If you have been watching the news lately, viral infection called the swine flu has been a hot topic. It basically is a mutated version of the influenza virus that came from pigs, birds, and humans. So far, it has not been an issue in the Washington state but we will have to keep an alert for possible epidemic since so much Eastside patients travel for vacation and work.

Lot of my patents have been calling because they are uncertain if they should come in or not. So, here is a chart to review and should call for an appointment if you or your child has these symtoms.

In children:

* High fever(above 103 degrees), or a fever that lasts for more than 3 days
* Symptoms that last for more than 10 days
* Trouble breathing, fast breathing or wheezing
* Bluish skin color
* Earache or drainage from the ear
* Changes in mental state (such as not waking up, irritability or seizures)
* Flu-like symptoms that improve, but return with a fever and a worse cough
* Worsening of a chronic medical condition (such as diabetes or heart disease)
* Vomiting or abdominal pain


In adults:

* A high, prolonged fever (above 102 degrees) with fatigue and achiness
* Symptoms that last for more than 10 days or get worse instead of better
* Trouble breathing or shortness of breath
* Pain or pressure in the chest
* Fainting or feeling like you are about to faint
* Confusion or disorientation
* Severe or persistent vomiting
* Severe sinus pain in your face or forehead
* Very swollen glands in the neck or jaw


You can reduce your risk of catching a cold or the flu by washing your hands frequently, which stops the spread of germs. Eating healthy, exercising and getting enough sleep also play a part in preventing colds and the flu because they help boost your immune system.

If you are sick, make sure that you cover your mouth when you cough and wash your hands often to prevent giving your cold or flu to others.

Vitamin D is a very important antioxidant that is essential to our body.

Unfortunately, research has shown nearly 75 % of people in Seattle might have deficient levels, especially in the winter months. It has been linked to higher risk of depression, fatigue, breast cancer, heart disease, bone loss, and many more. Now that we have pushed our patients to use sunscreen for protection against skin cancer and anti-aging of the skin, we have seen vitamin D levels go down even lower even in the summer months. Cholestrol molecule is converted to vitamin D in our skin by sunlight.

Currently, we do not suggest that everyone go get a tan and to stop using sunscreens due to risk of skin cancer and skin aging as mentioned above. However, we do need to take vitamin D supplements in addition to good healthy diet rich in vitamin D.

400 IU a day is the current recemmended dose but I believe this standard is too low. You should get a blood test to see if your level is low and then we can determine what dose you need to be on according to your level.

When we talk about hormone replacement therapy, what's the first thougtht that comes to your mind? Estrogen, right? Well, if you are a male, your answer should be Testosterone! Here is a copy of an article from Medscape Family Medicine, WebMD : Advances in the Treatment of Low Testosterone As men age, their testosterone levels steadily decrease. This decline is a normal part of aging and is not a problem in itself. However, in a significant percentage of men, decline in testosterone has been found to be associated with a constellation of symptoms, including loss of libido and sexual function, decreased energy and sense of well-being, increased body fat, reduced muscle mass, osteoporosis, and loss of body hair. Recent research has found associations between low testosterone levels and a number of life-threatening chronic conditions, including cardiovascular disease, diabetes, and the metabolic syndrome. " Men can get their testosterone tested and if low, can consider replacement as well.

(IRVINE, Calif., and NEW YORK, October 15, 2008) – Allergan, Inc. (NYSE: AGN), the #1 global medical aesthetics company, and Clinique, the #1 prestige cosmetics brand in the United States, today announced the nationwide availability of CLINIQUE MEDICAL. The new skin care line is scientifically-designed and clinically-proven to complement select in-office cosmetic procedures and available only through skin care physicians’ offices.

“Clinique has always been on the cutting-edge of breakthrough science and skin care technology,” said Lynne Greene, Global President, Clinique Laboratories. “We are proud that we can meet the modern and discerning consumer’s unprecedented needs in our innovative way.  Our collaboration with Allergan puts CLINIQUE MEDICAL in an ideal position to provide best-in-class professional skin care to both physicians and consumers alike.”

“CLINIQUE MEDICAL represents the latest innovation in Allergan’s commitment as a leader in medical aesthetics to the Science of Rejuvenation™ – that is to providing medical specialists and consumers with aesthetic products backed by science that deliver on a specific need in the market,” said Robert Grant, Allergan’s Corporate Vice President and President, Allergan Medical. “Combining the strengths of both Allergan and Clinique, the products in the CLINIQUE MEDICAL line leverage innovative technologies formulated to specifically address the explicit needs of patients’ skin when undergoing some of the most popular in-office procedures so they can have an optimal experience prior to and post-treatment.”

Named one of Allure magazine’s 2008 “Beauty Breakthroughs,” the products in the CLINIQUE MEDICAL Optimizing Regimen kit work together to help improve the skin’s receptivity to the benefits of laser skin resurfacing such as Intense Pulsed Light (IPL) or fractionated laser treatments, chemical peels such as 30% Trichloroacetic Acid (TCA) peels, and microdermabrasion.[i] Products in the kit also aid in the post-procedure process by helping to manage post-procedure visible excess redness and irritation, encourage even skin tone and enhance skin’s resilience to the visible signs of aging.

The CLINIQUE MEDICAL skin care line combines carefully selected ingredients with patent-pending components such as Probiotic Technology to create beautiful formulas that help prepare, support and maintain the skin pre- and post-treatment. The CLINIQUE MEDICAL Optimizing Regimen kit includes a Probiotic Cleanser, Skin Conditioning Treatment, Recovery Week Complex, Optimizing Treatment Cream and Daily SPF 38. The products included in the kit are also available for individual purchase. In addition, the CLINIQUE MEDICAL line also includes the Dry Spot Balm, an ultra-hydrating lip and facial spot balm designed to alleviate severe dryness and the associated discomfort related to some prescription medications.

Determination of the intake required to attain serum 25(OH)D concentrations >75 nmol/L must consider the wide variability in the dose-response curve and basal 25(OH)D concentrations. Projection of the dose-response curves observed in this convenience sample onto the population of the third National Health and Nutrition Examination Survey suggests a dose of 95 microg/d (3800 IU) for those above a 25(OH)D threshold of 55 nmol/L and a dose of 125 microg/d (5000 IU) for those below that threshold.
Am J Clin Nutr. 2008 Jun;87(6):1952-8.

For one out of five unlucky souls in the U.S., there's no mistaking the red, swollen eyes, drippy nose, sore throat and angry, inflamed nasal passages. The average person battles the scourge of allergy season with a small arsenal of pills, drops and inhalers, to the tune of $120 a year. And that's merely to stifle symptoms. Worse yet, such treatments won't stop about 20 percent of cases of allergic rhinitis from progressing to full-blown asthma - a condition that, despite improvements in drug therapies, now kills twice as many people in the U.S. every year as it did in 1980.

One weapon to tame the overreacting immune system is immunotherapy - gradual delivery of the substances that trigger allergies to acclimate the body to the world around it. In children it has been proved to prevent the development of new allergies and even asthma. For adults it can reduce the sneezing and wheezing of rhinitis by 80 percent and reduce the need for medications by an impressive 88 percent. This approach, however, requires the patient to assume the role of pincushion--doses must be delivered via a large needle twice weekly for the first few months and then monthly for up to five years. That's a total of at least 100 shots. No wonder the American College of Allergy, Asthma and Immunology found immunotherapy to be seriously underused.

But immunotherapy may soon be much more patient-friendly, thanks to the renaissance of an idea that has been around since the early 1980s--placing drops of the allergen extracts under patients' tongues. Mainstream medicine has been slow to embrace the latest incarnation of sublingual-swallow immunotherapy, or SLIT, but growing evidence from various clinical trials in Europe and a recent endorsement by the World Health Organization have made the idea much more palatable.

David Morris of Allergy Associates in La Crosse, Wis., is the most vocal advocate of SLIT in the U.S. He's leading an online campaign at allergychoices.com to educate other physicians and patients about the benefits, although skeptics argue he's no Jonas Salk. When asked to explain how the delicate allergens can survive the harsh environment of the digestive tract long enough to influence the immune system--the most common criticism of oral administration--Morris sighs and says, "I don't have to explain how it works. I have 60,000 patients who've had relief with the drops."

Luckily, research has begun to validate his campaign. Of 18 double-blind, placebo-controlled clinical trials in the past 15 years, 16 confirmed the effectiveness of SLIT in reducing patients' reactivity to grass pollen, house dust mites or birch pollen. Thus far studies have found that drops were as effective as shots and, not surprisingly, were better accepted by patients and were safer--though rare, a fatal systemic reaction to the shots is possible. This trickle of scientific support has prompted Richard F. Lockey, director of the Division of Allergy and Immunology at the University of South Florida College of Medicine, to put at least one foot on the SLIT bandwagon. "I'm a very skeptical person, and if I'm starting to believe it works, there might be something to it," Lockey says.

He concurs with the latest recommendations offered in "Allergic Rhinitis and Its Impact on Asthma," a position paper published lastNovember for the World Health Organization by an international consortium of 34 allergy experts. The group cautiously backs the use of sublingual therapy, especially for people who have experienced reactions to injections orwho are not likely to comply with a regimen of shots. Immunotherapy "should be a first-line therapy," Lockey says. "We need the drops, and we need them soon."

By Brenda Goodman

You hear all the time that to lose weight, you should track what you eat. Well, a recent study published in the American Journal of Preventive Medicine shows that keeping a food journal may increase your weight loss efforts. Researchers told 1,685 overweight and obese adults to adhere to a reduced-calorie diet and asked to record their daily food intake. After 20 weeks, researchers discovered that more participants recorded what they ate, the more weight they lost. Participants who did not keep a food diary lost about 9 pounds, while those who recorded their food intake six or more days per week lost 18 pounds.
Clinical pearl is that by tracking your food, you become more accountable to what you put in your mouth and shows you exactly what you're eating so you can make better, more informed choices.

Congress failed to pass a measure to block a steep reduction in the Medicare physician payment rate before adjourning for a weeklong July 4 recess. That failure allows a 10.6 percent cut to take effect on July 1 that could end up limiting or denying care to millions of Medicare beneficiaries.

'The impact of this failure goes beyond the medical community; it threatens Medicare beneficiaries' access to health care because it further drives family physicians toward financial insolvency," said AAFP President Jim King, M.D

To illustrate the emergence of those patient access problems, King cited a March 2008 report from the Medical Group Management Association stating that nearly 24 percent of physicians in all specialties had begun limiting or not accepting new Medicare patients. That same report noted that 46 percent of physicians said they would limit or stop accepting new Medicare patients if the 10.6 percent pay cut scheduled for July 1 went into effect.

"Family physicians have worked tirelessly on behalf of Medicare patients," King said. "Despite those efforts, family physicians have struggled with 20 percent inflation in costs for office space, equipment, supplies, health and administrative staff, medical liability insurance and other costs of business since 2001.

"During that time, their Medicare compensation for their services has stagnated. No small business -- as most family physician practices are -- can sustain that kind of loss and remain open to care for people."

Controlling skyrocketing healthcare costs is  important priority-particularly for employers. To help control costs, physicians need to urge employers to increase focus on the  wellness and prevention, yet we have  not given an outline or policies promoting this agenda and the employer's expanded role.

The consensus is that while governments have been held responsible for a population's health, government alone cannot prevent the spread of chronic disease. The workplace is seen as an important focal point for successful prevention strategies, and employers are seen as being able to influence individual behavior by providing a supportive environment and leveraging to offer low-cost but effective interventions.

There is emerging evidence to the employers that have instituted wellness and prevention programs have seen a clear return on their investment in terms of improved worker productivity or reduced absenteeism. That means programs to promote screenings, smoking cessation, weight loss, and regular exercise.
 
Let us know if your workplace is interested in starting a wellness program.  We can help.

Red yeast rice is the product of yeast ( Monascus  purpureus ) grown on rice, and is served as a dietary staple in some Asian countries. It contains several compounds collectively known as monacolins, substances known to inhibit cholesterol synthesis. One of these, "monacolin K," is a potent inhibitor of HMG-CoA reductase, and is also known as mevinolin or lovastatin (Mevacor®, a drug produced by Merck & Co., Inc).

Red yeast rice extract has been sold as a natural cholesterol-lowering agent in over the counter supplements, such as CholestinTM (Pharmanex, Inc). However, there has been legal and industrial dispute as to whether red yeast rice is a drug or a dietary supplement, involving the manufacturer, the U.S. Food and Drug Administration (FDA), and the pharmaceutical industry (particularly producers of HMG-CoA reductase inhibitor prescription drugs or "statins").

The use of red yeast rice in China was first documented in the Tang Dynasty in 800 A.D. A detailed description of its manufacture is found in the ancient Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, published during the Ming Dynasty (1368-1644). In this text, red yeast rice is proposed to be a mild aid for gastric problems (indigestion, diarrhea), blood circulation, and spleen and stomach health. Red yeast rice in a dried, powdered form is called Zhi Tai. When extracted with alcohol it is called Xue Zhi Kang.

Most experts recommend that you exercise up to 90 minutes most days of the week, emphasizing that you gradually work your way up to that duration. However, a recent study conducted at Boston Sports Clubs found that participants who exercised for 20-30 minutes did so more consistently than those involved in 45-60 minute workout sessions. This study shows that you're more likely to stick to a shorter duration workout than a longer one.

If you and your family members are having trouble staying consistent with exercise, try a shorter workout session. Tell yourself that you'll exercise for 10 or 15 minutes, and follow through with it. Of course 10 minutes of exercise is better than totally skipping a workout. But, once you've hit that small goal (whether it's 5, 10, or 20 minutes), ask yourself if you could keep going. You may find that planning on a short workout is enough to get everyone to the gym (or park, trail, etc.), and once you're there, you can do a lot more than you thought.

When you're injured, ice is the best.  Remember ice is like cold water to injury.   Injury is described as inflammation.  It simply means "fire"  What do you use to put out fire?  Yes, water. If you use heat, it's like adding fuel to the fire.  In fact, icing is an basic essential treatment for most muculoskeltal related injuries, for both kids and adults. It is the key ways to reduce the inflammation that occurs when you have muscle tear, tendonitis, bursitis, sprains or strains.  And remember, always call for an appointment and have your injury checked out.  It may be more serious than you think and will need further workup. 

Levels of certain nutrients have historically been measured in the serum.  Static measurements, such as serum assays, can be transitory, reflecting an individual's nutritional status over a narrow window of time.  New technology developed by the University of Texas and offered by SpectraCell Laboratories measures the intracellular function of selected vitamins, minerals, antioxidants and other essential micronutrients within your while blood cells (lymphocytes).  Since lymphocytes carry an individuals history for a period of four to six months, these new tests can reveal an individual's nutrient status over a period of time.  The results obtained, therefore, uncover deficiencies that standard serum tests may miss.  If not corrected, such deficiencies could impair your health by contributing to the overall development and/or progression of chronic disease.  Who should have this test done?  In an ideal world, everyone!  It is highly recommended for anyone with a chronic illness, such as arthritis, cancer, heart disease, fatigue, Diabetes, Fibromyalgia, those on medications, alcohol consumers, recreational drugs users, smokers, those who have sedentary habits, those who exercise a lot, or for anyone who is concerned about their overall health.  Most insurances cover this test with a nominal co-pay at the time of testing.

Up to 50% of people who have suffered a heart attack had "normal" cholesterol levels, according to standard cholesterol tests.  Fortunately, now there is technology that was developed at Texas A&M University and offered by SpectraCell Laboratories called LPP™ (Lipoprotein Particle Profile) that will measure true risk by looking at a more accurate predictor of heart disease – the actual lipoproteins.  Cholesterol is a necessary nutrient, needed for healthy cell membranes.  It is carried throughout the body by sphere-shaped particles called lipoproteins, which are classified according to their relative size and density.  It is these lipoprotein particles, not the cholesterol in them, that cause heart disease.  This is because these lipoproteins can infiltrate the arterial lining of your blood vessels, resulting in dangerous plaque formation, also known as atherosclerosis.  There are several types of lipoproteins, and even different types of LDL and HDL and some are much more dangerous than others.  This is why standard cholesterol testing misses many patients that are at high risk for cardiovascular disease.  Most insurances cover this test for a nominal co-pay at the time of testing, so ask your doctor about doing the LPP™ test to accurately assess your risk and determine how to lower your risk of the nation's #1 killer, cardiovascular disease.