Category Archives: Prevention

The Heart of Bones

I’ve been collecting blog posts on the whole calcium/heart disease issue. What I find surprising is that although there has been a lot of discussion of this topic among both local and internet colleagues, I haven’t had any patients ask me about this subject.

For more information here are some very thorough posts:

nice analyisis from Science-Based Medicine

my Aussie Rheumatologist friend weighs in


Does Vitamin C treat a cold?

How should you respond to a friend who, the minute you have a cough or sneeze, shoves a packet of Emergen-C in your face and orders, “Drink up!” Well, if you’re me, the response has always been, “You know, there are really no studies that prove this helps!” And I’m met with a lot of eye rolling and insistence that yes, it does help, and I’d better quit my “Dr. Know-it-all attitude” and push that vitamin C. Well, I kinda like the taste of Emergen-C, and it can’t hurt, right???

AND THEN . . .

Thank you, NYU Clinical Correlations blog for an excellent review of Vitamin C for the prevention and treatment of cold symptoms. I’d suggest reading the whole entry, but here’s the bottom line:

So, at the end of the day, is there any benefit to taking a daily vitamin C supplement, or for chugging down that fizzy shot of mega-dose vitamin C when you feel a cold coming on?  If you are a marathon runner, or if you are planning a winter adventure in the arctic tundra, you should certainly consider a daily dose of vitamin C.  For the rest of us, it doesn’t seem to be worth the hassle and expense of adding one more pill to our daily routine. 

 On the other hand, regarding the effect of vitamin C taken at the onset of cold symptoms, the Cochrane group left a little room for interpretation.  The group was unable to identify a clinically significant benefit of therapeutic dosing based on the majority of currently available research.  However, they pointed to a few interesting trials showing evidence of benefit, yet to be verified, for therapeutic vitamin C preparations containing 4 to 8 grams.  Furthermore, in the general population, vitamin C’s side effect profile appears to be relatively benign. 

Wash and Dry Your Hands!

We all know we’re supposed to wash our hands. A lot. Especially when we’re health care workers. All around the hospital and medical office are sinks and bottles of foam or gel sanitizer. Our patients probably have little bottles of sanitizer or wipes in their purses. There are antibacterial wipes at the grocery store so you can wipe down the cart handles. Kids these days use hand sanitizer, sneeze into their elbows and have no concept of life before digital cameras. (Yes, I know digital cameras have nothing to do with hand washing, but I’m always amazed that today’s kids will never know the agony of waiting for film to be developed before seeing whose head was cut out of the photo)!

Despite the fact that we know we’re SUPPOSED to wash our hands (a lot), we don’t do very well with this. Numerous studies have shown that health care workers have dismally low compliance with hand washing. Having conveniently placed foam or gel sanitizers everywhere you turn does help improve adherence. And, it seems, at least to me, does having cute or funny hand washing posters around the hospital. Recently some area hospitals have started displaying “movie” posters with important hand washing messages. I wasn’t sure if it was OK to photograph them, but trust me that I did laugh each time I turned a corner and saw one of my favorite movies turned into a message about hygiene. One poster has the classic outstretched fingers of “E.T.” but says, “E.G. – the extra-germestrial.” Instead of “Star Wars,” the familiar space logo now reads “Germ Wars.” I do have to admit that seeing these posters every day reminded me to wash my hands.

Once hands are washed, what about drying? I’ve noticed many hospitals and offices no longer have paper towels and instead have air dryers. Is there a difference, besides getting rid of the paper waste? In September, The New York Times’ Well Blog reviewed this topic. They found that there really was no difference in air vs. paper, as long as hands get dried. Personally, I’ve seen people not wash their hands at all or wash and leave without drying because of lines at the hand dryers. I timed a full dry cycle and it was 40 seconds until the machine shut off and my hands were still a little damp. Multiply 40 seconds by the dozens of times we wash our hands a day and that’s a good chunk of time. I could probably get some more blog posts out with all that extra time I’m spending drying my hands!

Bottom line – wash, dry, repeat! And sneeze into your elbow!

Photo Source: – it’s an e-card you can send!

Sleep More Eat Less

[picapp align=”left” wrap=”false” link=”term=sleep&iid=300458″ src=”0297/bcca01c9-e38c-41a9-84ae-a0d07a715029.jpg?adImageId=12802708&imageId=300458″ width=”319″ height=”480″ /]A friend suggested I post something about the link between sleep deprivation and eating. Luckily I don’t have to write anything original since the Well blog recently did an article. Here’s the link:

Preventing Hearing Loss

I read this post on the Running A Hospital blog last week and wanted to share it. I’m very proud of my talented musician friends and relatives but I worry about impact of the loud music on their future hearing acuity.  Interesting to see the awareness this organization ( is promoting. I recently saw another neighbor wearing ear protection mowing the lawn – nice to see, and not just for professional landscapers. I also cringe when someone is listening to an iPod with ear buds and I can clearly hear the music. Probably random strangers (teenagers!) don’t want me to stop them on the street and say “Protect your ears!” But I’m tempted. Now go turn down the volume . . .

Are we having fun yet?

[picapp align=”center” wrap=”false” link=”term=laughter&iid=300316″ src=”0296/5cb4596a-3361-4e8e-87b6-eee63e16579a.jpg?adImageId=12748371&imageId=300316″ width=”380″ height=”250″ /]I seem to have acquired the habit of asking my new patients, “What do you do for fun?” I don’t recall when exactly this question popped into my regular lineup of inquiries, but, after a few weeks or months, that phrase has stuck around. There are several reasons why I like asking this. I enjoy getting to know my patients as whole people and not just “lady with a sore knee” or “guy with RA.”  Some of my patients are artists, musicians, antiques collectors, pet lovers and more. I also enjoy knowing the next time I see a particular patient we are going to talk about great shopping deals, another will show me a new tattoo, another will bring in photos of a beautiful spring garden. I suppose what I’m really asking is “What are your hobbies?” However, many people have trouble answering that because a hobby sounds very serious and dedicated, while things like watching movies or reading mystery novels or going to yard sales are maybe things people do for fun without considering it a formal hobby.

As much as I like hearing the various answers to this question, I have been finding myself holding back asking it lately after the conversation goes something like this;

Me: “And what do you like to do for fun?”

Patient: “Nothing.”

Me: “Really? Nothing? No fun at all?”

Patient: “No, I don’t have any fun. How can I have any fun? I’m in pain all the time. I have arthritis. I have fibromyalgia. . .” and the list of reasons goes on.

I would argue that when struggling with a chronic illness, finding ways to add some fun into one’s life is very important. The American Psychological Association agrees, noting that when coping with a chronic illness it is important to:

  • Stay connected. Establish and maintain quality relationships with friends and family. Many health organizations also sponsor support groups composed of other people experiencing similar challenges. These groups will not only aid your own well-being, but also provide rewarding opportunities to help others.

    • Maintain a daily routine of work, errands, household chores, and hobbies as much as possible. This will provide you with a feeling of stability amid the chaos and uncertainty of your illness.
  • Take care of yourself. Don’t allow worries about your illness to get in the way of eating property, getting rest and exercise, and having fun.

  • Other resources, such as, show a way to live with chronic conditions rather than falling into the victim mentality.  While the definition of fun might change, it is still important to find things to bring joy, happiness, purpose or maybe even just some distraction into one’s life.

    More Vitamin D

    I have to admit that I’m probably one of those people who jumped on the vitamin D bandwagon early. Having measured quite a few serum vitamin D levels on patients in the last 6-12 months, I’ve been surprised at just how many are deficient. No, I don’t think that vitamin D is the cure-all for everything, but it sounds like randomized studies looking at effects of vitamin D on various disease are in the works. I heard someone say recently, “throw ‘vitamin D’ into a research idea and you’ll get published.” However, the studies so far have been primarily observational. I previously wrote about vitamin D here. I just finished reading an NPR story called “Are We Overselling the Sunshine Vitamin?”  Also interesting. Since the patients I see have arthritic and/or autoimmune conditions, I will continue to recommend appropriate screening and supplementation and await the new guidelines.