Category Preventative Health

Curbside Consults

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Even though my board specialty is family practice, this works!

Even though my board specialty is family practice, this works!

Ask any physician if he or she minds being asked a medical question by a stranger or acquaintance while at a party, and I will bet that the answer will bean emphatic YES across the board. Just because we docs take the Hippocratic Oath and are committed to the service of healing does not mean that we want to be on call wherever we go, doling out free medical consultations to anyone who asks. I am waiting for the day when an auto mechanic asks me to diagnose a medical condition so that I can respond with, “Hey, you’re a mechanic. Would you mind looking at my car and telling me what that ticking noise is?” Honestly, I am SICK OF IT. I have people private message me on Facebook because they know that I am a doctor, and they will go in to great detail in their descriptions of whatever ailment plagues them, then implore me to diagnose them for free.

There have been instances in which my friends have introduced me to people and have said, “Oh! Stacey is a doc…you know what? You should ask her about that thing on your shoulder!”, which is immediately followed by a quick history and an expectation for me to provide a quick consultation and diagnosis. I almost want to say, “Do you have any idea how much my education cost? Do you know how much it costs me for the privilege of being a doctor? Yet you want a free consultation? I’m trying to get to my gym bag here!” There are a few professions which get such queries for free advice, such as massage therapists, chiropractors and attorneys. Perhaps we would communicate our exasperation more clearly if we just said, “You want fries with that?” when someone asked us for free professional advice. I think that reply would stop anyone dead in their tracks.

I implore any of you who are considering asking a doctor for medical advice to resist the urge. We often cannot diagnose sight unseen, and we certainly don’t wish to take on the liability of providing medical advise, diagnoses or treatment suggestions in such an environment. Though you may balk at the process of scheduling an appointment to see a physician and driving to the office, please understand that we cannot provide a fast food type service in medicine. When we are off the clock, let us enjoy our lives outside of medicine.

Conformity In The Medical World

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stethoscope-doctorBefore I dive into this topic, I want to make it very clear that I am proud and honored to be a physician. I endured four years of medical school and three years of residency training because I had a lifelong love of medicine and truly wanted to be a healer. That being said, I have never been nor will I ever be what is considered typical for a physician. Don’t expect me to talk about medical cases and read medical tomes when I am away from the office. Many of my colleagues are so unbalanced that they will eat, breathe and live medicine constantly, but that is not my style at all. Some of them are also social misfits and cannot talk about a non-medical topic without stumbling and bumbling. The social awkwardness of some physicians is so painful to witness that I find myself cringing and looking for a quick exit when social hour begins at a conference or medical dinner.

I keep my fitness background on low profile when in medical circles because I realize that some of my colleagues may regard what I do in the fitness world as highly irregular and downright scandalous. To be honest, I really don’t give a hoot what they think, but because I don’t enjoy being scrutinized by conservative types, I avoid discussing my fitness activities as much as possible when at medical events. I realize that aside from our medical backgrounds, my colleagues and I share almost NOTHING in common. What could I possibly say to a colleague who brings a stethoscope to a medical dinner (yes, I have seen colleagues do this!)? The lives of most docs are boring to an extreme and do not hold my interest. I am not saying that all doctors are like this, but I definitely keep my interaction those who act like medical snobs to a bare minimum. There are a few doctors who will make a point of pimping the other docs at a dinner table. Pimping refers to quizzing on medical topics and cases and is typically performed by a professor or proctor and directed at a student or resident during teaching forums or rotations. It is extremely tacky when a physician attempts to pimp his colleagues and is a clear sign of an inflated ego.
cardinals
I don’t mind standing out in the flock with plumage that is brighter. It honestly suits me. But it doesn’t mean I am less than the other doctors who are out there. I am licensed and board certified, a published medical researcher and see patients on a regular basis. Thank goodness I have a very full life, one that is so varied and exciting that I can easily escape the dry and often depressing climate of medicine and enjoy something that has twists and turns.

Oil and Water: Why Crossfit Is Detrimental For Bodybuilders

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I will boldly state right now that I cannot stand Crossfit, and will be delighted when its novelty wears off. There are substantial reasons for my argument against the principles of Crossfit, especially when it comes to speaking to NPC and IFBB competitors who believe that Crossfit will enhance their efforts to get into contest shape. Not only will Crossfit widen your waistline as a result of the constant heavy lifting, it will also cause cortisol spikes which make your body hold onto belly fat for dear life.

Here are the nine fundamental exercises which Crossfit is built upon:

Air Squat
Front Squat
Overhead Squat
Shoulder Press
Push Press
Push Jerk
Deadlift
Sumo Deadlift High Pull
Medicine Ball Clean

I can only imagine how many lumbar disc herniations have occurred in weekend athletes as a result of performing most of these movements, not to mention the rotator cuff strains and tears from the stress on the shoulders. I also find it pretty annoying that Crossfit renamed the free squat or bodyweight squat in an effort to be catchy and original. What’s more, I see no point in getting a client to perform 200 or 300 “air” squats in a row, not unless your objective is to drive your client to complete exhaustion and overtraining. Based on what I have witnessed with the design of Crossfit regimens, exhaustion and overtraining is the inevitable outcome.

Crossfit routines also incorporate other exercises such as pullups and pushups. What bothers me is that these movements are performed in a high rep range, to the tune of 100 or more. Then the client may be pushed to do tire flips or some of the asinine Olympic lifts that Crossfit holds so dear to its faddish foundation. I am NOT impressed with the super high intensity workouts that define Crossfit. They tax the central nervous system to an excessive degree. Crossfit fanatics may love the feeling of being pushed to the limit, but this sport is downright DANGEROUS. When the body is fatigued to the extent that it is in a Crossfit routine, the risk for muscle breakdown and frank rhabdomyolysis is considerable. No physical discipline is worth the risk of landing in the hospital.

I understand that Crossfit offers a great social environment and a feeling of camaraderie, but at what price? Every single person I know who is a fan of Crossfit has been injured while doing it. The suggested Crossfit regimen of 3 days on, 1 day off is too rigorous when you consider the fact that Olympic lifts are part of the core of Crossfit training. The body simply cannot repair itself in enough time. To fatigue a Crossfit client by having him/her do a WOD (workout of the day for those of you not familiar with Crossfit) and then stack on deadlifts for reps or 5 foot high box jumps is insane. Benefits drop dramatically when the body is completely depleted like that. The Crossfit mentality of deplete and endure is pure bullshit. Bodybuilders, in contrast, train hard and heavy, and yes, they often train to depletion or failure, but they certainly aren’t going to attempt 100 pullups after destroying a traditional back workout. They understand the law of diminishing returns all too well.

Proponents of Crossfit often state that the training is functional and enhances the day to day activities which people perform. When was the last time you had to do a clean and jerk while on the job? Unless you work as a firefighter, stock room clerk or some other physically demanding work role, I seriously doubt that you are performing movements which mimic what happens while in a Crossfit box. Besides, if you’re injured as a result of Crossfit (or should I say WHEN), you can’t possibly perform any challenging physical movement which strains your injured body part.

Rich Froning World Champion Crossfit Athlete

Rich Froning World Champion Crossfit Athlete


Sadik Hadzovic IFBB Men's Physique Pro

Sadik Hadzovic IFBB Men’s Physique Pro


For those of you who compete in the NPC or IFBB (or INBA, WBFF, etc.), don’t expect to be able to incorporate Crossfit into your contest prep training and sculpt your physique in the manner required for bodybuilding. I actually had a client who begged me repeatedly to let her do Crossfit two days a week despite my recommendation that she abandon it and focus on traditional weight lifting. I finally acquiesced, and allowed her to incorporate Crossfit as part of her training. As I had predicted, she sustained an injury, her waist widened from all the heavy complex movements which made her midsection boxy, and she became soft as a result of the cortisol spikes which the high intensity Crossfit training created. After 3 weeks of seeing all her efforts from pre-Crossfit training unravel, I asked her to reconsider her decision to engage in Crossfit. As soon as she stopped doing Crossfit, her waist began to nip in, and her body began to tighten up again. Amen for old school weightlifting!

If it sounds like I am saying you will have to decide between doing Crossfit and competing in any of the bodybuilding divisions, I am. You simply cannot create the nipped in waist and beautiful taper that defines every single bodybuilding division. If you do Crossfit, you will create a strong body (plus some injuries), but you will also widen your silhouette and carry a layer of fat as a result of all that cortisol you will release from constant high intensity training. Look at a typical Crossfit athlete. Shoulders are broad, quads and hams are thick, and the abdominal region is thick and boxy. That is what happens when compound Olympic lifts are performed on a regular basis. If that is your aesthetic ideal, by all means knock yourself out with Crossfit, but you will be destroyed on a bodybuilding stage.

On the subject of Olympic lifts, even powerlifters have the sense not to rep out on these movements. Yet Crossfitters, blinded by the so-called warrior mentality that leads them to do stupid things that invite injury, will rep out on movements which recruit a tremendous amount of muscle fibers and hence tax the central nervous system. I am willing to bet that the Crossfit nation contends with adrenal burnout, permanent muscle damage, and repetitive tendon and ligament ruptures on a relatively consistent basis, and that such negative aspects will eventually cause the demise of this fad sport.

I will always staunchly defend the focus and the principles behind bodybuilding. I know that NPC and IFBB competitors are true warriors and know how to push through grueling training. I also strongly believe that for the most part, most competitors are smart enough not to overtrain or invite injury by performing movements which are biomechanically unsound. The world of bodybuilding not only rewards strength, but it also recognizes the aesthetic ideal which all bodybuilders aspire to achieve, regardless of division. Bodybuilding is not about flipping a massive tire across a gym, it’s about sculpting and defining muscle.

(Please also check out sportsuppguide.com for a posting of this article there.)

Taurine

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Taurine

If you want to live to a ripe old age, you should make sure you have a steady supply of taurine to guarantee it. Taurine is an amino acid which is found in large concentrations in the brain, heart, retina and platelets. This amazing amino acid protects against heart failure, detoxes the liver, maintains electrolyte balance in the body, supports the immune system, and promotes insulin sensitivity. If you consume a diet which incorporates meat and fish, your taurine levels may be normal, but if you are vegetarian or vegan, chances are that you don’t have adequate levels of taurine in your body. Another factor is the fact that as we age, we become less efficient at producing taurine.

Those of you who lift weights may already be aware of the energy boosting effects of taurine supplementation, and may be already taking it in the form of a preworkout mix which typically has taurine as part of the blend. Taurine also expands muscle cells, increasing the volume and contributing to the ever so familiar “pump” that comes from an intense lifts. But the additional health benefits of taurine supplementation make it almost impossible to pass up.

Taurine supplements are inexpensive and you don’t have to take high doses. A good dosage for most people is 1.5 grams, but you can double the dosage if you wish. You may notice a metabolic boost and significant weight loss as a result of taking taurine supplements. Taurine also causes a drop in serum triglyceride levels, making it an acceptable alternative to prescription lipid-lowering agents. Any excess is excreted by the kidneys.

Melatonin Article For RxGirl.com

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Original post can be found here:

http://www.rxmuscle.com/rx-girl-articles/11102-melatonin.html

Melatonin is a hormone produced by the pineal gland in the brain which regulates the wake-sleep cycle. Production is turned on later in the evening when lights are turned off for bedtime. However, there are a number of poor habits which people commonly engage in which interfere with the body’s production of melatonin, with harmful results such as impaired immune response, increased rate of cellular aging, and increasing the risk of cancer formation. Basically, those late nights you spend watching T.V. or reading are interfering with optimal health. As soon as a light is turned on at night, you send a signal to your brain that is daytime, and production of melatonin ceases, and does not resume when you turn the light off either.
Shorter wavelengths (red, orange, yellow) of light are less detrimental than white or blue light and should be used in the evening. I love the salt lamp I have in my bedroom and try to use that light as my sole illumination in the bedroom as much as possible at night. Why is it so important to preserve the body’s natural production of melatonin? Because melatonin is a potent antioxidant and excellent for reducing inflammation throughout the body, including the brain.

Implement the following guidelines to optimize the body’s production of melatonin:

SuprachiasmaticNucleus1. Try to get daily bright sun exposure. Production of melatonin approximates the contrast between bright sun exposure during the day and complete darkness in the evening.

2. Turn off your computer and T.V. at least one hour before going to bed. Both computers and T.V.’s emit blue light which interferes with the body’s normal production of melatonin.

3. Sleep without any lights on. The darker your room is while you sleep, the better chance you have of allowing your body to produce melatonin without interruption.

4. Drop the thermostat to 60 to 70 degrees.

If you think your melatonin levels are low or you have labwork demonstrating low melatonin, and you also suffer from insomnia, you might want to supplement with melatonin tablets. Beware of the dosage, and keep it at 0.5 to 3 milligrams maximum dosage each night. At higher doses, melatonin can have hypnotic effects on some individuals, and on others, a paradoxical hyperaware state may manifest. On a personal note, I had labwork early this year which demonstrated low melatonin, but I wasn’t suffering from insomnia. A colleague insisted I supplement with 3 milligrams of melatonin per night, which resulted in anxiety and a completely sleepless night for all of the nights I took melatonin. Another caution is if you are trying to get pregnant, you must avoid taking melatonin supplements, because they interfere with fertility.

Green Coffee Bean Extract

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You may be wondering what green coffee extract is, especially when the roasted variety has such a characteristic mahogany brown color. “Green” coffee refers to the most pure and raw form of coffee before it is roasted and processed in other ways. When coffee beans are roasted, a powerful chemical called chlorogenic acid is leached out, and it is this chemical which is believed to slow absorption of fat and glucose from foods, resulting in less fat deposition and greater weight loss. Dr. Oz was a major factor in popularizing this supplement, and allegedly conducted his own study using the extract, demonstrating effectiveness in his subjects. There are several studies which have concluded that green coffee extract can have a modest effect on individuals looking to lose weight, even if all other factors (diet, physical activity) remain unchanged.

I am very much a skeptic when it comes to supplements with weight loss claims, but green coffee extract seems to have some validity. I am seeing more thermogenic formulas with green coffee extract as part of the formulation, and feel comfortable recommending it either alone or in combination. The recommended dosage of green coffee extract is 800 milligrams twice daily before meals.

green coffee

Botox Treatments Are NOT An Urgent Issue

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injectables and faceWhile I appreciate the aesthetic benefits and self-confidence boost that injectables treatments confer upon the people who undergo them, I get very annoyed by the sense of urgency which some people adopt when it’s time to get treated again. I am not kidding you when I say I have had patients contact me asking for Botox, Dysport, Xeomin, Juvederm, Restylane, Perlane, Belotero, or Radiesse with a hint of desperation in their voices, as if it was a matter of life or death in getting a treatment lined up immediately.

In a way it makes perfect sense because these non-surgical fixes are a cost-effective way to smooth lines and furrows and restore lost volume. When the clock is turned back the first time and a new patient sees the results of injectables treatments, it’s a wonderful reveal which causes the patient to see himself or herself differently. The neurotoxins (Botox, Dysport and Xeomin) yield effects which last from 3 to 6 months, with muscle function gradually returning over time, along with the corresponding lines and wrinkles. Fillers have greater longevity and dissipate from 6 months to two years after the treatment is performed. The dissipation tends to be gradual, not sudden.

So when I have patients calling the office, calling me or texting me, insisting that they MUST come in IMMEDIATELY for treatment, I almost want to ask, “Where’s the fire?” Sometimes the request is on such short notice that I cannot accommodate it, which sometimes upsets the patient greatly. The response from the patient goes something like, “But I need it NOW! You need to do this for me. I’m sure you can find time in your schedule to stay late or somehow accommodate me.”

Such treatments are NEVER an emergency, and your face isn’t going to fall if you don’t get shot up with neurotoxin or filler immediately. Trust me on this!

How Weekend Drinking Binges Make You Fat

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young-people-in-club-or-bar-drinking-beer-out-of-a-beer-bottle-and-have-funOne of the reasons why people tend to look forward to the weekend so much, besides being away from work, is the ritualistic imbibing of alcohol and consumption of rich foods which many tend to engage in. I have clients who will follow a sensible and healthy meal plan during the week, only to abandon all self-control, put on party hats and eat and drink during the entire weekend.

I will explain to you why this practice is a sure way to keep you from attaining your fitness goals. When you drink large amounts of alcohol, say 3 drinks or more, your body gets a sudden influx of alcohol which puts your body’s metabolism of nutrients to a grinding halt. Why? Because the body cannot store alcohol and must use it immediately as a fuel source. What happens with nutrients is that they are converted to fat and then stored in fat tissue for later use, so alcohol essentially prevents the body from utilizing fat. High consumption of alcohol also impairs the cerebral function (specifically the prefrontal cortex), flattening inhibitions and increasing the appetite. That is why you will often crave greasy foods when you drink, because the body turns to rich foods to replenish nutrients. The combination of increased appetite and behavioral changes are enough to get you to eat a calorie laden, fatty meal which is then stored as fat.

I enjoy the occasional cocktail and as a result will never tell people to avoid drinking altogether. However, I have several recommendations which will minimize the fat deposition which alcohol consumption triggers.

1. Always eat a meal with PROTEIN, FIBER and HEALTHY FAT before you begin drinking to offset the surge in blood sugar which occurs with alcohol connsumption andto slow the absorption of alcohol once it is introduced to the gut.

2. Drink two glasses of water for every drink of alcohol. Alcohol is a diuretic, meaning that it will dry you out. Because of this, it is important to maintain a high level of hydration to offset the diuretic effect.

3. Limit consumption to 1 or 2 drinks in an evening. This will keep calorie consumption down.

Running On Empty – Progesterone And Stress

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Stress meterWe all know that constant stress can play havoc with our health and well being. In this post I will focus on the effects of excessive stress on progesterone levels.

Progesterone is produced in the ovaries, the adrenal glands, and in the placentas of pregnant women. It has a calming effect, is a natural diuretic, regulates menstrual cycles, and prepares the body for conception and pregnancy. Some women can experience excessive levels of progesterone which usually produces symptoms of PMS, but in general, progesterone is a vital and beneficial hormone.

Let’s examine what happens to progesterone if you are under constant and chronic stress. When the body is pummeled with endless stress, the adrenal glands simply cannot keep up with the demand for more cortisol, so they turn to progesterone, converting it into cortisol to make up for the deficit. Eventually, however, not only do cortisol levels plummet, but progesterone levels also drop to precipitously low levels. So that calming, diuretic effect of progesterone falls away, and menstrual cycles become erratic or periods cease altogether. Sounds like fun, huh?

I cam tell you that running on an empty tank of progesterone is no fun at all. You retain water, you get irritable and cranky, and you lose your ability to navigate calmly through stressful situations. If you’re like me and you depend on a regular menstrual cycle as a reassurance that all is right with the world, then living with the mystery of whether or when you might have a period can be maddening. I found out that I actually WANT a period, and I thought I would never feel that way.

Though I had regular periods until very recently, I began retaining water like crazy after attaining IFBB Pro Status last July, and I knew something just wasn’t right. I didn’t feel like I was in my own body, as strange as it sounds. I began flailing, and went through a rebound which was disturbing and unexpected. My emotional barometer was all over the place, and I couldn’t get out of the funk that I was in. Gaining eight pounds (which is considerable for me), most of which was water weight, made me even more depressed.

Another completely irritating set of symptoms which suddenly popped up at the end of January and which persisted every single night is that I would wake up at around 4 a.m., completely drenched in sweat and with a sensation which could best be described as being lit on fire from the inside. I would throw the covers off and quickly disrobe, then rather quickly fall asleep, only to awaken about 30 minutes later, shivering and pulling the covers over me.

The nightmare finally subsided to a great extent once I began replenishing my body with bioidentical progesterone in late February. Though I still retain a bit of water, my weight is back to a reasonable 120 lbs. versus the 125 I had been at in the Fall, my hot and cold episodes have subsided, i feel much calmer and I feel more like myself.

Had I removed the stressors that I had some control over, I am firmly convinced I would not have bottomed out with my progesterone levels like I did. Even if I had engaged in meditation more regularly a couple of years ago, I think I could have saved my progesterone levels from bottoming out. Trust me when I say that progesterone depletion can be incredibly disruptive and upsetting. And don’t think for a second that this is only a problem which women past the age of 45 deal with. I have come across female patients as young as 32 who had almost no progesterone in their lab tests.

If you do one thing to improve your health, please reduce your stress! You can do this by removing the stressors that you have some control over, practice breathing exercises, tai chi, yoga, and meditation, enjoy time with friends, loved ones and pets more often, and let go of anxiety and worry.