What to Know About the Newest Migraine Drug

, , Health Basics, Medications, Uncategorized

Our primary care concierge doctors in Jupiter have a great deal of sympathy for our patients who suffer from migraines. It can be a debilitating condition and is often difficult to treat. So we welcome any new drug that can help relieve the pain. 

The latest such treatment is a new nasal spray that the U.S. Food and Drug Administration (FDA) approved earlier this month. In a clinical trial, the drug was found to provide relief from migraine pain in as little as 15 minutes.

According to health experts, nearly 40 million Americans suffer from migraines.

“They often interfere with daily functioning, keeping patients away from their work and unable to enjoy time with their loved ones,” neurologist Leah Croll at the Lewis Katz School of Medicine at Temple University, told ABC News.

“The faster we can bring relief to people suffering from a migraine attack, the sooner we can give them back that lost time,” she said.

What is a Migraine?

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.

It is also possible to have many migraine symptoms, especially the aura, without a headache. The primary signs of a migraine, however, are the extreme incapacitation associated with the headache pain involved.

The Nasal Spray Advantage

According to the National Institute of Neurological Disorders and Stroke, migraines are caused by the activation of nerve fibers in the wall of brain blood vessels. 

Calcitonin gene-related peptide (CGRP) is a chemical messenger in the brain that controls pain and inflammation. The newly approved drug, Zavzpret, works by blocking CGRP’s pain signals, according to its maker Pfizer.

Pfizer says Zavzpret (generic name “zavegepant”) is the “first and only” CGRP nasal spray for treating migraines with or without an aura. A March study published in the journal Lancet found the drug began working to treat symptoms in as little as 15 minutes, offer normal functioning in 30 minutes, and provided some relief for up to 48 hours for 24 percent of migraine sufferers.

The rapid relief Zavzpret provides offers an advantage over existing oral treatments, Dr. Emad Estemalik, a headache specialist at the Cleveland Clinic, told NBC News.

“A lot of patients, when they have migraines, they’re throwing up, for instance, so they may not be able to hold oral medication,” he said. “That’s where an intranasal comes as an advantage.”

Kate Mullin, a board-certified neurologist at the New England Institute for Neurology and Headache who helped conduct the trial for Pfizer, explained to ABC News that at least 60 percent of migraine sufferers also experience nausea, making it difficult to swallow pills.

“You can’t absorb oral medications when you’ve got what’s called gastroparesis of migraine,” she said.

“Your gut pretty much falls asleep and is not in a place to absorb mediations effectively for many migraine sufferers,” she added. “A nasal spray helps bypass the gut altogether to optimize absorption.”

Some Reservations

As with all drugs, of course, there are side effects to Zavzpret.

The FDA listed the following side effects reported by participants during the clinical trial:

  • taste disorders (18 percent)
  • nausea (four percent)
  • nasal discomfort (three percent)
  • vomiting (two percent)

Still, those who treat migraines welcomed the addition of the new drug to the migraine arsenal. 

Elizabeth Kraus, Phar.D., Neurology Clinical Pharmacy Specialist at Corewell Health, told Prevention that while she’s not overly impressed with the 24 percent success rate, Zavzpret may be better for those whose migraines tend to progress rapidly, those who don’t do well with oral medications, and individuals who struggle with severe nausea.

Amit Sachdev, M.D. M.S. medical director in the Department of Neurology at Michigan State University told Prevention that he, too, wasn’t happy with the 24 percent success rate.

“I would like to see a more broad effect, but the current trial results wouldn’t keep me from thinking of this medication [for patients],” he said.

Kraus concurred.

“If I can give someone something that will act fast and have a more lasting effect . . . That’s what I care about,” Kraus said.

The new drug is expected to be released in July of this year.

Zero-Calorie Sweetener Linked to Heart Attacks, Strokes

Concierge Medicine, Health Basics, Medications, Nutrition, Preventative Health

You may have heard the expression, “There ain’t no such thing as a free lunch.” It means that few things are actually free; there’s often a hidden cost to “freebies.”

Our concierge primary care doctors in Jupiter were reminded of that saying when we heard the results of a new study on the sugar substitute erythritol, popular in keto diets, which suggested it can cause an increase in strokes and heart attacks.

The Study

Researchers from the Cleveland Clinic evaluated more than 4,000 Americans and Europeans who were being evaluated for heart disease. The results, published last month in the journal Nature Medicine, showed that those with the highest blood concentration of the artificial sweetener erythritol were at an increased risk of heart attack or stroke in the following three years.

The researchers examined the subjects’ blood platelets—the type of blood cell that sticks together to form blood clots—and found those with the highest level of erythritol showed increased platelet activity, thereby encouraging the greater formation of clots. Clots in the bloodstream have the potential to cause heart attacks or strokes when they block the normal flow of blood.

The researchers also injected mice with erythritol and found that clots formed more quickly after an injury than those who had been injected with saline.

Finally, they took blood samples from subjects who had consumed an erythritol-sweetened drink and found levels of the sweetener remained high for two days.

“Every way we looked at it, it kept showing the same signal,” Stanley Hazen, a cardiologist at the Cleveland Clinic, who also directs the Cleveland Clinic’s Center for Microbiome and Human Health, told The New York Times.

“People are trying to do something healthy for themselves but inadvertently may be doing harm,” he told the paper.

About Erythritol

Erythritol is a sugar alcohol like xylitol and sorbitol and is found naturally in many fruits, vegetables, and fermented foods. It is also manufactured artificially for use in food products.

It has become more popular than earlier types of artificial sweeteners because it has no lingering aftertaste, doesn’t spike blood sugar, and doesn’t cause the laxative effect common with other such additives.

USA Today reports that it is added to many processed foods and beverages and is commonly found in products aimed at those on the keto diet because it does not affect blood glucose. It is also an ingredient in the sweetener Truvia.

“Erythritol looks like sugar, it tastes like sugar, and you can bake with it,” Hazen told CNN.

“It’s become the sweetheart of the food industry, an extremely popular additive to keto and other low-carb products and foods marketed to people with diabetes,” he added.

The U.S. Food and Drug Administration (FDA) lists erythritol as generally recognized as safe or GRAS. Therefore, it is not required to be listed on a product’s ingredient list, according to Hazen. The label might simply say, “artificially sweetened with natural products,” or “zero sugar.”

Other Research

Robert Rankin, executive director of the Calorie Control Council, an association representing the low- and reduced-calorie food and beverage industry, told USA Today that the people in the study were at higher risk for cardiovascular disease (CVD), so the results shouldn’t be applied to the general population.

“The results of this study are contrary to decades of scientific research showing reduced-calorie sweeteners like erythritol are safe,” he said.

But other studies have raised the question about the safety of erythritol.

For example, Karsten Hiller, a biochemist, and specialist in human metabolism at the Braunschweig Institute of Technology in Germany published a paper in 2017 showing that Cornell University freshmen whose blood contained high levels of erythritol gained more weight than students with low levels, the USA Today reported. Which kind of defeats the purpose of using an artificial sweetener.

“Science needs to take a deeper dive into erythritol and in a hurry, because this substance is widely available right now,” Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health, a hospital in Denver, told CNN. Freeman was not involved in Hazen’s research.

Hazen agreed.

“I normally don’t get up on a pedestal and sound the alarm,” he told CNN.

“But this is something that I think we need to be looking at carefully,” he added.

Eating Healthier

Artificial sweeteners in general have been called into question by numerous studies. For example, a 2020 study by a group of Yale researchers found that those who used the artificial sweetener sucralose (found in the brand names Splenda, Zerocal, and others) can result in high blood sugar levels in the blood. The Washington Post reports that sucralose is found in thousands of consumer-packaged goods such as baked goods, yogurt, canned soups, condiments, and syrups.

Another study at the Weizmann Institute of Science last year looked at what happened to subjects who consumed aspartame, saccharine, stevia, or sucralose in amounts well below the FDA’s daily allowances. The researchers found that these sweeteners caused changes in both the function and composition of the participants’ gut microbiomes, the communities of bacteria, viruses, and fungi that live in the intestines, The Post reported.

There’s no question that artificial sweeteners are hard to avoid these days. And we keep trying to have our sugar without paying the price.

But for the sake of your long-term health, we recommend sticking as closely as possible to fresh, natural, unprocessed foods and beverages.

Best Ways to Treat Lower Back Pain

, Health Basics, Healthy Living, Lifestyle, Preventative Health

Whatever the cause of your low back pain—lifting your child, the wrong tennis move, or (often) no reason you can recall—what you want is relief: now!

Our concierge primary care doctors in Jupiter understand because we’ve been there. In fact, it’s estimated that at some point in our lives, 80 percent of us will seek medical attention for that searing pain that flares every time we move.

So we were pleased to learn of a new study that looked at the best medications for treating lower back pain. And there are other ways to treat the pain without drugs, which we’ll explore below.

The Latest Research

The study, published last month in the Journal of Orthopaedic Research, found that the best medications for acute lower back pain was a combination of a non-steroidal anti-inflammatory NSAID) drug and a prescription muscle relaxant. Acute lower back pain is defined as pain that lasts no longer than 12 weeks; chronic back pain lasts longer.

Researchers reviewed 18 randomized clinical trials that looked at various analgesics, including aspirin, acetaminophen, and NSAIDs (ibuprofen, naproxen, and celecoxib). The NSAID/muscle relaxer combination relieved pain and disability the fastest, often within one week.

The main drawback, of course, is that muscle relaxants—which actually tend to relax the whole body rather than just muscles—cause sleepiness, meaning they can’t be taken while driving or trying to function normally throughout the day.

And—as with all drugs, whether over-the-counter (OTC) or prescription—each drug comes with the possibility of side effects, including indigestion, dizziness, liver damage, and internal bleeding, among other risks.

Harvard Health Publishing notes that other drug treatments are also available for those whose pain isn’t helped by analgesics, or becomes more severe.

This includes opioids as a last resort, which are generally safe when taken for a short period and monitored by a doctor.

Certain antidepressants can also be prescribed off-label to treat pain, even if the person is not depressed.

Non-drug Approaches

Because of the risks associated with drug therapy, many people look to alternative methods to help relieve their pain.

Matthew Solan, the executive editor of Harvard Men’s Health Watch, mentions several options.

Cold and heat therapies can work by starting with ice packs immediately following the onset of pain to reduce swelling, followed by a heating pad or a hot-water bottle to relax muscles and increase blood flow.

Limited bed rest, although recently fallen out of favor as the preferred treatment for back pain, can still be helpful if the pain is so severe that it hurts to sit or stand. Try to limit it to a few hours at a time, however, and for no more than one or two days. 

Physical activity can not only help build strong muscles that are less prone to injury but can also help the healing process.

Complementary therapies, often thought of as “woo-woo nonsense,” have been shown to offer relief in many cases. They include:

  • acupuncture, in which needles inserted in precise points on the body are said to release blocked energy suspected of causing pain
  • spinal manipulation, in which chiropractors apply pressure to the body to correct spinal alignment
  • therapeutic massage to relax aching muscles
  • movement therapies such as yoga and tai chi

Another Non-traditional Approach

Nearly 40 years ago, the late back pain physician John Sarno proposed an entirely different approach to treating chronic lower back pain, and eventually pain of all sorts. He claimed that much of the pain was caused by the brain trying to repress unwanted or frightening emotions and that once this was acknowledged, the pain would resolve on its own.

This is a vast oversimplification of his theory, of course, and over the years has been vehemently rejected by pain sufferers who thought he was saying their pain was “all in the head,” which was not his message. Anyone who is familiar with the concept of mind-body medicine will understand the connection between the brain and what happens in the body.

Although the medical community has been slow to warm up to Sarno’s approach, two recent studies tend to lend credence to his theory.

One, published in the journal JAMA Psychiatry in 2021, was a randomized, controlled trial of 151 patients using an approach based on Sarno’s work: “pain reprocessing therapy,” or PRT, which taught patients to reinterpret their pain as a neutral signal from the brain. Researchers found that 98 percent of participants had at least some relief from their pain; 66 percent were nearly or fully pain-free, compared with 10 percent of the control group.

Another study, published the same year, found similar results to Sarno’s approach.

If you’re interested in pursuing this form of treatment, Sarno’s books are readily available online. Although he offered in-person counseling when he was alive, he also claimed that simply reading his books, which explained the theories behind his treatment, worked for many. 

A Final Word

Finally, if you have persistent or severe lower back pain, it’s important that you let us know because it could be a symptom of something serious.

Dr. Akhil Chhtre, who specializes in back pain at the Johns Hopkins Department of Physical Medicine and Rehabilitation, cautions that “in some cases, pain is your body’s way of telling you that something isn’t right.”

He says it could be sciatica, kidney pain, or even cancer (especially prostate cancer). So it’s important to have persistent lower back pain checked. 

Should You Worry About Catching Bird Flu?

Disease

Since the outbreak of the novel coronavirus, SARS-CoV-2, we’ve all learned a lot more than we ever wanted to know about viruses and how they work, including how they mutate and how they can spread from animals to humans.

So the recent widespread outbreaks of bird flu have made some people a bit anxious, mainly because it has been reported in a number of mammals.

Our concierge primary care doctors in Jupiter want to explain why you shouldn’t be overly concerned, although there is an element of risk. Here’s what scientists are saying.

Background

According to the Centers for Disease Control and Prevention (CDC), although avian influenza A, popularly known as “bird flu,” viruses usually do not infect people, “there have been some rare cases of human infection with these viruses.”

Infected birds shed the virus through their saliva, mucus, and feces. Bird flu can transmit to humans when a virus from one of these sources gets into a person’s eyes, nose, or mouth, or is inhaled, either from unprotected contact with infected birds or with surfaces contaminated with these viruses.

Some infections in humans, however, haven’t been traced directly to this type of transmission—in other words, no one knows how these “very rare” cases happened. That means some cases may have passed from human to human.

But historically, other types of bird flu have been responsible for several flu pandemics in America’s history, including the devastating H1N1 flu pandemic in 1918-1919, which killed 50 million people worldwide. (The current strain is Type A H5N1, which is not related.)

Recent Outbreaks

The current H5N1 flu virus was first identified in 1959 and can be found in wild birds in all 50 states, along with backyard flocks in most states, including one in a backyard flock in Florida last month, according to the CDC.

In the last year, 58 million birds were slaughtered because of the H5N1 bird flu. In addition, it began transmitting to mammals, including hundreds of wild sea lions in Peru and a farm of minks in Europe. The U.S. Department of Agriculture (USDA) also reported last month that the virus has been detected in skunks, bears, a raccoon, and red foxes.

Most of these mammal infections were probably stand-alone cases in which the mammal ate an infected bird, Jürgen Richt, professor, and director of the Center on Emerging and Zoonotic Infectious Diseases at Kansas State University, told USA Today.

The exception could be the October mink outbreak, he said, in which the virus transmitted from mammal to mammal. And because humans have never been exposed to H5N1, we don’t have any immunity to it—just as we didn’t to the SARS-CoV-2 coronavirus.

“If this virus has mammalian adaption and can transmit between mammals, humans are immunologically naive . . . and humans are mammals,” Richt said.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said last month that avian influenza’s spillover to mammal species must be monitored closely, but that the risk to humans remained low for the moment.

“But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said.

Low Chance

Still, most virologists aren’t yet alarmed, because the virus would need to mutate in a certain way in order to spread to humans.

“It’s a series of events, each of which is fairly improbable,” Anice Lowen, a virologist and associate professor at Emory University School of Medicine, told NBC News.

“This is why I say the risk to humans is presently low,” she said. “The evolutionary barriers are high. It’s a numbers game,” she added, meaning the large numbers of outbreaks around the world are in the virus’s favor, but it would need to undergo a complicated string of mutations to be able to pass to humans.

Nevertheless, the mink farm infestation caught scientists’ attention, even though none of the workers at the farm became ill.

CNN reports that researchers found multiple mutations of the virus in the minks, including one that made it better at replicating in mammals.

“But it’s when it starts to spread from one mammal to the next mammal to the next mammal, it’s in those environments where we think it’s most likely that it will pick up these changes that allow us to switch hosts, and that’s why we get concerned,” Richard Webby, an infectious disease researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, told CNN. Webby is also the director of WHO’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds.

Staying Safe

Of course, we can’t predict the future, and as we saw with COVID-19, viruses have a way of getting out of hand.

So the CDC recommends a few precautions, such as never handling a dead bird without gloves and a mask.

Songbirds don’t (yet) appear affected, nor do such wild birds as crows or pigeons, so backyard birders don’t need to worry. And the CDC says it’s safe to eat poultry and eggs that are properly handled and cooked.

“The chances are not zero that you could get this, and anything you can do to further reduce that risk is a good thing,” Webby told CNN.

“But you probably really have to work hard to be infected with this virus,” he said.

Live Longer with Blue Zone Foods

Environment, Health Basics, Healthy Living, Lifestyle, Nutrition, Preventative Health, Uncategorized

Of all the diet trends available today, one our primary care concierge doctors in Jupiter can highly recommend is the Blue Zone way of eating: fresh, healthy, unprocessed food, from as close to its source as possible, in meals shared with family and friends.

The term “Blue Zone” was coined nearly 20 years ago by journalist and researcher Dan Buettner in a 2005 National Geographic cover story titled, “Secrets of Living Longer.”

His team of anthropologists, demographers, and scientists had traveled the world to find the world’s longest-living people, and to discover the secrets to their longevity.

Buettner’s team found five seemingly disparate places where the people live exceptionally long, healthy lives: on average, around 100. (The term “blue zone” came from the blue circles the researchers drew on a map during their quest.)

The five places are:

Okinawa, Japan
the Nicoyan Peninsula in Costa Rica
the Seventh Day Adventists in Loma Linda, California
Sardinia, Italy
Ikaria, Greece

More than Diet

Of course, healthy eating is key to a healthy body, but the Blue Zone residents had more than good food on their side. Genetics, as always, plays a big role in how long anyone will live no matter where they are.

Other factors the team found the Blue Zones had in common were:

Natural movement: no marathons or gym visits, just long walks, hiking, gardening, etc.
Hara Hachi Bu: an Okinawan term for eating until they’re about 80 percent full
Plant slant: a preference for plant foods over meat
Grapes of Life: one to two servings of red wine daily (except for the Seventh Day Adventists, who eschew alcohol)
Plan de Vida: or “why I wake up in the morning,” i.e., a sense of purpose
Downshift: controlling stress, a sense of serenity
Belong: participation in a spiritual community
Loved ones first: making family a priority
Close tribe: social connectedness

Blue Zone Meals

The Blue Zone diet, which Buettner details in his latest book, “The Blue Zones American Kitchen: 100 Recipes to Live to 100,” is a cornerstone of the Blue Zone program, and closely resembles the Mediterranean diet, but with even less emphasis on fish and meat.

“The five pillars of every longevity diet, including the Blue Zones, are whole grains, vegetables in season, tubers, nuts, and beans. In fact, I argue the cornerstone of a longevity diet is beans,” he told CNN.

Legumes, in fact, are key, he told The Washington Post. They are rich in fiber, which is key to improving cholesterol and blood sugar levels.

“Figure out how to get a cup of beans into your diet every day,” he told the paper. “Just one cup gives you half of all the daily fiber you need.”

What Not to Eat

And even though the Mediterranean diet includes a certain amount of meat and fish, Blue Zone diets contain little, if any.

“People in Blue Zones don’t eat nearly as much fish as the Mediterranean diet prescribes, only three times a week and only three ounces,” he told CNN. “Meat is eaten only five times a month. There’s no cow’s milk in any Blue Zone.”

Instead, people eat goat and sheep’s milk cheeses such as feta and pecorino, he said.

In addition, “no more than three eggs are consumed per week,” he told NBC’s Today show.

“The Blue Zone eating pattern is 98 percent plant-based foods—whole food-based and high carbohydrate,” Buettner told CNN.

“But only complex carbs, not the simple carbs like salty snacks and candy bars and soda pop. You say carbohydrates and people are horrified, but the healthiest foods in our food system are complex carbohydrates,” he added.

Time and Place Count, too

In keeping with the other factors that affect longevity, sharing meals—especially with family—is another component. While our busy schedules might not often permit this, Buettner says it’s worth doing as often as possible.

“Families that eat together tend to each much more nutritiously, they eat slower, and there’s good research that children have fewer issues with disordered eating if they’re eating socially,” he told The Post.

And it turns out the recent trend toward intermittent fasting appears to have some validity. Buettner reports that people in Blue Zones tend to eat earlier in the day.

Okinawans, for instance, traditionally eat a big breakfast and a moderate lunch.

“They don’t even have dinner,” he told the paper.

And the Seventh Day Adventists in Loma Linda would eat a big breakfast at 10 a.m. and a moderate lunch at 4 p.m. “And then they’re done for the day,” he said.

Small Moves

Of course, there’s more to the Blue Zone lifestyle than just food, as we mentioned earlier. Three of the five Blue Zones are isolated, which forces tight social connections and a lot of walking.

“Walking is one of the best forms of exercise and you can do it without thinking about it,” Buettner told Today, suggesting that people think about adopting a dog as a strategy to encourage regular walks.

“We’re all looking for magic dietary pills or serums or supplements, but you see none of that in the Blue Zones,” he said. “It’s mostly small things driven by the right environment,” he said.

That includes social connections.

“We’re genetically hardwired to crave social interaction, and when you don’t have it, there’s a level of subconscious stress that grates away at you,” he added.

Common COVID-19 Misconceptions Linger Three Years Later

, , COVID

It’s been three years since the first cases of COVID-19 were diagnosed in the U.S., but our concierge primary care doctors in Jupiter are still hearing comments from friends, acquaintances, and even some of our patients that are just plain incorrect.

For instance, we were talking to someone the other day whose wife was very sick with COVID-like symptoms: body aches, severe cough, fever, chills, and so on. When we asked if she’d been tested for COVID-19, he replied, “No, she’s already had it.”

We happen to know that her previous infection was a year ago when the delta variant was the predominant strain. Today, it’s the XBB.1.5 subvariant of the omicron variant. And as with the flu, which is also a virus, it is possible to get COVID-19 more than once, even if you’ve been vaccinated (which she hasn’t).

The problem with his not knowing this is that she could have received the antiviral pill Paxlovid or similar medication early on to lessen her symptoms, instead of spending over two miserable weeks in bed. By the time we talked, it was too late—you must receive the treatment within the first five days.

Understandable Confusion

Of course, much misinformation spreads wildly on social media. And it’s not just misinformation, but dangerous, outright fabrications. For example, Dr. Anish Agarwal, an emergency physician in Philadelphia, recently told the New York Times he’s still seeing patients who believe what he called “crazy” claims that the COVID vaccines “will insert robots into their arms.”

“We battle that every single day,” he told the paper.

We believe our patients are savvy enough to discount such craziness and hope they will check with us if they read something like this that concerns them.

But many of the misconceptions we hear arise because people are busy and don’t have time to keep track of all the news about the coronavirus, or they make assumptions based on misunderstandings like our acquaintances did.

So here’s a capsule summary of the facts we know about COVID-19 and the vaccines. Again, we hope you’ll contact us with any questions.

COVID-19 Facts

Yes, COVID-19 is still a threat, in some regions of the country more than others, especially the Northeast and Midwest. Hospitalizations, including here in Florida, have declined in recent weeks. But according to an NBC News tracker, the U.S. is still averaging 524 deaths from COVID-19 every day, including 63 Floridians.

And of course, hundreds of thousands of Americans are still dealing with the devastating effects of long COVID, and while we’re learning more all the time, we still don’t have a cure or effective treatments.

Despite a recent study that seemed to question the effectiveness of wearing face masks in public places, numerous studies have found they do work, not only to help prevent the spread of COVID-19 but also to protect the wearer.

The most recent study, conducted by the California Department of Public Health and published in the CDC’s journal Morbidity and Mortality Weekly Report, showed that those who reported wearing masks were about half as likely to become infected than those who didn’t. The analysis found the odds were even lower for those who reported masking “all of the time” vs. “some” or “most of the time.”

Other studies conducted over the course of the pandemic showed infection reductions from wearing well-fitting masks as high as 70-80 percent.

Vaccine Facts

COVID-19 vaccines are safe and effective. Adverse events connected with the vaccines are infrequent:

  • Myocarditis (inflammation of the heart muscle) associated with the mRNA vaccines occurred in 1,626 people out of 192,405,448 participants in one study.
  • Thrombosis (blood clots) associated with the Johnson & Johnson vaccine occurred in four out of one million people who received the vaccine.
  • And cases of both myocarditis and thrombosis were higher in those who contracted COVID-19 and hadn’t been vaccinated.

Vaccines often don’t prevent minor or even severe symptoms, but they do reduce the chance of serious disease and death. A research report by the Commonwealth Fund estimated that vaccines prevented 3.2 million deaths and 18.5 million hospitalizations in the U.S. between December 2020 and November 2022.

A primary series (two doses of the mRNA vaccine) plus a booster dose is more effective than a primary series alone; a second booster dose increases protection even better, and so on, because vaccine protection against serious illness begins to wane within four to five months after inoculation. 

Pfizer-BioNTech’s newer bivalent vaccine is more effective against both the original strain and the newer omicron and XBB variants than the original vaccine, according to a November 2022 study.

One 2022 study also found that vaccination reduces the risk of developing long COVID.

Vaccines also help to prevent transmission of the virus, as a November 2022 study found. In January, Forbes reported that those who had received the vaccine were 24 percent less likely to infect close contacts than those who were unvaccinated; those who had been previously infected were 32 percent less like to spread the virus; and those who had been vaccinated and previously infected were 41 percent less likely to transmit the virus. 

Keep in mind that even after three years of experience with the novel coronavirus, there’s still much we don’t know. But what we do know is based on solid, extensive, worldwide research, not on wild supposition or hearsay passed along on the Internet.

Here’s to Your Heart Health

, , , Disease, Health Basics, Healthy Living, Nutrition, Preventative Health

In recognition of American Heart Month in February, our primary care concierge doctors in Jupiter thought we’d share some facts with you about your heart, and what you can do to keep it healthy.

Surprising Heart Facts

First, from the Cleveland Clinic, here are a few interesting things you may not know about your heart.

Your heart is about the size of your two hands clasped together.
It beats 100,000 times a day.
The beating sound is the clap of valve leaflets opening and closing.
A woman’s average heartbeat is faster than a man’s by almost eight beats a minute.
Every cell in your body gets blood from your heart, except for your corneas.
The heart pumps blood through 60,000 miles of blood vessels.
A normal heart pumps approximately four tablespoons of blood with each beat.
Each minute, your heart pumps 1.5 gallons of blood.
Your heart has its own electrical supply and will continue to beat when separated from your body.
Heart cancer is very rare because heart cells stop dividing early in life.

About Heart Disease

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the U.S. About 697,000 people in the U.S. died from heart disease in 2020 (the most recent figures available). And every year about 805,000 people in the U.S. have a heart attack; over 600,000 of those are first heart attacks.

According to the Centers for Disease Control and Prevention (CDC), the term “heart disease” refers to several types of heart conditions.

The most common type of heart disease in the U.S. is coronary artery disease (CAD), which affects blood flow to the heart. Decreased blood flow can cause a heart attack. In 2020, about 20 percent of deaths from CAD occurred in adults below the age of 65, known as an “early cardiac event.”

Common Symptoms of Heart Disease Include:

Heart attack: chest pain or discomfort, upper back or neck pain, pain in the jaw or throat, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness, a cold sweat, and shortness of breath
Arrhythmia: fluttering feelings in the chest (palpitations)
Heart failure: shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen, or neck veins

The Cleveland Clinic’s Dr. Curtis Rimmerman, a cardiologist, emphasizes that symptoms of a heart attack can vary widely, but adds that the discomfort is usually unrelenting, typically lasting five minutes or more.

“Regardless of where the pain is, people typically can’t find a position that relieves the pain,” he says. “Nor do they find relief by taking a drink of water, popping antacids or taking deep breaths.”

That means it’s time to call 911, he adds.

Increasing Risk

Unfortunately, about one in every five heart attacks are “silent”—that is, the damage is done, but the person is not aware of it.

That’s why it’s important to know your risk factors and what you can do about them.

About half of all Americans (47 percent) have at least one of the three key risk factors for heart disease: high blood pressure, high cholesterol, and smoking.

In addition, several other medical conditions and lifestyle choices also put people at a higher risk for heart disease, the CDC reports, including:

diabetes
overweight and obesity
unhealthy diet
physical inactivity
excessive alcohol use

In addition, a 2021 study published in the journal Heart found that those who used illicit substances, including amphetamines, cocaine, and cannabis, were far more likely to experience an early cardiac event than those who didn’t.

And another study, published in the Journal of the American Heart Association (AHA) in 2020, found that the chances of developing cardiovascular disease (CVD) were 19 times higher in women who consumed one or more sugary drinks a day. This included everything from fruit juices to soft drinks (not diet) to coffee with sugar.

Lowering Risk

Some risk factors cannot be controlled, such as age or family history of heart disease, but you can take steps to lower your risk by changing the factors you can control.

Have your blood pressure, cholesterol, and triglycerides checked regularly.
Ask us whether you should be tested for diabetes.
Quit smoking.
Limit the alcohol you consume to one drink a day.
Learn how to manage stress levels by finding healthy ways to cope with stressful events.

In addition, there are two other ways that have been shown to dramatically reduce your risk for heart disease.

The first is exercise. According to the Cleveland Clinic, regular moderate-intensity exercise for at least 150 minutes is the single most important—and free—key to heart health.

The second is diet, specifically a plant-based diet. This doesn’t necessarily mean going totally vegetarian, just making plant foods vs. animal foods the main component of your diet.

“I’ve seen people whose diabetes, angina, or blood pressure goes into remission [on a plant-based diet],” Andrew Freeman, a cardiologist and the co-founder of the Nutrition and Lifestyle Work Group at the American College of Cardiology, told The Washington Post.

“I’ve seen autoimmune diseases go away when you cut inflammation,” he said. “The best way to do that is with a plant-based diet, and people get better.”

Is a Neti Pot Right for You?

, , Health Basics, Healthy Living, Lifestyle, Preventative Health

Because our concierge primary care doctors in Jupiter have been receiving more questions about the effectiveness of Neti pots for various sinus conditions, we thought we’d take some time to explore their usefulness—and to reiterate a special warning about their use.

What is a neti pot?

Neti pots are one type of nasal irrigation device that use a saline or saltwater solution to treat congested sinuses, colds, allergies, and congestion from flu and COVID-19.

These devices include the teapot-looking container that originated with Ayurvedic medicine in India, along with bulb syringes, squeeze bottles, and more expensive motorized pulsed water devices.

In general, these devices all introduce salt water (saline) into the nostrils to flush out mucus, allergens, and bacteria. The saline helps thin the mucus, making it easier to expel.

The U.S. Food and Drug Administration (FDA) says that such saline rinsing “can remove dust, pollen, and other debris, as well as help to loosen thick mucus. It can also help relieve nasal symptoms of sinus infections, allergies, colds, and flu.

“Plain water can irritate your nose,” the agency says. “The saline allows the water to pass through delicate nasal membranes with little or no burning or irritation.”

How do they work?

 “There are various ways to deliver saline to the nose,” says Eric A. Mann, M.D., and Ph.D., a doctor at the FDA.

“Nasal spray bottles deliver a fine mist and might be useful for moisturizing dry nasal passages. But irrigation devices are better at flushing the nose and clearing out mucus, allergens, and bacteria,” he says.

Information that comes with each device can give more specific instructions, but in general, the FDA says they all work basically the same way:

  • Leaning over a sink, tilt your head sideways with your forehead and chin roughly level to avoid liquid flowing into your mouth.
  • Breathing through your open mouth, insert the spout of the saline-filled container into your upper nostril so that the liquid drains through the lower nostril.
  • Clear your nostrils. Then repeat the procedure, tilting your head sideways to the other side.

While some people experience immediate relief from their symptoms, for others it may take a few days to begin breathing more freely.

And experts caution that—like oral decongestants—nasal irrigation devices are simply a treatment for a symptom, not a cure for the underlying cause.

Some Cautions

Although the FDA says that neti pots and other similar nasal irrigation devices are generally safe, they may not be right for everyone. If your immune system isn’t working properly, the agency advises checking with your healthcare provider before using any nasal irrigation system.

A few users report ear discomfort, nasal irritation, a burning or stinging sensation, and even nosebleeds. But in general, the FDA considers them safe to use, even for children aged two and up.

The most significant warning, however, concerns the type of water used in them. 

“Tap water isn’t safe for use as a nasal rinse because it’s not adequately filtered or treated,” the FDA cautions.

“Some tap water contains low levels of organisms—such as bacteria and protozoa, including amoebas—that may be safe to swallow because stomach acid kills them. But in your nose, these organisms can stay alive in nasal passages and cause potentially serious infections.”

They can even be deadly, the Centers for Disease Control and Prevention (CDC) reports. Since 1993, there have been at least 70 cases of “brain-eating” amoeba infections in the U.S., which are “almost uniformly fatal,” the agency reports.

Safe Use

The safety of neti pots and other such nasal irrigation devices—including the motorized versions—depends on the type of water used and how meticulously the containers are cleaned after each use.

The FDA lists the following types of water as safe to use for neti pots and similar devices:

  • Distilled or sterile water, which you can buy in stores. The label will state “distilled” or “sterile.”
  • Boiled and cooled tap water—boiled for three to five minutes, then cooled until it is lukewarm. Previously boiled water can be stored in a clean, closed container for use within 24 hours.
  • Water passes through a filter designed to trap potentially infectious organisms. The CDC has information on these filters here. 

To safely use and care for your device:

  • Wash and dry your hands.
  • Check that the device is clean and completely dry.
  • Prepare the saline rinse, either with the prepared mixture supplied with the device, or one you make yourself.
  • Follow the manufacturer’s directions for use.
  • Wash the device, and dry the inside with a paper towel or let it air dry between uses.

Does it Work?

Most people who use neti pots to relieve nasal congestion and allergies swear by them, especially if they want to avoid using over-the-counter decongestants. 

“Just about any condition that causes irritants and mucus to build up inside the nose will benefit from saltwater rinsing with a net pot or similar device,” Richard Orlandi, a nasal and sinus specialist and professor of surgery at the University of Utah Health in Salt Lake City, told Consumer Reports (CR).

“These include allergies, nonallergic nose irritation, colds, and sinus inflammation and infections,” he said.

The World Health Organization (WHO) reports that rinsing your nose with saline does not prevent COVID-19, by the way.

If saline rinsing doesn’t relieve your symptoms, or if you have a fever, nosebleeds, or headaches while using the devices, let us know.

Nature Can Heal in More Ways Than One

, , , , , , , , Environment, Health Basics, Healthy Living, Lifestyle, Motivation, News, Preventative Health, Uncategorized

Humans evolved in the natural world. We may have retreated to caves or huts to protect ourselves from the elements, but we spent much of our time outdoors, hunting, gathering, cooking, telling stories, and so on. Our lives these days, though, are largely spent cut off from nature.

This way of life has sparked a wealth of studies showing that our loss of contact with nature—dubbed “nature deficit disorder”—has a real impact on our physical and mental health.

So our primary care concierge doctors in Jupiter weren’t too surprised to learn of a new study published this month in the journal Occupational & Environmental Medicine, which found that enjoying nature up to four times a week reduced the odds of needing mental health medications by 33 percent.

It also reduced the odds of using blood pressure pills by 36 percent and asthma medications by 26 percent.

The Study

Researchers interviewed about 6,000 people who live in large cities in Finland, asking about their access to and use of green and blue spaces, including parks, zoos, rivers, lakes, or the sea. 

They also asked subjects whether they could see views of nature from their homes, how often they spent time outdoors as well as how much they exercised while outdoors.

The study also accounted for other possible factors such as traffic-related outdoor air pollution and noise, which have been proven to have an adverse effect on health.

Respondents were then asked about their use of medications for depression, anxiety, high blood pressure, asthma, or insomnia, and correlated these with time spent in nature.

As noted above, the results were markedly better for those who were regularly exposed to green or blue spaces. Notably, those who lived in areas with a lot of green spaces or who simply looked at nature from their windows showed no improvement in any of these categories.

“Frequent green space visits, but not the amounts of residential green or blue spaces, or green and blue views from home, were associated with less frequent use of psychotropic, antihypertensive, and asthma medication in urban environments,” the study authors wrote.

Confirming Prior Research

Numerous earlier studies have found significant benefits from spending time in nature.

One meta-review of 143 other studies published in the journal Environmental Research, for example, found that people with access to green space generally had a slower heart rate, lower blood pressure, and fewer blood levels of the stress hormone cortisol. Researchers also found significantly fewer cases of diabetes and lower rates of mortality from heart disease in the group regularly exposed to nature.

An American Institutes for Research (AIR) study in 2005 found that sixth-grade students who attended three outdoor education programs showed marked improvement in conflict resolution skills.

Another study in China in 2013 involved 60,000 children between the ages of two and 17. It showed that regular exposure to nature, or “greenness” around their schools, reduced the incidence of attention deficit/hyperactivity disorder (ADHD). A more recent study at the University of Illinois produced similar results.

And a 2016 study of nearly 100,000 women conducted over eight years found that having access to the greenest space not only improved the subjects’ mental health but also reduced their death rate by 12 percent.

Nature Deprivation Hurts

Author Richard Louv coined the phrase Nature Deficit Disorder (NDD) in his 2005 book “Last Child in the Woods: Saving Our Children from Nature Deficit Disorder.” In it, he argued that elements of our urbanized lifestyle, including few natural spaces, a car-focused culture, more screen time, changes in the perception of risk (e.g., fear of “stranger danger”), less leisure time, and increased time pressure from work or school, combine to decrease or even eliminate contact with nature for both adults and children, according to the National Institutes for Health (NIH).

“The average young American now spends practically every minute—except for the time in school—using a smartphone, computer, television, or electronic device,” Tamar Lewin reported in a Kaiser Family Foundation study on the subject.

According to the Children and Nature Network (C-NN), which was co-founded by Louv, an expanding body of scientific evidence suggests that nature-deficit disorder contributes to:

  • diminished use of the senses
  • attention difficulties
  • conditions of obesity, and
  • higher rates of emotional and physical illnesses

Make the Connection

Unfortunately, to get back to nature, you may need to make a specific effort, because in our harried lives trapped indoors, focused on our screens, we have very little time for real relaxation.

Therefore, it’s often necessary to add nature breaks to our schedules the same way we schedule everything else.

One way is to undertake the Japanese practice known as “forest bathing,” or shinrin-yoku. As Kaiser Permanente’s’ online Thrive explains, “Heading out to a heavily wooded area isn’t required. You could take a trip to a nearby park, your favorite local trail, the beach, or any natural setting. Just be sure to turn off or silence your phone or other devices.”

Psychology Today explains, “Forest bathing is an antidote to pinging distractions, impending deadlines, and never-ending obligations . . . . The idea is to immerse yourself in a natural environment and soak up the many health benefits of being in the green woods.”

However, you manage it, for the sake of your overall health we recommend you take the time to reconnect with the natural world as often as possible.

Damar Hamlin Brings CPR Into the Spotlight

, News, Sports

It was a terrifying moment on the field at the Buffalo Bills-Cincinnati Bengals game earlier this month when Bills safety Damar Hamlin stood up following a hit to the chest and then collapsed on the field.

But the good news is that he seems to be well on his way to a remarkable recovery. So our concierge primary care doctors in Jupiter want to join with so many others who are using the incident to urge everyone to learn the lifesaving cardiopulmonary resuscitation (CPR) technique that helped save his life.

What happened to Hamlin?

First, let’s discuss how a routine hit in a football game drove a man to the brink of death.

While full details are not yet available, it appears he was the victim of a rare phenomenon called “commotio cordis,” or ventricular fibrillation. It occurs when an impact directly to the heart occurs at the precise millisecond of the heartbeat when it becomes susceptible to such a blow, interrupting the rhythm.

In such cases, “there is nothing wrong with the heart,” Dr. Hari Tandri, director of the cardiac arrhythmia program at Vanderbilt University Medical Center in Nashville, Tennessee, told NBC News.

Dr. Comilla Sasson, an emergency medicine physician in Denver and a spokesperson for the American Heart Association (AHA), told NBC: “It’s not about how hard a hit it was. It’s actually about the timing of when the blow happens.”

CBS News medical contributor Dr. David Argus told “CBS Mornings” that he believed Hamlin sustained blunt force trauma to his chest “in the exact right spot, at the exact right moment during his heartbeat,” causing his heart to go into arrhythmia, or “not beat effectively to push blood to the brain,” he explained.

“It happens in Little League baseball,” he added. “A ball is thrown by a pitcher and hits the person in the chest. It happens in soccer where there’s something that causes that blunt force trauma. So, remarkably rare.” So rare, in fact, that he estimated that only about 30 of these cases occur in the U.S. every year.

Hamlin was Lucky

As Hamlin continued to rapidly recover in the days following his collapse, observers credited his survival to the immediate response of medical personnel on the field.

“When someone is having a sudden cardiac arrest emergency for any reason . . . time is absolutely critical,” Matthew Levy, an associate professor of emergency medicine at Johns Hopkins University School of Medicine, told The Washington Post.

“For every minute that someone is in sudden cardiac arrest—every minute where their heart is not beating normally and their body tissue is not getting the oxygen it needs—their [chances of] survival goes down by like seven to 10 percent,” he said. “So time is absolutely of the essence.”

“The key in any cardiac arrest is how quickly and effectively CPR is done,” Aaron Baggish, a Mass General Brigham sports medicine cardiologist and founder of the Cardiovascular Performance Program at Massachusetts General Hospital, told The Post.

“So it has to start soon, and it has to be done well enough to get blood to the brain and the other vital organs for as long as it takes to start the heart again with defibrillation,” he said.

Rapid Response

Which is what happened with Hamlin.

Within seconds of Hamlin’s collapse, assistant athletic trainer Denny Kellington began administering CPR to Hamlin, according to a tweet from Bills offensive lineman Dion Dawkins. Others followed the CPR with use of an automated external defibrillator (AED) before Hamlin was rushed to the hospital.

Observers credited the immediate CPR and AED with saving his life. But only about half of Americans report having received CPR training.

And unfortunately, many people who witness a cardiac arrest are reluctant to perform CPR, either because they don’t know how or are afraid of causing further harm. But Good Samaritan laws in all 50 states protect bystanders who step in to help during an emergency from legal liability.

Florida’s statute provides that “Any person . . . who . . . in good faith renders emergency care or treatment . . . shall not be held liable” for damages. Read the whole law here.

But too few Americans have CPR training, the AHA reports.

A Simple Technique

Formal training, which typically involves practicing on a dummy, is preferable to reading about the technique, doctors say.

“You can certainly learn a lot by reading it online, and you can certainly watch videos and understand and learn the technique, but, ultimately, the best thing is to actually get into a class so you can actually practice,” Dr. Jayne Morgan, a cardiologist at Piedmont Healthcare in Atlanta, told NBC News.

The Cleveland Clinic’s Dr. Michael Emery, a sports cardiologist there, told USA Today that CPR is “the most profound, life-changing thing you could potentially learn and do for someone.”

If you’re interested in someday possibly saving a life, you can find CPR classes near you here.

And if you find yourself in a situation where you need to perform CPR, the AHA recommends doing chest compressions at a rate of 100 to 120 per minute, but in the throes of trying to save a life, it can be difficult to count the precise beats needed to keep up the correct rhythm.

So the AHA created a playlist of over 50 familiar songs on Spotify to help bystanders maintain the beat. Click here to listen!

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