There are so many things to love about the holiday season: the decorations, the gaily wrapped gifts, the songs, the traditions, the parties. Along with the parties, however, comes a binge of indulgence in sweets. There’s nothing wrong with the occasional treat, but we do tend to overdo it at this time of year.
Those who are struggling to lose weight sometimes joke that they envy those who can drop pounds without even trying. But unintentional weight loss, especially in older people, can be a sign of a serious problem. Your concierge family practice doctors at MD 2.0 in Jupiter, Florida, would like to examine the phenomenon and suggest what you can do about it.
If you have a painful throbbing in your head, you may be very uncomfortable but think it couldn’t be a migraine because it’s not debilitating. Or you don’t have the shimmering lights in your vision or nausea and vomiting that you’ve heard usually accompanies a migraine.
Regardless, you could still be suffering from a migraine and not know it. Or you could have an ordinary headache with several of the symptoms of a migraine. The symptoms of headaches and migraines can vary so much from person to person that it can sometimes be difficult even for doctors to tell the difference.
So why does it matter, then? Can’t you just pop a couple aspirin, slap on an ice pack and say you’ve got a painful headache? No, because the treatments are different for each, and sometimes a headache is more than that. That’s why your concierge doctors at MD 2.0 in Jupiter, Florida, want to explore the different types of headache, including migraine, and help you decide when to get seek medical attention.
A migraine is not technically a headache, but a neurological disorder that includes a constellation of symptoms, with a painful, long-lasting headache at the center. Its main symptom is a severe throbbing pain or pulsing sensation in the head, which feels like a very bad headache, usually on one side of the head, but in a third of migraine attacks, both sides are affected. It is often—but not always—preceded by what is known as an “aura,” strange tricks of vision that can encompass anything from a blind spot in the vision to flashing or shimmering lights to wavy or zigzagging lines. Migraines are also usually, but not always, associated with such symptoms as nausea, vomiting, and extreme sensitivity to lights and noises, and can also include a pins-and-needles sensation in the arms and legs or a weakness or numbness on one side of the face or body.
One or two days before the onset of a migraine, patients often experience subtle body signals (called “prodrome”) that can alert them to an upcoming migraine. These changes can include neck stiffness, constipation, increased thirst and urination, food cravings, frequent yawning, and mood swings from depression to euphoria. To complicate the issue even further, it’s possible to have many of the migraine symptoms, especially the aura, without the headache. The primary signature of a migraine, however, is the extreme incapacitation associated with the headache pain involved.
Other headache types
Just because a headache isn’t officially classified as a migraine doesn’t mean it can’t be painful or even somewhat debilitating. And there are several types:
• Tension headache, the most common, is usually felt around the head and scalp and the back of the head or neck. Often called “stress” headaches, they are further divided into episodic and chronic, depending on how often they occur, and can be uncomfortable but don’t normally restrict regular activities.
• Cluster headaches, most often experienced by men, are called that because they tend to occur in clusters or groups, sometimes several in a day over a period of weeks or months, then they disappear, often for years. Because they can be quite painful and occur on one side of the head, they are sometimes difficult to distinguish from migraines.
• Sinus headaches are frequently misdiagnosed, but in general, they must be accompanied by nasal congestion, watery eyes, and fever, due to the infection in the sinuses that causes them.
There are a number of other types of headaches, categorized by their causes, such as menstrual headaches, ice cream headaches, and caffeine headaches, among others. The most serious (i.e. dangerous) is the so-called “thunderclap” headache which occurs suddenly like a clap of thunder and causes extreme pain. This is a medical emergency that must be investigated immediately.
For common headaches, many people find relief with over-the-counter (OTC) pain medications, ice packs, and rest. Others swear by less conventional treatments such as caffeine, ginger, hot showers, acupuncture, or even massaging the temples with lavender or peppermint oil. It’s helpful to determine the cause of frequent headaches, so keeping a diary of symptoms can help pinpoint triggers.
Because symptoms and treatments of the different headache types overlap, if these typical home remedies don’t work, it’s best that you come and see us for an evaluation. There are numerous new prescription drugs available to treat migraines, as well as other more stubborn headaches.
Sometimes a headache isn’t “just a headache,” so if your headaches are debilitating, let us know. We can help.
The flu killed 80,000 Americans last year and was responsible for the hospitalization of another 960,000. Then there are those whose symptoms didn’t reach such drastic levels, but who spent many miserable days suffering the effects.
So our concierge family practice doctors in Jupiter, FL, at MD 2.0, were pleased to note that last month the U.S. Food and Drug Administration (FDA) for the first time in 20 years approved a new drug designed to help alleviate the symptoms of the flu. Xofluza (baloxavir marboxil) is a single-dose oral prescription drug intended for patients 12 years of age and older who have been experiencing symptoms for no more than 48 hours.
The difference in Xofluza
Just in time for flu season, Xofluza joins other antiviral treatments currently available, including Tamiflu and Relenza. The difference between Xofluza and other antiviral drugs is in the way it’s administered. It is the only antiviral that can be taken as a single dose to be effective. Others must be taken over several days or inhaled as a powder. While Xofluza did not work any better in clinical trials than its competitors already on the market, it’s the convenience of the single oral dose that sets it apart. The most common reported side effects of Xofluza were diarrhea and bronchitis.
“With thousands of people getting the flu every year, and many people becoming seriously ill, having safe and effective treatment alternatives is critical,” FDA Commissioner Scott Gottlieb, M.D., said in a statement. “This novel drug provides an important, additional treatment option.” Xofluza was expected to be available “within the next several weeks.”
“Xofluza is unique in that it acts to inhibit replication of the flu virus in the first place, at a step much earlier than the current medications available . . . which only block release of virus that has already been produced from a host cell,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City told CBS News.
Dr. Debra Birnkrant, director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research, hailed the addition of Xofluza to the arsenal of weapons against the flu.
“Having more treatment options that work in different ways to attack the virus is important because flu viruses can become resistant to antiviral drugs,” she said on the FDA’s website.
You still need a flu shot
While the antiviral medications, including Xofluza, can reduce symptoms and help them recede faster than a placebo, they are not an instant curative. Nor do they prevent the flu or prevent you passing it on to others. If you contract the flu, you will still have to endure several days of misery, and you will still be contagious while exhibiting symptoms. So it’s best not to catch it all all.
“[S]easonal flu vaccine is one of the most effective and safest ways to protect yourself, your family, and your community from the flu and serious flu-related complications,” Gottlieb said. “Yearly vaccination is the primary means of preventing and controlling flu outbreaks.”
We concur. Last month the Centers for Disease Control and Prevention (CDC) released a report showing that less than 40 percent of adults in the U.S. received flu shots last winter, the lowest rate in seven years and probably one reason that last season’s flu outbreak was the deadliest since the 1970s. Of the 183 children who died last year, 80 percent had not been vaccinated.
You can help boost your immunity by exercising, eating healthfully, washing your hands often, and getting enough sleep, but there’s still no better way to prevent the flu, or lessening symptoms and its complications, than by receiving a flu shot.
“Yearly vaccination is the primary means of preventing and controlling flu outbreaks,” said Gottlieb.
And if you or your children do come down with the flu, contact us immediately. The sooner you receive Xofluza or other antiviral medications, the better they will work.
Your concierge family practice doctors at MD 2.0 in Jupiter, Florida, realize that to some people “exercise” is a chore. But study after study demonstrates the health benefits of regular movement, as well as the dangers of little-to-no exercise.
The danger of not exercising
Here’s another study that underscores the dangers of the sedentary lifestyle. Published last month in the Journal of the American Medical Association (JAMA), this one found that a lack of regular exercise is as detrimental to health as smoking, diabetes, and heart disease.
“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Dr. Wael Jaber, a cardiologist at the Cleveland Clinic, told CNN. The senior author of the study, he called the results “extremely surprising.”
“We’ve never seen something as pronounced as this and as objective as this,” he added. “[Being unfit] should be treated almost as a disease that has a prescription, which is called exercise.”
Researchers investigated 122,007 former patients at Cleveland Clinic who were tested on a treadmill between January 1, 1991 and December 31, 2014. They found those with the lowest level of fitness, i.e., a sedentary lifestyle, had a risk of death almost 500 percent higher than those who were the most physically fit.
This is only the latest study to document the danger of the sedentary lifestyle. Here are just a few others:
- A Texas study published in January found that for people over 50, regular exercise reversed the effects of aging, including hardening of the arteries and less efficient heart muscle action.
- Another showed a 40 percent decrease in cancer deaths among those who were more active than their sedentary counterparts.
- In the famous Nurses’ Health Study, those who exercised for a half-hour or more a day halved their risk of heart attack and stroke.
- Another Texas study found that men who were considered physically active lowered their stroke risk by two-thirds.
There are many others, and they all reach similar conclusions: A lifestyle that includes little physical exercise is deadly.
Too late to start?
But what if you’re no longer in the so-called “prime of life”? It’s a little late to bother with exercise, isn’t it? The answer is a resounding no. One study published in the Journal of the American College of Cardiology tracked the progress of 33,000 Swedish men from 1998 to 2012 who began exercising at an average of age 60. They reduced their risk of heart failure by 21 percent.
The important thing to remember when starting an exercise routine later in life is to start slowly, don’t push yourself, and work your way up to maximum fitness level. You may never compete in the Olympics, but you’ll notice improvements in every area of your life.
Benefits of exercise
Whatever age you begin regular exercise, you’ll begin to notice the positive effects within days. According to the Mayo Clinic, here just 10 of the many benefits of regular aerobic exercise:
- Losing weight and keeping it off
- Increased stamina
- Warding off viral illnesses like colds and flu
- Reduced risk of obesity, heart disease, high blood pressure, type 2 diabetes, stroke and certain types of cancer
- Control of chronic conditions including coronary artery disease
- Strengthening the heart muscle to slow the pulse, pump blood more efficiently, and improve blood flow to the entire body
- Boost the “good” cholesterol (high-density lipoproteins or HDL) while lowering “bad” cholesterol (low-density lipoproteins or LDL) helping to reduce plaque buildup in the arteries
- Reducing tension, anxiety, and depression
- Helping maintain mobility and brain function in older age
- Living longer.
We cannot stress this enough: Regular exercise is vital to your overall health and well-being. If you’re tired of feeling tired and dealing with various aches and pains, pick an exercise and go for it. Just be sure to check with us first.
Attention Deficit/Hyperactivity Disorder (ADHD) is often thought of as a childhood condition, but many people aren’t aware that it can linger into adulthood. Furthermore, up to 90 percent of sufferers go undiagnosed.
What is ADHD?
ADHD is a disorder of the brain that is marked by such characteristics as hyperactivity, impulsiveness, and an inability to concentrate. When first seen in children who had trouble paying attention in school or sitting still during class, it was known as ADD, because the focus was on the “attention deficit” part of the disorder. Later, hyperactivity was recognized as another part of the syndrome, and the name was expanded to include that facet.
The condition was initially thought to resolve itself once children reached adulthood, but that was possibly due to the fact that once youngsters graduated they began functioning in a different environment. In a work setting where sitting still and paying attention to a teacher was no longer required, ADHD-type behavior might not have been as noticeable. In addition, the behaviors altered into less-recognizable symptoms. But as many as 60 percent of children who were diagnosed with ADHD will still have it as adults. And adults who were never diagnosed as children may not realize they have the disorder.
Adult ADHD symptoms are different
Part of the problem in recognizing ADHD in adults stems from the fact that “symptoms might look different at older ages,” the Centers for Disease Control and Prevention (CDC) explains. “For example, in adults hyperactivity may appear as extreme restlessness or wearing others out with their activity.” Other ADHD symptoms in adults can include: inability to follow directions or remember information; boredom, difficulty concentrating or organizing tasks; brain fog; anxiety; sensitivity to light; difficulty falling asleep or staying asleep; procrastination or chronic lateness; mood swings; relationship problems; substance abuse or addiction; or low self-image.
ADHD can be misdiagnosed
Because there is no definitive clinical test available to diagnose ADHD in either children or adults, it can often be mistaken for other medical conditions. These include mood disorders like depression and anxiety; medical conditions like thyroid problems and hypoglycemia; and negative reactions to both legal and illegal drugs.
Furthermore, many people still believe ADHD is a “made-up disease” meant to either enrich the pharmaceutical companies or explain away simple laziness in those who suffer from it. The fact is, however, that 4.4 percent of adults do have this disorder, and it can be treated.
How ADHD is diagnosed
ADHD is diagnosed through a combination of methods, beginning with ruling out other physical and mental causes for symptoms, and reviewing the results of ADHD rating scales. There are several tests available online that can help determine whether ADHD might be a cause of some of the symptoms mentioned above, including the Adult Self-Report Scale (ASRS) Screener available from the Attention Deficit Disorder Association (ADDA).
Such screening tools are not definitive but merely point toward the possibility of the disorder. The National Institutes of Mental Health (NIMH) says: “Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as pediatrician, psychologist, or psychiatrist with expertise in ADHD. . . . The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. . . . For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.”
How is adult ADHD treated?
While there is no cure for ADHD, many different approaches may be used to help reduce symptoms and improve functioning. These include medication, psychotherapy, stress management techniques, and support groups. The ADDA says the most effective treatment for ADHD is a combination of medication and therapy.
If you believe you may have ADHD, please talk to your concierge doctors at MD 2.0. We can help you rule out other possible causes of your symptoms, as well as get you the help you need.
Your concierge family practice doctors in Jupiter, Florida, at MD 2.0., have been hearing concerns from our patients about the recent publicized increases of a rare polio-like disease occurring mainly in children. The Centers for Disease Control and Prevention (CDC) is investigating as many as 127 cases of acute flaccid myelitis (AFM) in at least 22 states this year. Some news outlets place the number of states affected closer to 30, because reporting cases to the CDC is voluntary, and this information may not have reached the CDC yet.
The symptoms of AFM are very similar to polio, a disease that was eradicated in the U.S. through the use of universal immunization. AFM affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. It tends to begin about a week after a slight fever or respiratory illness, but can suddenly appear as weakness in the arms and legs. Other symptoms can include slurred speech or difficulty swallowing, or a “drooping” appearance in the face. Many patients recover quickly, while others continue to have paralysis requiring ongoing care.
More than 90 percent of the cases the CDC has confirmed have occurred in children under age 18; the average age is four. Although one death from AFM was reported last year, no deaths have been associated with the illness so far this year.
Cause still unknown
AFM was even rarer prior to its first major U.S. outbreak in 2014 when 120 cases were confirmed. The illness seemed to slack off in 2015 with only 22 confirmed cases, then spiked again in 2016 (149 cases), dropped in 2017 (33 cases), and now in 2018, we have 62 confirmed cases so far with an additional 65 suspected cases being investigated by the CDC. So not only do the cases seem to be rising then declining from year to year for reasons that are still unclear, but they also seem to cluster in the fall months. There are no state clusters, however, suggesting the illness is not spread from person to person but arises spontaneously.
The most frightening thing about AFM is that scientists have been unable to pinpoint a cause. All the confirmed AFM patients have been tested for poliovirus, and have definitively tested negative. The CDC has also tested every case for evidence of a wide range of known pathogens (germs) or viruses and has been unable to detect a consistent pattern among those affected.
What is known
Scientists continue to look for a common thread. Given the persistent controversy over vaccinations, it should be noted that those affected have differing histories on vaccinations: Some of the patients were vaccinated, some were not. (Incidentally, in October an unvaccinated child in Florida became the first person to die from this year’s flu.)
Unless it can be found that all those who contracted the illness share a common trait, such as being or not being vaccinated or contracting the same type of cold or flu, or having traveled to a certain place or having come in contact with some pollutant, the cause of the syndrome will remain a mystery.
What is also known is that the chances of developing AFM is less than one in a million, according to the CDC.
Should you worry?
The likelihood of you or your child developing this distressing illness is miniscule, but there is a chance, especially since this is a year in which the cases are spiking. But we believe there is little cause for concern. As a parent, you should take the typical precautions you always do to ensure your child stays healthy: obtaining the recommended vaccinations, ensuring they wash their hands regularly and practice accepted hygiene methods, eating well, exercising, and getting enough sleep.
Just be aware that AMF strikes with little warning, and watch your child for any signs of the symptoms described above. If you have any concerns or questions, please don’t hesitate to contact us immediately.
Last year, 80,000 Americans died from complications of the flu, according to the Centers for Disease Control and Prevention (CDC). The 2017-18 flu season death toll was the highest in nearly 40 years, and almost twice as high as what health experts would typically consider a “bad” flu season. It also lasted longer—from November to March—than any recent flu outbreak.
If the idea of consuming all the eggs, steak, butter, and whipped cream you want while still losing weight appeals to you, you may think you’ve found your heaven-on-earth in the popular “keto” diet. As with all unusual ways of dieting, it is often unsustainable over the long term. Which may be a good thing as this type of eating can sometimes lead to negative health consequences.