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions. Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs.

Sleep Tips for Better Rest

  • Exercise. Physical activity helps people sleep better. But avoid vigorous activity for several hours before bedtime.
  • Keep a routine. Try to go to bed and wake up at about the same time every day, even on weekends.
  • Try not to eat right before bedtime. Eat three hours or more before going to bed.
  • Avoid caffeine after 3 p.m. Some people need to avoid caffeine even earlier.
  • Limit alcohol. Alcohol causes sleepiness at first, followed by wakefulness.
  • Create the right environment. Keep the bedroom peaceful. And avoid mental excitement before bedtime.
  • Avoid bright lights. Watching a bright screen can make you stay awake.
  • Control pets. Pets disrupt sleep if they are on and off the bed, taking up space, or wanting to be let out.
  • If you don’t fall asleep soon, get out of bed and do something that will make you sleepy, such as reading. Return to bed after you start to feel drowsy.

For additional information, visit healthinaging.org.

When to try sedative-hypnotic drugs.

Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped. But your health-care provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.

More information >

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Nine moves for strength training

Here are the best recommended body weight strength training moves that combine for a complete body workout.  Do each exercise for desired time until you complete the set, take a one minute break and then move on to the next set.

Beginner – 1 minute for each exercise nine minutes
Intermediate – 2 minute for each exercise, eighteen minutes
Advanced – 3 minute for each exercise, twenty seven minutes

SET ONE

  • Body Weight Squat
  • Pushups
  • Mountain Climbers

SET TWO

  • Forearm Plank
  • Bodyweight Split Squat
  • Single Leg Hip Raise

SET THREE

  • Burpee with Pushup
  • Single Leg Toe Touches
  • Leg Raises

See this web page for more information and how-to videos.

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How to identify ticks and avoid tick bites

Tick season in Maine becomes more of a concern each year as tick borne illnesses are on the rise.  Here are some tips on prevention and tick removal.

Prevention

  • Wear light colored clothing to find ticks easily
  • Wear EPA-approved insect repellent on skin or clothing
  • Treat dogs & cats as recommended by your vet
  • Check for ticks daily during the season (April – August), under arms, in and around ears, inside belly button, behind knees, between legs, around waist and on hairline and scalp.
  • Shower soon after being outdoors

Tick Removal

Remove ticks immediately.  Ticks need to attach for 24 hours to transmit Lyme disease.  Consult your family practitioner if you remove an engorged deer tick.

  • Use a tick spoon, apply slight pressure downward on the skin and “frame” the tick in the spoon notch, then continue to slide the spoon to detach the tick.
  • Use tweezers to grasp the tick as close to the skin as possible and gently pull until the tick lets go.

In general, it is not recommended to take antibiotics following a tick bite, instead a person who has experienced a tick bite should be alert for symptoms suggestive of tick borne illness and consult your family practitioner if fever, rash or other symptoms develop.

Deer Tick Identification

Deer Tick Identification

For more information see Tick ID information from Maine Public Health.

 

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Should I take antibiotics before a dental procedure if I’ve had a hip, knee or other joint replacement?

Short Answer:  No.

Long Answer:  There has been a fair amount of recent recommendations to take antibiotics before a dental procedure if you’ve had a joint replacement to prevent a hardware infection.  There have been very few reported cases of joint infection after dental procedures or an association between dental procedures and bacteria causing infections in joints because of  those procedures.  There was a case study done from 1997 – 2006 resulting in no significant association between dental procedures and prosthetic joint infection.  So don’t just take it from us, the American Academy of Oral Medicine, the American Dental Association (ADA) in conjunction with the American Academy of Orthopedic Surgeons (AAOS), and the British Society for Antimicrobial Chemotherapy all advise against universal use of antibiotics prior to dental procedures for prevention of PJI or prosthetic joint infection.

Read more from Up To Date website>>

According to the CDC, overusing antibiotics is the leading cause of antibiotic resistance.  Up to one-third to one-half of antibiotic use in humans is either unnecessary or inappropriate.

Read more from the CDC website >>

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Practitioners at Hope Health Family Practice Encourage ALL Parents to Immunize Their Children

  • Imagine you are the parent of a newborn who is too young for a Pertussis (whooping cough) vaccination.  A group in your community has decided not to immunize and an outbreak of Pertussis occurs and spreads rapidly throughout this group.  Your infant is exposed (the library, grocery store, playground, etc…) and contracts this disease which could potentially be fatal.  This has happened, and does happen, and infants as well as other immunocompromised individuals have died from this disease when it could have been prevented.
  • In 1952 38,000 people contracted polio in America alone, according to the Centers for Disease Control. In 2012 there were fewer than 300 reported cases of polio in the entire world.  With more and more parents choosing not to immunize, this number could begin to rise again.
  • If you do not immunize and have never come face to face with a serious disease that is preventable by vaccine, you can thank the rest of your community for being immunized.  The people who choose to immunize are the people who have kept these diseases from making a comeback in our communities.  Again, with more and more people choosing not to immunize, the risk is becoming greater and greater.
  • Vaccines can eradicate disease and prevent serious illness and death. Mandatory vaccination has eradicated diseases that once killed thousands of children, such as polio and smallpox. According to researchers at the Pediatric Academic Society, childhood vaccinations in the US prevent about 10.5 million cases of infectious illness and 33,000 deaths per year.
  • The study that linked autism to childhood vaccines (specifically the MMR vaccine) was retracted and the study’s author, Dr. Andrew Wakefield, stripped of his medical license due to fraud.  Wakefield has been unable to reproduce his results in the face of criticism, and other researchers have been unable to match them.
  • 75% – 94% of the population (depending on the disease) must be vaccinated to achieve “herd immunity” or “community immunity”.   When herd immunity is achieved the number of immunized individuals is high enough to prevent the spread of disease through the population.  This is important!   In order to continue preventing the spread of serious disease that once killed thousands of people, everyone must participate as a community.

The information below is taken from http://www.vaccines.gov/basics/protection:

Community Immunity (“Herd Immunity”)

Vaccines can prevent outbreaks of disease and save lives.

When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained. This is known as “community immunity.”

In the illustration below, the top box depicts a community in which no one is immunized and an outbreak occurs. In the middle box, some of the population is immunized but not enough to confer community immunity. In the bottom box, a critical portion of the population is immunized, protecting most community members.

The principle of community immunity applies to control of a variety of contagious diseases, including influenza, measles, mumps, rotavirus, and pneumococcal disease.

Illustration of Community Immunity (also known as “herd” immunity)

Like any medication, vaccines can cause side effects.  The side effects are almost always mild (such as redness and swelling where the shot was given) and go away within a few days. If your child experiences a reaction at the injection site, you can use a cool, wet cloth to reduce redness, soreness, and swelling.

Serious side effects following vaccination, such as severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. Pay extra attention to your child for a few days after vaccination. If you see something that concerns you, call us.

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What Does “Gluten-Free” Really Mean? The New FDA Labeling Standard

Earlier this month the Food and Drug Administration (FDA) announced that food claiming to be “gluten-free” must meet a new stringent standard:  Gluten is a protein found mostly in wheat but also is some other grains.  To comply with the FDA’s new rules, products labeled “gluten-free” must contain less than 20 parts per million of the protein—or about an eighth of a teaspoon of flour in 18 slices of gluten-free bread. That’s low enough for most people who have mild to severe gluten allergies to safely consume the product.  This new labeling standard is the same as the European and Canadian requirements.  Manufactures have until August 5, 2014 to comply with the new standard.

There are a few details of this new labeling requirement that are important to know.

·         This standard applies to dietary supplements claiming to be “gluten-free” as well. 

·         Manufactures using the “gluten-free” claim may not have had their product tested for compliance.  The onus is on the FDA to test products making the “gluten-free” claim.  Some manufactures making the claim may go untested or slip through the cracks.

·         Manufactures can use other wording such as “No Gluten Ingredients” or “No Gluten Added” that would exempt them from the “gluten-free” labeling standard.

·         Alcoholic beverages are not regulated by the FDA.  Therefore they are not part of this labeling requirement.

·         Foods that naturally have no gluten can use this labeling as a way of looking more health conscious.

So, while the new labeling is an improvement, consumers must be knowledgeable about the finer points of this new standard.  If you have celiac disease, or some other reaction to gluten, continue to be careful about your food choices and don’t completely rely on the new labeling requirements.

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Nurse Practitioners: Understanding and accepting all that we do

One of the biggest challenges our practice has is overcoming the perception that Nurse Practitioners can’t provide comprehensive primary care.   The health care culture in this country assumes that only MDs are qualified to provide this kind of care.   However, Nurse Practitioners are qualified and have been providing this kind care for years.   Now, as our health care system is struggling to meet the needs of our communities, Nurse Practitioners are finally being recognized and accepted as providers who are providing excellent comprehensive primary care services to people throughout this nation.

Attached is a great article from the NY Times about MD acceptance of the Nurse Practitioner role.

http://www.newstimes.com/opinion/article/A-greater-role-for-nurse-practitioners-4660232.php

 

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On-line drug interaction websites: Make sure your medicines/remedies are safe to take together.

Attached is a quick article with links to on-line drug interaction sites.  These sites are designed to help you make sure that your prescription medications, over-the-counter remedies and herbs or supplements are safe to take together.  When you read this remember to contact your prescriber or pharmacist if you have any concerns.  Many medications will say there is a risk for interaction but the interactions are dose dependent.  Additionally, many medications should not be stopped abruptly without the guidance of the prescriber.

http://news.consumerreports.org/health/2013/06/where-can-i-look-up-drug-interactions.html?EXTKEY=NB36S00H

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Sitting: Why it is Bad for Us

 

Many people struggle with getting enough exercise to stay healthy and maintain a healthy weight.   Our days are often consumed with commuting, working behind a desk, doing school work, eating, watching TV or working on a computer.  If anything, our society is moving even more so in this direction as much of our leisure time is taken up with technology and screen activities.    For those of us who do exercise, we hope that our 30-60 minutes of exercise 3-5x per week will be enough to stave off the ravages of sitting too much.   Unfortunately, those faithful exercise sessions, although better than nothing, are probably not enough to do the trick.   

One reason for this may be the need to increase levels of Lipoprotein Lipase in our blood stream.   Lipoprotein Lipase is increased when we use our leg muscles.  This protein is responsible for grabbing onto triglycerides in the blood and transporting them to the cells to be used for energy.  When the levels of Lipoprotein Lipase fall the triglycerides in the blood get stored as fat instead of used as fuel.    It appears that the levels of Lipoprotein Lipase fluctuate throughout the day depending on our level of activity.  Therefore, getting up and moving around every 30 minutes may make a difference in the way triglycerides are utilized in our bodies.  If you move around every 30 minutes in addition to your regular workout, you may stave off some of the ravages of our modern sedentary lifestyle.

Attached is a great article about the research behind this finding and the importance of frequent activity throughout the day.

 

http://www.drlenkravitz.com/Articles/movemoresitless.html

 

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Do You Know the Unique Heart Attack Symptoms in Women?

When someone is having a heart attack we often imagine someone clutching their chest and describing the sensation of having an “elephant sitting on their chest”.  While this is often the case, women may experience different symptoms causing a delay in getting appropriate medical care.

Women are more likely to have the following symptoms when having a heart attack:

·         Atypical chest pain that presents in the upper back, shoulders, jaw, neck, arms and upper abdomen.  The pain may not be as severe as one would think.  Often this pain can be confused with heartburn.

·         Shortness of breath that does not necessarily correlate with the activity being done.  Some women describe a feeling of gasping for air like they had run a marathon. 

·         Heavy sweating that is sudden.  It may be difficult to differentiate from a menopausal hot-flash.  Some women describe it as feeling both hot and cold with clammy skin.

·         Unusual fatigue can be described in the days or weeks prior to the heart attack.  The fatigue is often described as profound, limiting even the most simple daily activities, such as making a bed, walking to the bathroom or lifting a laptop.

·         Lightheadedness and nausea can occur during an attack. 

·         Women can also have the classic crushing chest pressure.  However, it is important to remember that heart attack symptoms in women can be much more subtle.

Most of the heart disease risk factors for women are similar to men but there are some differences. 

·         High cholesterol and triglyceride levels.

·         Loss of estrogen after menopause.

·         Weight gain around the belly – usually most prominent during and after menopause.

·         Smoking!!!!   This has been shown to be a bigger risk factor for women than in men.

·         Being overweight.

·         Not exercising.

·         A diet high in saturated fats and refined carbohydrates.

·         High blood pressure and Diabetes.

·         Family history of heart disease.

·         Women in their early fifties can have a heart attack.  So you do not have to be older to have a heart attack.

What can you do to lessen your chances of having a heart attack or suffering a severe heart attack?

·         Know the symptoms.  Call 911 or seek medical care immediately if you experience the above symptoms!

·         Exercise regularly:  That means 30 to 60 minutes a day.

·         Don’t smoke!

·         Maintain a healthy weight.

·         Eat a diet of lots of fruits, vegetables, whole grain, olive oil, monounsaturated fats and complex carbohydrates.

·         Reduce emotional stress.

·         Take prescribed medications properly.

Prevention of heart disease and early recognition of a heart attack symptoms are the keys to preventing serious damage from heart disease.   

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