Suicide Prevention Month: know the signs

I have have known people in my life that suffer form serious depression, and some that have come to a very distressing and upsetting end, not because no one cared, not because people didn't say the right things, but just because everyone has a breaking point, and you never know what it is. May is mental health awareness and suicide prevention month, so this is coming a little bit early, but the world has been filled with a lot of sadness and a lot of great stuff too, but people have been focusing on the sad and negative.  Life can be tough, and dealing every day with depression can be so unbearable, on top of every day stress, and you never know who is battling to live every. single. day.

Depression is a very serious problem, that can cause an array of health issues, but be easily overlooked by sufferers and by people close to them.  Sometimes it is just a feeling of not being "right" or feeling "off" or being really sad or listless, and it can effect different age groups in different ways. And there are numerous different types of depression: postpartum (after giving birth), chronic, Seasonal Affective Disorder SAD (related to less light in the winter), major depression, transient depression (related to one major traumatic issue), etc. And it may be hard to diagnose or notice an issue.  I think depression should be better screened for by HCP's in general, but I look towards patients and their family members to mention if you see any of these signs or symptoms because if you don't tell us what is really going on, it is very difficult for HCPs to pick up these symptoms during an appointment or quick visit:

Adults:


-Feelings of sadness or unhappiness
-Irritability or frustration, even over small matters
-Loss of interest or pleasure in normal activities
-Reduced sex drive
-Insomnia or excessive sleeping
-Changes in appetite — depression can cause decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain
-Agitation or restlessness — for example, pacing, hand-wringing, or new aggression
-Slowed thinking, speaking or body movements
-Indecisiveness, distractibility and decreased concentration
-Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
-Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right
-Trouble thinking, concentrating, making decisions and remembering things
-Frequent thoughts of death, dying or suicide
-Crying spells for no apparent reason
-Unexplained physical problems, such as back pain or headaches that aren't related to allergies, etc. that don't respond to OTC medications (i.e. ibuprofen, acetaminophen)

Young Children: can show signs of hopelessness, sadness, worry.

Teens: Can be irritable, anxious, angry, and avoid social interactions. Also, changes in sleep patterns....are they up all night for no reason?  Sleeping excessively?   We also need to be aware that during the teenage years is when other mental disorders can start to become prominent.

Elderly: fatigue, loss of appetite, loss of interest in sex, feel bored and helpless or worthless, and avoiding social interactions.  With the elderly, there are usually other health issues involved, so people can tend to link in the symptoms of depression with their other disease processes, so it is important to be aware of the signs.  For example, cardiac disease can also cause depression, so is the issue new onset?  Did something major just happen like the loss of a loved one?

For some people the signs are really severe and very obvious, but for other people, they are very subtle and occur over a period of time making them much harder to notice, especially with those close enough to the person suffering.  People are really good at hiding things, and the longer you live with (or around someone) it's easier to make excuses for behavior, exhaustion, and you might not even notice the behavior because you are so used to it.  I also think that it is the first instinct to get very defensive when other people make comments to you or your loved ones about various behaviors, but once you get over the initial defensiveness, soak it in, and try to see things from a different perspective.  Obviously if someone is just being mean, then let it slide, but if a close friend/family member tries to give you some insight, take it....when you are ready. 


Awareness of the signs is the first step to getting help, so please take notice in your own life and of your loved ones and do a mini checklist to see if  you or they have any of these symptoms.  If you or your loved ones do, try to talk to them, open up the discussion, and if they are not willing to, then please call your HCP and make an appointment to talk about it, OR if you want to talk to someone immediately, please call the National Suicide Prevention Lifeline at 800-273-8255.  I also encourage you to talk to anyone...a friend, family member, clergy member about your feelings, about what you think may be going on. Talk to anyone you feel comfortable with because the first step to getting help is to realize that there is a problem.  Also, sometimes you keep things inside and you realize that other people are going through what you are going through, and talking to someone with similar problems and issues may help you, or help you to get professional assistance that you need.


Please remember that the person you may see crying while walking down the street might be on the edge, or the "crazy" person you see that is pissed off in line at the Post Office, or the person that you know really well acting totally different than you remember them to be, may be suffering from depression or another mental illness. I used to not think about that, and think people are totally off their rockers, until things have happened to me and my family; there are some days you do what you can to get through the day, but you have to remember that there is a light at the end of the tunnel.
If you/your friends/loved ones have thoughts of suicide or homicide please seek help immediatelyand call 911 or go to the nearest Emergency Department for help.



Yours in Good Health
B

Hot tub sex: Something you might want to skip

I know that so many movies, TV shows, etc have scenes with people making out in pools, hot tubs, oceans, etc and innuendo is that they are leading to sex.  While that may look super romantic, really hot , whatever floats your boat, it can actually be pretty detrimental to both partners floating in that water....most often the ladies get the brunt of the issues, always the short end of the stick, ladies, but it makes us only that much stronger, right?  Why is it so bad?  And how to make it that much better for you :)

What's the Deal?
To be clear, having sex in water isn't bad, but what's IN the water can be pretty creepy.  Hot tubs and pools people tend to think are pretty safe, and I always hear people say that they have chlorine in them and "chlorine kills everything".  OK, so chlorine at the night level might kill a lot of stuff, but the levels of chlorine required to meet government standards doesn't necessarily kill off all of the bacteria present.  Pools and hot tubs are full of different bacteria from peoples skin, babies (and adults too....) peeing in the pool, and you think you are the first person to get busy in that public pool/hot tub?  Sadly, no.  So all of that bacteria from all of these different sources is still hanging around in that water.  When you have sex, there is thrusting back and forth, allowing for skin tears to occur and openings in the skin to allow for bacteria to creep in.   Having sex in a hot tub, ocean, etc. can actually increase your risk of contracting an STI (sexually transmitted Infection), because the natural lubricant that bodies create, is whisked away in the water source.  so having all of this thrusting with no lubricant, can allow for larger tears.  Plus, this water source that may have bacteria present is pushed forcefully into the vagina, anus, penis etc.  And in the ocean/lakes/ponds, there are living microbes in the water, and they are getting pushed into you/your partner.  These factors increase the risk of a urinary tract infection (both for men AND women), bacterial vaginosis (for the ladies), and if there are any other STIs lurking in that water (from your partner or from others) because of the broken skin due to lack of lubrication, and the force of the water, there is a higher risk to contract the STI (for both).  Also,because of the lack of lubrication, men can get chaffing of the penis which can lead to a yeast infection (which, fellas, is not comfortable).  Plus, more people tend to skip using protection (i.e. condoms) when they have sex in water.  All in all, not a good idea.

Can I decrease my risk?
You can use condoms, and the best advice is to make sure that you are in a private pool or hot tub for those sorts of shenanigans to make sure that you are actually in a clean environment that you can control. You never know how much chlorine is in the public pool or hot tub, and I think that you private parts are worth a safe and clean environment, right??  So, I know the lure of the hot tub and some champagne, but get out before you get too loopy in a public arena and take it somewhere else that might be a little bit cleaner...then get a dirty as you want ;)

Yours in Good Health
B

Is that a Zit, Cyst, or Furuncle??

I am sure that many of you have seen some of the videos on YouTube with people "popping" enormous "zits" with handfuls of pus come out. Despite the allure and excitement that all of you seem to have with these videos, they are actually not zits...most often they are furuncles!  And, again, I totally get the excitement of wanting to squeeze those suckers, they should actually be seen by an HCP and treated.  How do you know the difference between a zit, cyst, and furuncle?  Read on my friends, we can figure out the difference, what should be seen by an HCP, why, and what you can feel free to squeeze and post to YouTube all on your own!

What is the Difference Between a Zit and a Cyst?
So a zit (AKA a blemish, pimple, spot, acne, etc) is the result of excess oil getting trapped in your pores, along with the naturally shedding skin cells, glue together and cause blockages, leading to a pustule/whitehead/zit, and they are very superficial.  As we all know, acne is usually treated with over the counter medications that help to kill off the bacteria that can pool and cause the inflammation, as well as face washes that dry up the oil production.  A cyst is a bit of a different beast; they are enclosed structures filled with either gasses, liquids, or semi-solid substances (i.e. pus) that are under the skin, within your organs, etc. When I am referring to cysts here, I am talking about the kind that are jet under the surface of your skin, but fully enclosed, not the ones that you might have in your ovaries, bladder, etc, purely talking superficial sebaceous cysts.  These cysts can be caused by infection, a blockage of a duct (causing a fluid build up), an inflammatory process, or just genetic bad luck!  Usually you feel an abnormal lump underneath the skin, and that is a cyst- not painful, just a lump that is there, more annoying than anything.  The treatment of cysts really depend on the size, where they are, and how annoying they are for you; but they either need to be lanced (opened up with a scalpel) and drained UNDER STERILE CONDITIONS, then treated with antibiotics and left as is to close on their own or they can be packed with gauze to help drain any excess fluids from the area.  Sometimes, depending on placement, they need full surgical removal (usually for deeper cysts), and, again, treatment with antibiotics.

What is a Furuncle?
A furuncle is also known as a boil, which is an infection (usually due to Staphylococcus aureus) of an entire hair follicle and the surrounding skin areas, and are usually caused by staff infections.  The skin goes from tender, pink, warm skin to firmer, and then you can feel a lump under the skin (not much unlike a cyst).  The main difference is that the bigger a furuncle gets, the more painful it gets, until that fluid/pus it is filled with is released; sometimes they open on their own, or they should be opened by an HCP (again under sterile conditions!)  Also, you may feel tired, have a fever, or get some itching over the site before the furuncle is visible, which is another difference between a zit or a cyst. Occasionally, but rarely, they will heal on their own, but most often they need to be opened by an HCP, under sterile conditions, especially if they continuously come back, are near your spine, on your face, or cause general health symptoms like fatigue and fevers, because you are at a high risk for having a generic systemic infection that can be deadly, known as sepsis.  Plus, if you open these on your own and they don't fully empty and heal well, they can spread and grow larger and in different places. Plus, something that is opened by a non-professional that doesn't heal well can cause scarring. Yikes!

Furuncle

draining furuncle

Zits

Cyst

Is There Anything I Can Do to Prevent Cysts and Furuncles?
Good hygiene like showering every day can go a long way (not just for preventing infections, but to keep people form steering away from you due to stench), wearing clean clothes (especially changing clothes after/between workouts), and using antibacterial soaps can help to prevent bacteria from growing and thriving on your skin.  And good hand washing also is really imperative in preventing infections (all sorts) but Staph is lurking everywhere, and washing your hands before touching anything on your skin (especially if the skin is open- even if you can't see it like cracked winter dry skin) can really help to prevent bacteria from embedding in your skin and creating infectious processes.  If you have a furuncle, then do not share towels or washcloths with anyone because you can spread the Staph infection, and same advice if you have a cyst that has been opened or a zit that you "popped".  It is really important to make sure that we are keeping all wounds clean and preventing infections at any cost.

So, What Can I Pop?
Honestly, every dermatologist out there would kill me for this one, but the only thing I will tell you is that you can pop a zit at home....I know, nothing YouTube-able, sorry! Even popping zits is really bad because it can cause long term damage and scarring, and you might not completely empty the pore and cause a larger infection, but it is the best oft he three worst choices you have :) I cringe seeing those videos thinking about the risk those people are putting themselves at for further infections, sepsis, necrotizing fasciitis, or death. It may seem fun to "pop" such boils/cysts and see all that pus come out, for those of you into that (which, I'm not gonna lie, I get intrigued...but I use self restraint!!)  I see people on the street with huge furuncle, and I want to pounce, but I don't....and I'm asked to pop it, I tell them to get it done in their HCPs office.  Sorry dudes and dudettes, keep your hands away from those cysts and furuncles, but have at it with those whiteheads, and you can damn me about not squeezing those tempting larger sacs of pus, but you'll thank me when you aren't raging with infection, scarred, or dead :)

Yours in Good Health
B

How often should I get tested?

I get a lot of questions from people asking me how often they should get checked for Sexually Transmitted Infections (STIs).  This is a very person dependent question, but there are some standard times you should get checked, and you may be surprised to know that when you got for your annual physical with your Primary Care Physician (PCP) it isn't standard to check for  STIs.  I know that a lot of people assume that it is done in the blood panel that your HCP draws, but unless you specifically ask for it, it isn't done. So, when should you ask for STIs to be checked?  When should we go in just to have that checked out?

What Are STIs?
STIs are really any infection that is most often transmitted through sexual intercourse and are also known as Sexually Transmitted Diseases or STDs.  They are passed from an infected person to another person through any form (oral, anal, vaginal) intercourse.  And some are even transferable with the use of condoms (yikes!)  The most frequent STIs are (in no particular order):
-Bacterial Vaginosis (BV)
-Hepatitis B, C
-Chlamydia
-Gonorrhea
-Genital/Oral Herpes (HSV 1 and HSV 2)
-HIV/AIDS
-Human Papilloma Virus (HPV)
-Pubic Lice (AKA crabs)
-Syphilis
-Trichomoniasis

How Do You Get Tested?
There are a few ways to get tested for STIs. Usually it is required to have a physical and or pelvic exam, so that your HCP can assess for warts, rashes, lesions, etc so we can view if you look to have been exposed, and also for women, we can assess your cervix and look for any changes in discharge color, or internal changes to the vaginal walls, and assess for pain with inspection due to pelvic inflammatory disease (PID) which is STI related. During your pelvic exam, a swab (just like your annual pap smear) will be sent off (to test for HPV), and for men, a swab from inside the urethra (your pee hole) may be taken to test for HPV.  You will also be required to submit urine and blood samples.  That will cover you for the all genital STIs.

How Often Should I Get Tested?
As I said earlier, it is a very personal thing, but there are some good basic rules.  I would tell you that at a MINIMUM, you should get tested for STIs annually with your annual physical starting from the time that you are sexually active (anal, oral, or vaginal), so make sure to ask your HCP to add those labs on to any others they might be ordering for you. If you have unprotected sex, get tested, and every 3 months after that for HIV until you come back negative for a full year with no other unprotected sexual encounters.  If you are in a monogamous relationship (living together, dating, married, civil union, whatever you have going on) get tested at a minimum of annually.  Call me a naysayer, but infidelity is on the rise, and to best protect yourself and ensure your safety, it is best to get tested...just for peace of mind, right? Don't assume just because you have sex with women, or because you asked your partner and they said they were clean, that you are going to be "clean" after an unprotected encounter.  Just watch out for yourself, as not all STIs are curable; they are all treatable, but some will come snack (like Herpes, genital warts)

A good rule is to assume that everyone has been exposed to an STI, and seeing as you don't want an STI, you will use all prevention possible, right?  And, think about who you are interaction with because condoms, while they decrease transmission rates, they do not prevent all transmission of STIs.  For example, herpes and genital warts are still transferable through condoms....so make sure that partner is totally worth the risk before hopping in the sack.  And, if there are any worries or concerns, talk to your HCP and be really honest and open; the HCP's at the free STI clinics have heard it all and are super laid back and cool about everything; they will assuage your fears if you don't need to be freaked out, and they will be honest with you about your risks.

Can a negative attitude make you ill?

I was told last weekend that people with negative attitudes tend to get sick more and die younger. I was in a social setting, and said that I didn't think that was true.  When pushed further, I added that it was not a factually based statement and there was nothing in the research to suggest that was a true statement. They claimed that it was, so here we are!  Maybe there is some truth to it, I clearly don't know everything, but that seemed like a far fetched statement to me.  Honestly, I always think of older curmudgeons that seem to live forever....right??

What does the literature say?
There are some small studies that say that pessimism can affect your life negatively and affect your health negatively but it won't kill you.  Research has shown that people that have a positive outlook on life have less stress and effective stress management techniques are associated with health benefits.  But, that doesn't mean that you can turn the same statement negative and make it true.  So, just because thinking positively can decrease your stress level doesn't mean that thinking negatively increases your stress level...you just might not have all of the benefits of a manageable stress level when you think more negatively. When I refer to positive thinking, it really means that you react to unexpected or more negative issues; you look towards the best possible outcome, as opposed to the worst. The research is unclear in why people have health benefits with positive thinking, but some of the benefits are:
-Increased life span
-Lower rates of depression
-Lower levels of distress
-Higher resistance to the common cold
-Reduced death from cardiovascular disease
-Better coping skills during times of high stress

What else can a positive attitude do?
The studies have also shown that people who are more positive also tend to live healthier lifestyles; they work out, eat healthier, and don't smoke/drink in excess, or use illicit drugs.  Basically, people who tend to be more positive, have a better outlook on life, and don't get sucked into the negative or poor behaviors associated with depressive states. You think positively, you will act positively!

How can I be more positive?
Try to surround yourself with positive people, then it will be easier to actually change your outlook.  Filter things before you say them; if it wounds negative in your head, then it is probably negative, so try to take a positive spin on it, you will see a difference in how people react to you and how to react to things.  Finding the humor in situations will always make you feel better, even if you are just making a joke to yourself! And just check yourself to make sure that you are focusing on the positive things in your life; don't internalize things and blame yourself when things go wrong.  Sometimes things don't go your way, it's part of life, right? If everything was always awesome, it would be called 'super happy terrific time' instead of life, but it's how you react to those things that define who you are and how you live your life.

So if you feel good and healthy, you will act good and healthy, thus you will have the benefits of an overall healthier lifestyle (such as stronger immune system due to healthier diet, less cardiovascular disease risk, etc.)  Every choice you make in life has an effect on you, whether it is positive or negative, so make the positive choice, and you will have the benefits of it.  No, being negative won't kill you off early, but it will make life a less pleasant experience and can lead to negative behaviors that can have some bad outcomes....plus who wants to live life thinking that every day is the worst day ever?  Not me!!  Things don't always seem like they are going your way...but think positively and they just might!

Yours in Good Health
B

Eating chocolate may keep you skinny!

Let's not get too excited, but this is the kind of research I can get down with, seeing as I have quite a chocolate addiction...I have a few bites of chocolate almost every single day. Literally, a few bites, not a few candy bars.  I've honestly always felt that if you crave something you might as well give yourself a little bit of it to satiate your craving, so you don't deprive yourself then go bonkers the next time you have it, right?  Makes sense to me!  And, it works for me too!  So, the study that just came out showing that people who eat chocolate more, have a lower Body Mass Index (BMI) an tend to be happier. I correlate with that, but I work out a ton and am not the average person as far as work and lifestyle is concerned!

What was the study all about?
So the study wasn't initially intended to find out this amazing news about chocolate (even though it makes all chocoholics super excited!)  It was actually survey of people who take cholesterol lowering medications, know as statins.  1017 people were surveyed related to their chocolate intake, form ages 20 to 85, and they were all relatively healthy people without any cardiac disease, diabetes, or extreme cholesterol levels.  They assessed all aspects of these peoples lives including: exercise, daily calorie intake, frequency of chocolate intake (i.e. how many times a week), overall saturated fat intake, and happiness (they used an accepted depression screening test).  And, for 978 of the people surveyed had their BMI's measured.  A BMI is a scale that uses height and weight to estimate you and scales you as underweight (<18.5), normal weight (18.5-24.9),overweight (25-29.9), or obese (30+).  I want to be very clear that a BMI is not a great estimate to use if you have a lot of muscle- it won't take that into account and it will say that you are obese (just an FYI).  They found the moire frequently people ate chocolate, the lower their BMI, and the happier they are!

So I eat chocolate every day and then I'll be skinny?
NO!  I think we all wish that one was true, and some people will trick themselves to think that is real, but it isn't.  They found a correlation between the frequency that people ate chocolate and lower BMI's BUT they did not find a correlation between the amounts they ate. What does that mean?  Basically, people who got the hankering for some chocolate and, for example, ate a couple pieces of chocolate a few times a week, had lower BMIs.  It does not mean that people who get the hankering for chocolate who eat an entire chocolate bar or a pint of Ben & Jerry's have a lower BMI.

They are doing further correlations and some follow-up study work, but it looks like living in moderation including indulging in moderation is the way to be: keeps you slim, makes you happy, thus making you feel better about yourself.  So, keep active getting your minimum of 30 minutes of exercise in a day, eat healthy, and give yourself a candy break every now and again because you deserve it!

Yours in Good Health
B

Is Creatine Safe?

Creatine is one of the most frequently used athletic enhancement supplements.  It is a naturally occurring chemical in the body, created by the liver and kidneys, and 95% of it is stored in the skeletal muscles and the rest is circulating in the bloodstream. In the 1970's some Soviet scientists found that oral creatine supplements improved brief intense athletic periods (such as sprinting), and then in the 1990's it was reported that oral creatine supplementation actually increases your body muscles creatine content (seems like a silly statement, but that it actually builds up and stays in your muscles- it isn't just absorbed then excreted by the body). Besides creatine created by your body and oral supplementation, the other ways to ingest it is to eat red meat and fish.  So, it is a naturally occurring substance, that may enhance your workouts, but how does it work and is it safe for you?

What does creatine do?
Basically, creatine is involved in making the energy that muscles need to work. Normally, when you eat carbohydrates (and other food) your foodstuffs are broken down in the stomach, then further broken down with the help of the liver and made into a usable energy source by the body, such as ATP (Adenosine Triphosphate), which transports energy within cells. When the ATP sources are depleted in your muscles, they become tired because there is no energy source left within the cells of your muscles, your body will try to create energy from food sources, but it always ends up failing when needed for high energy needs, quickly. Then creatine comes into play: creating that is stored in your muscles, converts into creatine phosphate and reacts with ADP ( adenosine diphosphate- a non unusable form of energy) to makes more ATP and boost your muscles energy .  Thus for longer workouts, creatine supplementation is enhanced when taken with carbohydrates; your muscles get an extra boost of immediate viable energy.

How do you take it?
It comes in powders, drinks, pills....and some people will split doses and take it three times during the day, whereas others will take it an hour before working out and then 1 to 3 hours after working out to replenish the stores in the muscle.  There are plenty of theories, but most people tend to take a loading dose (high level for a short period of time to raise the amount in their system and saturate their muscles with creatine) of 9 to 20 grams per day for 6 days, then 2 grams a day from then on.  One other thing to note is that most athletes "cycle" their creatine supplementing so that they test their bodies with and without the supplement, so their body doesn't ever get lazy; they will usually take the supplement for 8 weeks, off for 4 weeks, then back on.

Does it actually work?
Here's the rub, a lot of professional and non-professional athletes take creatine supplements, and people report feeling like they have more energy and have better workouts, but the research is mixed because your muscles do have a saturation point with creatine.  On the other hand, it is really hard to eat a diet high in creatine, basically to get 3 grams a day, you would have to eat a little over 3lbs of raw red meat a day...which I can't see very many people doing.  There are some very high quality studies that do show an increase in muscle mass with using supplementation, thus increasing lean muscle mass.  So, I would say that it does work for performance athletes, I don't think that someone who sits around all day and might lift a 5lb dumbbell a couple times a week will look like Arnold Schwarzenegger, but if you work out hard, and are looking to increase your muscle mass quickly, this will help you, and give you more energy at the beginning of your workout to lift more.

Are there any side effects?
Most notably, when people first start taking creatine they can have some stomach upset (nausea, vomiting, diarrhea) and you WILL gain weight, because you are gaining muscle, and possibly a little bloat at the beginning, but as your body gets used to the creatine, it will even out.  People with renal disease or diabetes (at risk for renal disease) ned to be really careful as creatine is excreted through the kidneys, and a build-up of creatine has been shown to put a lot of stress on your kidneys, so if they are already at risk or not working optimally, the supplement can put an unneeded risk on them (there are studies that go both ways with this topic).  Also, people with liver disease (or at high risk for liver disease) should definitely talk to their HCP before starting creatine supplements.  If you have any doubt, or even if you don't, I suggest going to your HCP and getting a physical with some blood work to check your liver and kidney function, just to be safe, before starting this supplementation.  And follow-up with your HCP if you notice anything different about your body (besides building extra muscle because that's the whole point, right?) Just remember, these supplements are still undergoing testing for long term use AND they are not FDA approved, so you never know exactly what you are ingesting.....

Give it a go, work out hard, and see where it leads you!

Yours in Good Health
B