Coping With Seasonal Allergies

As a physician, I've seen a significant uptick in allergy-related complaints lately. It's that time of year again—the pollen is high, the air is thick, and many of you are battling the familiar symptoms of seasonal allergies. So, let's talk about how to manage these pesky symptoms and find some relief.

Understanding the Culprits

Seasonal allergies, also known as allergic rhinitis or hay fever, are triggered by airborne allergens like pollen from trees, grasses, and weeds. These allergens cause your immune system to overreact, releasing histamine and other chemicals that lead to those uncomfortable symptoms.

Common symptoms include:

• Sneezing
• Runny or congested nose
• Itchy eyes, nose, and throat
• Watery eyes
• Postnasal drip
• Fatigue

Practical Tips for Relief

Here's some practical advice to help you manage your allergies:

1. Monitor Pollen Counts: Stay informed about local pollen levels. Many weather apps and websites provide daily pollen forecasts. When pollen counts are high, try to limit your outdoor activities, especially during peak pollen times (usually mornings and evenings).
2. Create a Barrier:
   • Keep windows closed, especially at night.
   • Use air conditioning with a HEPA filter to trap allergens indoors.
   • Consider using a dehumidifier to reduce mold growth.
   • When you come indoors, change your clothes and shower to remove pollen.
3. Nasal Irrigation: Rinsing your nasal passages with a saline solution can help clear out allergens and mucus. You can use a neti pot or a saline nasal spray.
4. Over-the-Counter Medications:
   • Antihistamines: These medications block histamine, reducing symptoms like sneezing, itching, and runny nose. Look for second-generation antihistamines like cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra), as they are less likely to cause drowsiness.
   • Decongestants: These can help relieve nasal congestion, but they shouldn't be used for more than a few days, as they can lead to rebound congestion.
   • Nasal Corticosteroids: These nasal sprays, like fluticasone (Flonase, Veramyst) or mometasone (Nasonex), are very effective for reducing nasal inflammation. They are generally safe for long-term use, but it can take a few days to see their full effect.
   • Eye Drops: For itchy, watery eyes, over-the-counter antihistamine or lubricating eye drops can provide relief.
5. Consider Allergy Immunotherapy (Allergy Shots): If your allergies are severe and significantly impact your quality of life, talk to your doctor about allergy immunotherapy. This involves gradually exposing you to small amounts of allergens to desensitize your immune system.
6. Maintain a Clean Environment: Regularly clean your home to reduce dust and mold, which can exacerbate allergies.
7. Hydration and Diet: Staying well-hydrated can help thin mucus. A healthy diet rich in fruits and vegetables can support your immune system.

When to See a Doctor

While over-the-counter medications can be helpful, it's essential to see a doctor if:

• Your symptoms are severe or persistent.
• Over-the-counter medications aren't providing relief.
• You have asthma or other respiratory conditions that are worsened by allergies.
• You have concerns about possible side effects from medications.
• You are experiencing sinus infections or other complications.

A Caring Approach

Remember, you're not alone in this. Allergy season can be tough, but with the right strategies, you can manage your symptoms and enjoy the outdoors again. Don't hesitate to reach out to your healthcare provider for personalized advice and treatment options.

Coping With Stress During The Corona Virus Pandemic

With the corona virus pandemic, most of us have some degree of stress. This is a normal human response and we should learn to recognize its manifestations.  Stress has behavioral, physical, emotional, and cognitive aspects.  Below is a partial list you might recognize in yourself and others.

Behavioral

• Poor appetite or over-eating
• Excessive use of alcohol or smoking
• Irritability 
• Poor ability to concentration
• Blaming others
• Self-isolation
• Risk taking

Physical

• Headaches
• Stomach aches
• Shakiness or tremors
• Heart palpitations
• Feeling jumpy or easily startled
• Bowel problems
• Feeling nauseated
• Insomnia

Emotions

• Elevated anxiety or fearfulness
• Sadness or depression
• Anger/rage
• Guilt
• Euphoria

Thinking

• Confusion
• Poor memory
• Poor concentration
• Problems deciding what you should do
• Denial that anything bad is happening

Some Ways To Relieve Stress

Most of us have dealt with stress before.  We have learned tactics and techniques that have worked.  Your knowledge and experience can help in the present situation.  

Getting enough sleep, eating a healthy diet, taking breaks from the news media, and doing something relaxing can help. Activities such as reading a book, stretching, yoga, listening to music, walking or other exercise, meditation, and even taking a bath can all reduce stress.

You should stay informed with reliable sources of information like the Centers for Disease Control and Prevention or the World Health Organization.

Stay connected to friends and relatives by calling or using other social media.  It helps to share your feelings.

Recognize when normal stress becomes exaggerated to the point you are having difficulty functioning.  You should be open to asking for help.  Contact your  primary care provider or mental health services in your community.  If you feel suicidal, call 911 or your local mental health hotline.

Contact CDC.gov for more information on the pandemic.  Stay Safe, Stay Home!

Garcinia Cambogia for Weight Loss

Garcinia cambogia is a fruit that grows in Southeast Asia.  It has become popular in the U.S. for its reported weight loss properties.  The active ingredient is called hydroxycitric acid (HCA) found in the peel of this fruit.  It has been found to inhibit an enzyme called citrate lyase and cause interference with fatty acid metabolism and theoretically resulting in less fat accumulation in the body.

Several studies have shown this to be true in laboratory animals.  However, studies in humans using an experimental group that received the real substance and a control group receiving a placebo or inactive substance showed no significant difference in weight loss between the groups.

Conclusions so far are that garcinia cambogia is not an effective weight loss remedy.

A healthy weight loss program continues to be a reduced calorie diet, exercise and healthy changes in eating habits.  As always, you should consult your health care provider before engaging in diets or taking any supplements.

Vitamin D Supplementation

Vitamin D is a fat-soluble vitamin.  It is called the sunshine vitamin because it is made in the body when ultraviolet rays from the sun strike the skin and trigger the synthesis of vitamin D3.  Plants synthesize vitamin D2.  Both forms of the vitamin must be converted in the liver and kidneys to the active form, 1,25-dihydroxyvitamin D to be used in the body.

The main function of vitamin D is to facilitate the body’s absorption of calcium, a major ingredient in bone formation.  A shortage of vitamin D leads to weak, brittle bones in both children and adults; resulting in diseases known as rickets in children and osteomalacia in adults.

Promising uses of vitamin D have been noted in recent research involving reduction of heart attacks.  In one study, men deficient in vitamin D were twice as likely to have a heart attack as men who had adequate levels.

Studies have indicated that vitamin D status in the body can affect cancer risk.  It appears to play a role in the prevention of colon, prostate, and breast cancer. 

Vitamin D levels are lower in the fall and winter months, a time when colds and flu are more prevalent. Observational studies have shown that people with low vitamin D levels are more likely to get these infections or have had a cold or flu in the recent past.

Studies are mixed regarding whether vitamin D helps reduce weight.  A recent study with laboratory rats showed that rats given vitamin D directly to the brain had large decreases in food intake and weight when compared to rats not given the vitamin.

Recommended daily average vitamin D intake recommended by the Food and Nutrition Board is the following :

•       Birth to 12 months - 400 IU
•       1 to 13 years - 600 IU
•       14 to 18 years - 600 IU
•       19 to 70 years - 600 IU
•       71 years and older - 800 IU
•       Pregnant and nursing women - 600 IU

Optimal vitamin D intake is reported to be much higher, with 1,000 to 2.000 IU for adults.  There is a growing consensus that vitamin D intake should be at these higher levels with the widespread prevalence of vitamin D deficiency. 

Safe upper limits of vitamin D intake are reported to be 1,000 – 1,500 IU per day for infants, 2,500 – 3,000 IU for children 1- 8 years, and 4,000 IU for children 9  and older, adults, pregnant and breastfeeding women.

Taking too much vitamin D can cause weight loss, increased urination and abnormal heart rhythms.  It can also raise blood levels of calcium which can cause deposits in tissue and blood vessels and thus damage the heart, blood vessels, and organs.  Increased kidney stone occurrence has been reported.   

Getting too much vitamin D from food is highly unlikely.  Excessive sun exposure will not over produce vitamin D since the heated skin is thought to degrade previtamin D3 and vitamin D3 as it is formed.

Before taking vitamin D supplements, you should consult with your healthcare provider to determine if you require them and how to take them safely.

Nightime Leg Cramps

Nighttime leg cramping is a common ailment especially in people over the age of 50.  As many as half report cramps at least three times per week, and 5-10 percent have them nightly.  Cramping usually occurs suddenly in the calf muscle resulting in significant pain and sleep disturbance.  Cramps can last from a few seconds to more than fifteen minutes. 

The cause of leg cramps is mostly unknown, although imbalances in electrolytes like sodium, calcium, magnesium and potassium have been implicated.  Circulation problems, dehydration, sedentary lifestyle and certain medications like diuretics (water pills), angiotensin receptor blockers (blood pressure medication), benzodiazepines (anxiety medication), statins (for high cholesterol), certain cancer treatment drugs and oral contraceptives also may cause leg cramps. Diseases associated with nighttime leg cramping include diabetes, hypothyroidism, hypoglycemia, alcoholism, muscle disorders, Parkinson's disease and other neurologic disorders. 

Leg cramps can often be relieved by flexing the toes upward to stretch the calf muscle or by getting up and walking around.  Gentle massage of the tensed muscle and warm compresses can be helpful.  In one study, passively stretching the calf muscles three times a day for several days successfully prevented cramps.  Subjects stood three feet from a wall, leaning against it with arms outstretched and gently tilting forward with the heels kept firmly in contact with the floor until a non-painful stretch was felt in the calves.  This position was held for 10 seconds and repeated after five second intervals for 3-4 repetitions.

Staying well hydrated and exercising regularly is recommended not only to prevent cramps, but to help maintain overall health. 

Medications may be used when cramps are persistent and severe.  Quinine was commonly used in the past with varying degrees of success but has been discontinued more recently due to potential side effects involving blood and heart problems.  Muscle relaxers, antihistamines, calcium channel blockers, and anti-seizure medications are other common treatments.

Persistent, painful leg cramping should be evaluated by your health care provider to determine if a disease process is involved and to develop a treatment plan specifically for you.

Poison Ivy and Other Poison Plant Rashes

With spring and summer, you may come in contact with plants such as poison ivy, poison oak and poison sumac.  With contact, most people will develop an itchy red rash accompanied by blistering of varying degrees. 


Poison ivy is common in most areas of the U.S. with the exception of Hawaii and part of Alaska.  It appears in clusters of three leaves with red stems and often grows like a vine, climbing up trees.  Leaves range from light green to dark green and turn bright red in the fall.  Leaflets have a few to no teeth along the edge.

Poison oak is seen west of the Rockies and in the Southeast.  Its leaves are divided into three leaflets with scalloped, toothed, or lobed edges.  They can resemble the lobed leaves of a true oak.  Leaves are generally bronze when they first appear, but turn bright green in the spring, yellow-green to reddish in the summer and bright red or pink from late July to October.

 Poison sumac is seen in the Northeast, Midwest and parts of the Southeast.  It grows as a shrub or small tree in moist areas and has stems with 7-13 smooth-edged leaves in pairs.  The leaves are orange in spring, green in summer, and yellow, orange, or red in fall.

Poison plant rashes cannot be spread to others by fluid from blisters or skin to skin contact.   The plant oil can stick to clothing, tools and pets and cause a rash with contact.  Plant oil can last up to five years on inanimate objects.  Oil should be removed from your skin as soon as possible with soap and water.  Removal from objects can also be accomplished with soap and water or rubbing alcohol.

The rash can appear to be spreading to other parts of the body since it is absorbed at different rates.   Spreading can occur by scratching with oil trapped underneath fingernails.

Apply over-the-counter corticosteroid creams to ease the rash and itching.  Calamine lotion, wet compresses, soaking in cool water, and oral antihistamines can offer additional relief.  Avoid hot showers or baths.

See your doctor if the rash is extensive, pus or tenderness is present, the rash spreads to your eyes, mouth, or genital area or if it does not resolve in a few weeks.

Prevention is by avoidance and wearing long sleeves, pants and gloves when exposure is likely.  Wash exposed clothing separately in hot water and detergent.  Skin barriers such as lotion containing bentoquatum can be protective if applied before exposure.  Do not burn poison plants since the plant oil can attach to smoke particles and be inhaled causing serious respiratory problems. 

Creatine Supplement - Uses and Precautions

Creatine is a popular supplement often used by athletes to improve muscular performance.   It is classified as a nitrogenous organic acid that is naturally produced in the body primarily by the kidneys and liver.  It can also be consumed in the diet since it is present in meat and fish.  Creatine is produced as a food supplement in powder form or capsules.  More that 4 million kilograms are used by Americans each year.

Athletes and body builders use creatine supplementation to increase muscle mass and muscle performance in anaerobic type activities.  This would include brief, high-intensity exercise such as sprinting.  Data suggests that creatine may benefit athletes such as hockey players, football players, rowers, squash players, and wrestlers.  Creatine does not seem to improve performance in aerobic exercises.  It also has not been found to improve performance or body composition in people over 60.

Creatine has been used to treat health problems such as Parkinson's disease, muscular wasting, depression, bipolar disorder, high cholesterol, vision problems and ALS (amyotrophic lateral sclerosis or Lou Gehrig's disease).  Efficacy in these areas is variable.

Creatine is considered safe when used in recommended doses.  It can cause stomach pain, nausea, diarrhea and cramping in some people.  If taken in high doses, there is concern that it could cause kidney, liver and heart problems, but this has not been confirmed.  People with kidney disease, diabetes, pregnancy or breast feeding should not use creatine.  Combining creatine with caffeine and ephedra could cause serious side effects.  There is a report of a stroke in an athlete who used this combination for a number of weeks.

If you choose to use creatine, consult your doctor first to ensure your safety.

Healthy Snacks To Help You Avoid Weight Gain

American's continue to struggle with over-weight and obesity problems.  This has become a major health problem for both adults and children.  A big part of the problem is that we eat unhealthy snacks in addition to over eating at  meals.  Calories we do not burn off are stored by our bodies as fat.

The National Institutes of Health (NIH) has developed a list of healthy snacks.  Fruits and vegetables are among these choices.  They are full of vitamins and low in calories and fat. Some crackers and cheeses also make good snacks.
More examples of healthy snacks are:

• Apples (dried or cut into wedges)
• Bananas
• Raisins
• Fruit leather (dried fruit puree)
• Carrots (regular carrots cut into strips, or baby carrots )
• Snap peas (the pods are edible)
• Nuts (but not too many)
• Dry cereal (if sugar is not listed as one of the first 2 ingredients)
• Pretzels
• String cheese
• 1/3 cup of grape nuts with 4 ounces of nonfat plain vanilla yogurt
• 8 ounce low-fat or nonfat yogurt
• Toasted English muffin with jelly
• Dozen baked potato chips
• Air popped popcorn
• 1/2 cup cherry or grape tomatoes
• 1/4 cup hummus, 3 carrot sticks

Put your snacks in single portion sized containers to keep from over-eating and so you can transport them to places like work.  Bringing your own snacks will help you avoid the always present cakes, pies, cookies, donuts and candy you find in most break rooms.

It is OK to have something not so healthy on occasion to avoid the "forbidden fruit" problem, but planning ahead and preparing and eating healthy snacks is the way to go to help maintain a healthy weight.

Holiday Depression, Frustration and Anxiety

The holidays are times of pleasure and joy but can also be times of sadness, anxiety, loneliness and depression for some individuals.  There are a number of suggestions that have been offered by mental health professionals that may help you avoid or reduce negative feelings.

Here is a list that may be helpful:

• If you are lonely, make an effort to help others such as volunteering at a food bank or facility that feeds those less fortunate.  Go to a nursing home and visit with someone who may also be lonely. When you help others your thoughts are off yourself and you will feel better. Get together with your friends, your club or your church group.  If you look around you are not really alone.

• Budget your time and money so you do not over-commit.  We often say yes to too many parties and over-spend on gifts.  This can lead to frustration and anxiety.

• When you are with family and have unresolved issues, offer to deal with conflicts at another time when it is more appropriate.  Remember that it takes two to have an argument.

• Be sure to not neglect your regular exercise routine.  Taking time out for exercise helps relieve stress and improve mood.

• Get enough sleep even though it may be tempting to stay up all night to wrap gifts or prepare food.

• Ask for help when shopping, decorating, preparing meals and cleanup.  You should not have to do everything yourself.

• Do not over indulge in food or drink, but don't feel guilty when you eat that dessert.  What you eat the rest of the year is what really matters.  Eat a nutritious snack before you go to the party.  This will help you avoid eating too many sweets and other less healthy foods.

• If your feelings of depression or anxiety get to be overwhelming, don't hesitate to seek out help.  Ask your family doctor or other health care provider for guidance, or call your local Mental Health Association for information.  These problems have beneficial treatments, you don't have to suffer.

What To Do If You Get the Flu

Flu (influenza) is a respiratory tract infection caused by viral influenza A or B.  Flu is a seasonal infection that occurs mostly during the winter months.  The virus is transmitted in water droplets that are expelled into the air when someone who has the flu coughs, sneezes or even talks.  Breathing in these droplets can then give you the flu.

Symptoms may include a runny nose, fever, cough, headache and muscle aches.  Symptoms of the flu can be similar to other viral infections, but are usually more severe.

Anti-viral medications are available from your health care provider and have best results if given within two days of symptom onset.  These medications can shorten the course of the infection by 1 or 2 days. Even without anti-viral medication flu is usually self limited in the general population to one week.  Cough and fatigue may last a bit longer.

Treatment at home should include over-the-counter medication for fever and aches such as acetaminophen or ibuprofen, extra fluid intake to avoid dehydration and lots of rest.

Complications can occur with the flu, including ear and sinus infections.  Viral and bacterial pneumonia can also occur.  These complications will require treatment with antibiotics or anti-virals.  Hospitalization may be required in more severe cases.

The best prevention for seasonal flu is a flu shot, but remember, it takes up to two weeks for immunity to develop after the shot.

If you have any questions about your symptoms or your symptoms are severe, see you health care provider.

Probiotics - Are They Helpful?

Probiotics are bacteria that are the same or similar to bacteria that live naturally in the body and considered beneficial.  There are many probiotics on the market in the form of supplements or in yogurt.  These products often claim to offer health benefits.  However, the Food and Drug Administration has not approved probiotics for the treatment of any disease or condition.

There has been some evidence that probiotics can be safe and effective in preventing Clostridium difficile      ( C. diff. ) related diarrhea in children and adults taking antibiotics.

Pregnant and nursing women who take probiotics have been found to have babies that are less likely to develop eczema, a skin ailment, during the first years of life.

There are conflicting results in the research regarding the cholesterol lowering effects of probiotics, indicating that more research is needed.

Whether you should take probiotics is still largely a question to be answered with further research.  Many of the claimed benefits are yet to be fully proven.

Should You Get a Flu Shot?

The CDC (Centers for Disease Control and Prevention) recommends that everyone 6 months and older get vaccinated for the flu.  Flu viruses tend to change each year and thus you need the new vaccine developed to prevent the current year's strain.  October is a good time of year to get your vaccination, but as late as March will still provide some benefit.

The flu vaccines are either dead virus particles or weakened viruses and thus cannot give you the flu.  They do stimulate your immune system to develop antibodies against the actual flu virus.  It takes about two weeks after immunization for you to be fully protected.

Side effects from the flu shot can be a sore arm from the injection and occasionally short-term low grade fever and body aches.  The nasal spray flu vaccine may cause congestion, runny nose, sore throat and cough.

Ask your doctor what form of flu vaccination is best for you. 

Thousands of people die from the flu and its effects each year in the U.S..  Taking advantage of the protection of flu vaccination is a healthy choice for most people.

Diabetics and Fast Foods - Is This a Good Combo?

The American Diabetic Association (www.diabetes.org) has listed a number of tips for eating at fast food restaurants.  These tips are for diabetics, but everyone should follow them to stay healthy and still enjoy the experience of eating out.

The following tips are from the ADA website:

• Know that an average fast-food meal can run as high as 1000 calories or more, and raise your blood sugar above your target range.
• Know the nutritional value of the foods you order. Although there are some good choices, most fast-food items are high in fat and calories.
• If you're having fast-food for one meal, let your other meals that day contain healthier foods, like fruits and vegetables.
• Think about how your food will be cooked. Chicken and fish can be good choices - but not if they are breaded and deep fried.

If breakfast is your fast-food meal, choose a plain bagel, toast, or English muffin. Other muffins may be loaded with sugar and fat. Add fruit juice or low-fat or fat-free milk. Order cold cereal with fat-free milk, pancakes without butter, or plain scrambled eggs. Limit bacon and sausage because they are high in fat.

The fast food we eat may stick around a lot longer than we'd like. It may linger in our bodies as excess blood fats and extra pounds.

• Watch out for words like jumbo, giant, deluxe, biggie-sized or super-sized. Larger portions mean more calories. They also mean more fat, cholesterol and salt. Order a regular or junior-sized sandwich instead.
• Choose grilled or broiled sandwiches with meats such as lean roast beef, turkey or chicken breast, or lean ham. Order items plain, without toppings, rich sauces, or mayonnaise. Add flavor with mustard, and crunch with lettuce, tomato, and onion.
• Skip the croissant or biscuit. Eat your sandwich on a bun, bread or English muffin and save calories and fat.
• Stay away from double burgers or "super" hot dogs with cheese, chili, or sauces. Cheese carries an extra 100 calories per ounce, as well as added fat and sodium.
• Go for the salad bar, but watch out for high-fat toppings like dressings, bacon bits, cheeses, and croutons. Even too much low-calorie dressing can add up. Check the calories on the packet. Also limit salad bar items that are dressed with a lot of mayo, such as potato or macaroni salad. Fill your salad with things like carrots, peppers, onion, celery, broccoli, cauliflower, spinach, and etc.
• Order bean burritos, soft tacos, fajitas, and other non-fried items when eating Mexican fast foods. Choose chicken over beef. Limit refried beans. Or ask if they have beans that aren't refried. Pile on extra lettuce, tomatoes, and salsa. Go easy on cheese, sour cream, and guacamole. Watch out for deep-fried taco salad shells - a taco salad can have more than 1,000 calories!
• Pizza can be a good fast food choice. Go for thin crust pizza with vegetable toppings. Limit to 1-2 slices. Meat and extra cheese add calories, fat and sodium.
• End your meal with sugar-free, fat-free frozen yogurt or a small cone of fat-free yogurt. Better still, bring a piece of fresh fruit from home. Ices, sorbets, and sherbets have less fat and fewer calories than ice cream. But they are chock full of sugar. They can send your blood sugar too high if you don't work the extra carbohydrate into your meal plan.
• Be alert for traps. Fat-free muffins for breakfast may have plenty of sugar. Skinless fried chicken can have almost as much fat as the regular kind. Chinese food may seem like a healthy choice, but many dishes are deep fried or high in fat and sodium, especially in the sauces. 

It is always a challenge for diabetics to decide what to eat in order to keep good control of blood glucose levels.  The key is to always think before you eat so you don't consume food impulsively and then regret it later. 

Caffeine Consumption May Reduce Type II Diabetes In Postmenopausal Women

A study published in the January, 2011 issue of Diabetes indicates that postmenopausal women who drink caffeinated coffee may have a reduced risk of type II diabetes.  The study looked at women who drank at least 4 cups of caffeinated coffee per day compare to non-drinkers of caffeinated coffee.  The drinkers level of sex hormone-binding globulin (SHBG) was higher and this is what is believed to reduce the occurrence of diabetes.  Decaffeinated coffee and tea had no association with SHBG.  This being noted, there may be risks for drinking caffeinated coffee for some people such a heart rate problems and other side effects from too much caffeine.

ADHD

The CDC has published a survey that indicates between 2003 and 2007, the number of kids between four and 17 with ADHD (attention deficit hyperactivity disorder) jumped by one million, a 22% increase.  It is not clear what has caused this rise, but more awareness of this disease and more screening may account for part of the increase.  There is some concern kids may be lumped into this category due to inaccurate diagnosis because they have ADHD-related behaviors.  Factors including lead exposure, low birth weight, and premature birth have all been shown to contribute to ADHD symptoms.

Ginkgo Biloba - Beneficial or Not

Ginkgo biloba is from an ornamental tree originating in China thousands of years ago. The ginkgo is the world's oldest living tree species. Ginkgo is available as ginkgo leaf, ginkgo leaf extract, and ginkgo seed. Ginkgo leaf extract is the most commonly used form.

Uses

There has been a large amount of research on the use and benefits of ginkgo. Most of the studies have been poorly designed, yielding questionable results. More well designed studies are needed in order to make valid recommendations regarding use and benefits.
Ginkgo extract is reported to aid in mental functioning and relieve muscle pain. It may have blood pressure lowering ability, inhibit blood clotting, and have anti-aging properties.
There is some amount of evidence that ginkgo may be helpful with the following conditions:

• Intermittent claudicaton
• Alzheimer's/multi-infarct dementia
• Cerebral insufficiency ( characterized by impaired concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression and anxiety)

There is indefinite but early evidence indicating gingko is beneficial for the following conditions:

• Memory enhancement in healthy people
• Altitude (mountain) sickness
• Symptoms of premenstrual syndrome (PMS)
• Reduction of chemotherapy induced end-organ vascular damage.
• Tinnitus (ringing in the ears) - use is controversial and a recent large trial showed evidence that it is not helpful

Precautions

Ginkgo is usually well tolerated but may increase bleeding and should be used cautiously by persons with known blood clotting problems or receiving blood thinners.
Ginkgo seeds are toxic and can cause seizures and loss of consciousness. They should not be consumed.
Insulin and blood sugar levels can theoretically be affected by ginkgo. Diabetics should be closedly monitored if taking ginkgo.
Consumption of ginkgo is not recommended in pregnancy or during breast feeding.

Side Effects

The use of ginkgo has produced rare side effects including:

• Headache
• Dizziness
• Stomach upset
• Nausea
• Diarrhea
• Vomiting
• Muscle weakness
• Loss of muscle tone
• Restlessness
• Heart racing
• Rash
• Irritation around mouth

Dosing

Adult dose is generally 80 to 240 mg of a 50:1 standardized leaf extract taken daily by mouth in two to three divided doses. Ginkgo is not recommended for children. This herb has been taken safely by adults at recommended doses for up to six months.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no assurance that the product you purchase is pure and of a specific concentration. There may also be contaminants present that could have harmful effects. These substances can interact with your current medications and with other supplements you may already be taking. Before taking any herb or supplement, you should tell your health care provider to receive appropriate advice.

Resources

National Center for Complementary and Alternative Medicine

Tick Bites and Lyme Disease

Tick bites are more common in the late spring and summer months.  Lyme disease is a tick-transmitted disease caused by a bacterium, Borrelia burgdorferi.  This organism is carried by the deer tick and the white-footed mouse is the primary animal reservoir for Borrelia burgdorferi and the preferred host for nymphal and larval forms of the deer tick.  Deer are hosts for adult ticks but do not carry Borrelia.

Lyme disease has been reported in 49 states, but most cases occur from Massachusetts to Maryland, in Wisconsin and Minnesota, and in California and Oregon.

Deer tick nymphs attack humans and are very small and hard to see.  Infection does not usually occur until the tick has been in place for more than 36 hours.  Looking for and removing ticks quickly can prevent development of Lyme disease. 

The proper technique for tick removal includes the following:

• Use tweezers to grasp the tick as close to the skin surface as possible.
• Pull backwards gently but firmly without jerking or twisting.
• Do not squeeze, crush, or puncture the body of the tick.
• After removing the tick, wash the skin and hands thoroughly with soap and water.
• If any mouth parts of the tick remain in the skin, these should be left alone; they will be expelled on their own. 

Ticks that transmit Lyme disease are usually brown and about the size of a poppy seed (nymphs).  Larger ticks that are brown with a white collar are usually dog ticks and do not transmit the disease.

Even a deer tick must first take a blood meal which takes 36 to 48 hours and transmit the organism that causes Lyme disease.  That is why early removal of the tick before it is engorged with blood will help prevent the disease.

Lyme disease usually manifests on the skin with a red area at the bite site.  The area expands, often with central clearing.  If untreated, other smaller areas develop on the skin over time.  Flu-like symptoms then develop with malaise, fatigue, chills, fever, headache, muscle aches and joint pain.  These and other symptoms may continue for weeks.  Neurologic symptoms may develop in some patients including numbness and sensory changes.  A small number of patients will develop cardiac symptoms such as heart block, decreased cardiac output and inflamed heart muscle with chest pain.

Untreated Lyme disease will develop late stage symptoms months or years after the initial infection.  This can include arthritis with joint pain and swelling.  Mood changes, sleep disturbance and memory problems are also late stage manifestations.

Lyme disease is treated with antibiotics.  Patients that have been bitten by a suspect tick but with no clinical manifestations are often treated with a single dose of doxycycline.  Patients with symptoms of disease are treated with doxycycline for 14 to 21 days.  Other antibiotics are also used depending on the situation.

There is currently no vaccine available to prevent this disease, so careful monitoring for tick bites is the best prevention.

Cold Cereal For Breakfast May Not Be Bad

A recent study comparing children who skipped breakfast with those who eat cold cereal and those who eat "other breakfasts" indicates that the cereal eaters have healthier diets.

It was found that breakfast skippers tended to eat more snack foods during the day with higher calorie content. They ended up with larger waists and higher BMIs (body mass index) than their cereal eating counterparts. Twenty-two percent of breakfast skippers were overweight compared to just under 20% of the "other breakfast" eaters and 15% of the cereal eaters.

Kids who ate ready-to-eat cereals had more favorable nutrient intake profiles and healthier weights that either the breakfast skippers or kids who ate "other breakfasts."

Researchers found that 20% of children between the ages of 9 and 13 and nearly a third of kids from 14 to 18 were skipping breakfast.

So the bottom line appears to be, don't worry about your children eating cold cereal for breakfast. Eating cereal appears to be healthier than not eating breakfast or eating other types of breakfast food.

Topical Anti-Inflammatory Medications May Be Safe

A recent report indicates that topical non-steroidal anti-inflammatory drugs (NSAISs) may be safe and effective for acute musculoskeletal conditions in adults.

The use of topical NSAIDs is attractive because there is found to be no GI side effects from using these medications compared to taking the same medications by mouth.

The goal of the study was to evaluate the evidence from randomized double blind, controlled trials of the efficacy and safety of topically applied NSAIDs for relief of acute pain. There were very few systemic adverse events or adverse events causing study withdrawals, and local skin reactions were usually mild, self-limited, and not different from those seen with placebo.

It has been concluded that topical NSAIDs can provide good levels of pain relief without the systemic adverse events associated with oral NSAIDs when used to treat acute musculoskeletal conditions.

Topical NSAIDs can provide good levels of pain relief in acute conditions such as sprains, strains and overuse injuries, probably similar to that provided by oral NSAIDs. Topical NSAIDs are not associated with an increased incidence of local skin reactions compared with placebo, and do not cause systemic(gastrointestinal problems) problems seen with oral NSAIDs. This makes them particularly useful for individuals unable to tolerate taking these medications by mouth.

Stress Relief

Stress is defined as a state of mental or emotional strain. Everyone experiences stress to some degree and depends on individual perception.

Stress has been termed the "fight or flight" response to perceived danger. This occurs when you must defend yourself from real danger by either standing your ground and fighting or running away to a safer place. The body's physical response includes releasing a surge of hormones such as adrenaline and cortisol that cause increased glucose to the blood, elevated heart rate and blood pressure and heightened alertness by increasing the brain's use of glucose.

When sources of stress become constant and more difficult to deal with, the "fight or flight" response continues on with no let up. The constant heightened level of bodily response then begins to show negative symptoms that indicate harm to overall health and emotional well being.

Stress can occur due to physical trauma such as an accident or surgery, but also due to psychological factors such as relationship problems, pressure of school, job, or social situations like speaking before a group or meeting new people.

Harmful effects of stress can include increased blood pressure, headaches, stomach ache, muscle aches, sleep problems, diarrhea, constipation, fatigue, appetite problems, weight problems, sexual problems, increased susceptibility to infections, and others.

Emotional effects can include depression, anxiety, irritability, panic attacks, feelings of helplessness, confusion, forgetfulness, guilt, mood swings and insecurity.

Social effects of stress can include job dissatisfaction, decreased productivity, marital problems, social isolation, resentment of others, angry outbursts, loss of friends.

Managing stress includes many aspects. Learning what is stressful to you and talking control is important. Developing a realistic work schedule, managing time more effectively, taking time out to relax, saying "no" when necessary, prioritizing time, delegating tasks and standing up for your rights will lessen stress.

Learning how to relax by using relaxation training techniques and meditation can be very helpful. A regular schedule of exercise like walking, swimming, or biking is often recommended along with a balanced diet.

Connecting with friends and family, talking with a counselor or therapist is often recommended. Medications are available that can reduce symptoms of stress, so discussing problems with your primary care doctor can be helpful.

Community mental health centers, the YMCA and other community organizations offer stress management programs.