running

Does Running Really Ruin Your Knees?

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

Our primary care concierge doctors in Jupiter have heard it for years: “I don’t run because I don’t want to wreck my knees.” Intuitively, that makes sense. The argument goes something like this: When you run, each time the foot hits the ground, the body experiences a force equal to eight times body weight, and that will eventually cause osteoarthritis.

The good news is that study after study confirms that’s not the case; in fact, the opposite appears to be true: regular running actually strengthens cartilage, according to experts.

Counterintuitive Findings

One 2020 Stanford University study on the effect of running on knees found that for young, healthy individuals, such exercise appears to trigger an anti-inflammatory reaction in the joints.

“In fact, a normally functioning joint can withstand and actually flourish under a lot of wear,” the study’s lead researcher, James Fries, told Time magazine. Fries is a professor emeritus of medicine at Stanford.

He explained that cartilage—the soft connective tissue that surrounds the bones in joints—doesn’t contain arteries that deliver blood along with its rejuvenating dose of oxygen and nutrients. As a result, cartilage depends on movement to obtain needed nourishment.

“When you bear weight,” he said, “[the joint] squishes out fluid, and when you release weight, it sucks in fluid,” thereby delivering the nutrients necessary to build new cartilage.

What Other Research Says

Studies on this issue go back decades. For example, in 1971, researchers began to look at the children and spouses of the famous Framingham, Mass., Heart Study. Called the Framingham Offspring Cohort, 1,279 volunteers enrolled in a study of exercise and arthritis. The results of the study showed no link between jogging and arthritis.

The results of other studies went even further, appearing to actually show improvement in runners’ knees from their avocation, as the Stanford study found.

A 2008 Australian study found that subjects who engaged in vigorous exercise had knee cartilage that was thicker and healthier than those who didn’t exercise routinely.

In another study, published in the Journal of Orthopedic and Sports Physical Therapy in 2017, 10 percent of those who weren’t runners developed osteoarthritis in their knees or hips over the course of the study, while only 3.5 percent of runners did so.

Again echoing the Stanford results, another 2017 study, published in the European Journal of Applied Physiology, found that running decreased inflammation in the knees of study subjects, suggesting that running was a kind of medicine for those who were experiencing knee pain.

Overall Health Benefits

And running, along with other vigorous aerobic activities, provides whole-body benefits not confined just to the knees.

One study published in JAMA in 2008 followed members of a running club, comparing them with healthy non-runners, all of whom were over 50 at the beginning of the study. After 21 years, the researchers found that more of the runners than non-runners were still alive, as well as reported much less disability than those in the non-running group.

Another study confirming the health benefits of aerobic exercise such as running was published last month in the journal JAMA Network Open, conducted by the Division of Nutrition, Physical Activity, and Obesity at the Centers for Disease Control and Prevention (CDC).

Researchers found that doing between 10 and 300 minutes of aerobic exercise a week was associated with a 24 percent lower risk of death from any cause than exercising less than 10 minutes a week.

Another 2018 study, published in JAMA, produced similar results. 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 that 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.

Some Cautions

Does this mean everyone should lace up their sneakers and head for the trails? Not necessarily.

Mark Harrast, medical director of the Sports Medicine Center at the University of Washington, told HuffPost that running could cause damage in the knees of people who have already experienced trauma to knee cartilage.

“If you have cartilage damage from an injury, such as skiing, a torn meniscus, or a blown-out ACL, and if you run regularly and overuse it, that’s a set-up for arthritis,” he said.

Other reasons you might not want to take up running include having a family history of arthritis, or being overweight or over the age of 50.

Running, even for young, healthy people, though, is not without some risks, including the possibility of stress fractures and soft-tissue injuries. But with sensible safeguards, these issues can generally be prevented. 

Precautions include wearing a proper pair of running shoes, matched to your gait and foot size.

In addition, before you begin each run, always warm up with long, slow stretches to get the blood flowing. 

As with any form of exercise, you need to build up to full speed gradually. And have any pain you experience evaluated early to prevent further injury.

As long as you pace yourself and take it easy, there’s no reason you can’t enjoy the proven health benefits and euphoria of the “runner’s high.” Just be sure to check with us if you’re just starting out.

belly fat

From Fat Belly to Flat Belly: 3 Effective Ways to Slim Down

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

You think you’re doing all the right things: exercising, eating healthy, and keeping your weight in check. So why do you look down and see that bulge hanging over your belt line?

Our concierge primary care doctors in Jupiter can’t promise that the following tips will give you a washboard abdomen, but we do know that you can at least reduce the problem area if you know what causes it and, therefore, how to combat it.

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vit d

Vitamin D: Is It the ‘Cure-All’ Vitamin?

Health Basics, Healthy Living, Lifestyle, Medications, Nutrition, Preventative Health

Studies surrounding vitamin D can be conflicting, often leading to confusion on the part of our patients. So our concierge primary care doctors in Jupiter thought we’d take a look at some of the newest findings about this essential vitamin.

Dueling Conclusions

As an example of how different researchers can draw opposite conclusions even from the same study, one doctor recently wrote in The Washington Post that a study she led “found no statistically significant reduction in cardiovascular disease or cancer” in a nationwide randomized trial of 26,000 adults over five years.

Furthermore, she wrote, “My colleagues and I have conducted further studies from VITAL [the study’s title] showing that vitamin D supplements do not decrease the risk of cognitive decline, depression, macular degeneration, atrial fibrillation or several other health conditions. The most recent report showed no reduction in the rate of bone fractures—once the vitamin’s most commonly touted benefit.”

She concluded that the vast majority of Americans are already getting all the vitamin D they need from brief sun exposure and a normal diet.

“Is it necessary for you to spend money on the supplement? For most healthy adults, the answer is no,” JoAnn Manson wrote in The Post.

However, this same researcher told the Harvard Gazette in January of this year that the VITAL study showed subjects who took vitamin D, or vitamin D and omega-3 fatty acids, had a significantly lower rate of autoimmune diseases such as rheumatoid arthritis and psoriasis than those who took a placebo.

“Given the benefits of vitamin D and omega-3s for reducing inflammation, we were particularly in whether they could protect against autoimmune diseases,” she said.

More Confusion

So maybe the vitamin has some value after all, at least for some.

Yet in 2018, another study published in the National Institutes of Health’s (NIH) National Library of Medicine looked at the prevalence of vitamin D deficiency in the U.S. population. In the introduction, the study’s authors wrote that, “Since foods containing natural vitamin D are rare, the primary source of the compound remains . . . exposure to ultraviolet rays in sunlight.”

It went on to assert that “subclinical vitamin D deficiency . . . plays a role in downstream clinical consequences, including cardiovascular disease, cancer, diabetes, osteoporosis, and fractures.”

Why the frequent discrepancy among various studies? One 2020 clinical study published in the journal BMJ sought to answer that question. 

“Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the question of why vitamin D ‘worked’ in some trials, but not in others,” Adrian Martineau, a professor at Queen Mary University of London (QMUL) and a lead researcher on the study, wrote in a release.

Those who have the lowest levels of vitamin D in their blood seem to show the largest benefit, he said, along with those who took it daily or weekly, as opposed to intermittently.

The Last Word?

A fact sheet on vitamin D produced by the NIH’s Office of Dietary Supplements (ODS) updated last month summarized numerous studies, including the VITAL study.

For each of the most common health claims connected to vitamin D it reached the following conclusions:

Bone health – All adults should consume recommended amounts of vitamin D and calcium from foods and supplements.

Cancer – Taken together, studies to date do not indicate that vitamin D with or without calcium supplementation reduces the incidence of cancer, but adequate or higher levels might reduce cancer mortality rates.

Cardiovascular disease (CVD) – Overall, clinical trials show that vitamin D supplementation does not reduce CVD risk, even for people with low levels as measured in their blood.

Depression – Overall, clinical trials did not find that vitamin D supplements helped prevent or treat depressive symptoms or mild depression, especially in middle-aged to older adults who were not taking antidepressants.

Type 2 diabetes – Clinical trials provide little support for the benefits of vitamin D supplementation for glucose homeostasis.

Weight loss – Overall, the available research suggests that consuming higher amounts of vitamin D or taking vitamin D supplements does not promote weight loss.

And although the COVID-19 pandemic sparked hope that vitamin D could help prevent or reduce the severity of the illness, two new clinical studies released this month found that it didn’t help with the coronavirus or any other type of respiratory virus.

Vitamin D Overdose?

According to the NIH, the recommended daily allowances for vitamin D are:

  • 0-12 months: 10 mcg (400 IU)
  • 1-70 years: 15 mcg (600 IU)
  • >70 years: 20 mcg (800 IU)

And while many people who supplement with vitamin D take much higher doses than that, too much can be dangerous. Vitamin D is a fat-soluble vitamin, which means it tends to be stored in the body’s fat and can lead to accidental overdoses. 

The upper limit of safety appears to be 100 mcg (4,000 IU) daily.

Those who take more than that could experience side effects from supplementing with vitamin D, including nausea and vomiting, constipation, weakness, and kidney damage, among others.

Overall, most studies seem to show that supplementing with vitamin D doesn’t have much effect on various conditions. On the other hand, moderate doses from a reputable manufacturer are generally considered safe. So if you think you could benefit from vitamin D supplements, the decision is up to you.

vaccine

Latest on COVID-19 Omicron Boosters

, , , , COVID, Disease, Lifestyle, Preventative Health, Vaccinations

The Centers for Disease Control and Prevention (CDC) earlier this month approved two new booster vaccines specifically formulated to target the BA.4 and BA.5 omicron subvariants of the SARS-CoV-2 coronavirus, so our primary care concierge doctors in Jupiter want to bring you up to date on the latest information.

What’s different about this vaccine?

The COVID-19 vaccines that have been in use since they were first rolled out in 2021 were all designed to target the original strain. They also effectively reduced hospitalizations and deaths against the different variants that emerged in the following months, including the widespread delta variant.

As the newest omicron subvariants emerged and are now responsible for 90 percent of COVID-19 infections, vaccine makers Pfizer-BioNTech and Moderna developed new, more tailored versions to specifically target them.

The new formula is defined as “bivalent,” meaning it protects against both the original strain as well as the highly contagious BA.4 and BA.5 subvariants. They are the first updated COVID-19 vaccines to be cleared by the U.S. Food and Drug Administration (FDA).

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” said CDC director Rochelle Walensky.

“They can help restore protection that has waned since previous vaccination and were designed to provide broader protection against newer variants,” she added. “This recommendation followed a comprehensive scientific evaluation and robust scientific discussion.”

Tests in mice have shown they produce a good immune system response to omicron’s BA.4 and BA.5 subvariants.

Are they safe?

Some have questioned the safety of the new versions of the shots because they haven’t been tested in humans, only in mice. But the new vaccines have merely been “tweaked” to “change the recipe,” as the University of Colorado’s UCHealth website explains.

The original Pfizer and Moderna vaccines have been fully tested in humans, and more than 600 million doses in the U.S. and millions more around the world have been given safely. The advisors and experts at both the FDA and the CDC have determined that the newly formulated booster shots are safe.

UCHealth infectious disease and COVID-19 expert Dr. Michelle Barron compared the new boosters to the flu shot, which is updated every fall as vaccine makers guess which strains of the flu will be circulating, and change the recipe to match. But the vaccine itself is not entirely new, she explained.

“We don’t test the flu shot each year. We just change it slightly,” Barron said.

“This new COVID-19 booster just tweaks the formula. The technology is the same. The safety of the vaccines will be exactly the same because it’s not a new vaccine,” she explained.

Who can get them?

The Pfizer vaccine is authorized for anyone ages 12 and older; the Moderna vaccine is authorized for adults 18 and older.

Like the previous coronavirus vaccines, the new boosters are free to the public. They will be available to anyone who has already had their primary vaccine series from any authorized U.S.-approved company regardless of how many boosters they’ve already received.

Public health officials recommend that those who are pregnant or have been pregnant recently should also get the updated boosters because they are at a slightly increased risk of more severe illness and death from COVID-19.

For those who recently received a booster of the previous vaccines, the FDA has set a minimum waiting period at two months, but advisers to the CDC recommend waiting longer: at least three months for those at high risk, or as long as six months for everyone else.

It’s also recommended that anyone who has recently recovered from a COVID-19 infection should wait at least three months to be vaccinated, not only to boost the effects of the vaccine but also to avoid the possibility of a rare side effect, heart inflammation, that sometimes affects teen boys and young men.

“If you wait a little more time, you get a better immunologic response,” CDC adviser Dr. Sarah Long of Drexel University told CBS News.

According to the CDC, side effects are expected to be similar to those associated with the current vaccine, including headache and muscle soreness, occasional fatigue, and redness and swelling at the injection site.

What about other vaccines?

As we head into the fall flu season, several of our clients have asked whether they can get a coronavirus vaccine along with a flu vaccine. The answer is yes, one in each arm.

In fact, health officials have recommended this protocol, and the government is preparing to launch a campaign that will urge Americans to do just this, due to the possibility of the high spread of flu and COVID-19 this season.

As for the Jynneos monkeypox vaccine, the CDC suggests that adolescent and young adult men consider waiting four weeks after receiving the monkeypox vaccine before receiving a Moderna, Novavax, or Pfizer COVID-19 vaccine, because of the risk of inflammation of the heart muscle (myocarditis) or inflammation of the tissue surrounding the heart (pericarditis).

However, the agency adds that the monkeypox vaccination “should not be delayed” due to recently receiving a coronavirus vaccine.

If you have any questions about whether or not to get the new booster, don’t hesitate to contact us for advice.

organic

Some Common Questions About Organic Foods

Environment, Healthy Living, Lifestyle, Nutrition

Our concierge primary care doctors in Jupiter of course want our patients to eat healthy foods as much as possible.

This typically means a diet low in processed foods and high in fresh fruits, vegetables, nuts, and seeds, along with lean meats and fish.

Does it also mean eating organic foods as well? Many people hear the word “organic” and automatically think it equals “healthy,” but that may not always be the case. So let’s try to clear up the confusion around this widely available—and usually much more expensive—food.

What does the term “organic” mean?

The word “organic” refers to the way the food is grown and processed. The U.S. Department of Agriculture (USDA) has created a set of standards that describe the specific requirements that must be verified by a USDA-accredited certifying agent before products can be labeled organic.

The National Organic Program (NOP), an advisory committee that includes members of the public, develops these rules and regulations for the USDA.

They include several restrictions on farming practices and raising livestock and poultry, as well as on handling and labeling.

In general, the regulations restrict the types of pesticides, fertilizers, and seeds that can be used, and ensure healthy farming practices to protect the environment.

To receive the USDA Organic seal, a product must:

Improve soil and water quality.
Enable farm animals’ natural behaviors.
Cut pollution.
Promote a self-sustaining cycle of resources on a farm.

Certified organic products cannot use:

artificial fertilizers or sewage sludge as fertilizer
radiation to preserve food or get rid of pests or diseases
genetically modified or engineered materials to improve crop harvests or improve pest or disease resistance
antibiotics or growth hormones for livestock
most synthetic pesticides (except in special, USDA-approved circumstances)

Is organic food healthier?

You can find all kinds of persuasive arguments and testimonials online about how organic food is so much healthier for you to eat.

It’s certainly healthier for the environment, because of the sustainable practices organic farmers use.

It’s also undeniably better to avoid products from animals that have been fed antibiotics throughout their lifecycle to promote unnatural growth and suppress diseases that occur from overcrowded conditions. This is one of the things that contribute to antibiotic resistance in humans.

Other than that, though, science has so far not been able to prove that organic foods contain more substantial nutrients than conventionally grown foods.

As reported by Harvard Health, one meta-study by Stanford researchers, for example, found little difference in nutritional content, except for slightly higher phosphorus levels and a higher omega-3 fatty acid content in organic milk and chicken. And the bacteria that can cause food poisoning were equally present in both organic and non-organic foods.

And according to the Mayo Clinic, studies have shown much lower cadmium levels in organically grown grains, but not fruits and vegetables. Cadmium is a toxic chemical found naturally in the soil and absorbed by plants as they grow.

Is the label ‘organic’ a guarantee?

If the food contains the USDA Certified Organic label, that means it was grown and processed according to federal guidelines.

According to the USDA, “Produce can be called organic if it’s certified to have grown on soil that had no prohibited substances applied for three years prior to harvest. Prohibited substances include most synthetic fertilizers and pesticides.

“As for organic meat, regulations require that animals are raised in living conditions accommodating their natural behavior (like the ability to graze on pasture), fed 100 percent organic feed and forage, and not administered antibiotics or hormones.”

The agency performs more than 45,000 onsite inspections per year to ensure compliance with regulations. If foods are labeled “100 percent organic,” that means all ingredients are certified organic. Foods labeled “organic” contain at least 95 percent certified organic ingredients.

On the other hand, labels that say “made with organic” or “organic ingredients” can’t carry a USDA seal, because they contain less than 95 percent organic ingredients.

More confusion in labels

In addition, there is a difference between “organic” and “natural” on a product’s label. The term “natural” may simply refer to products or animals that have been minimally processed and contain no artificial ingredients, but that doesn’t mean they’re organic.

Another confusing term is “grass-fed,” which means animals receive a majority of their nutrients from grass throughout their entire life and have continuous access to pasture during the growing season. It does not mean they have been raised without the use of antibiotics, hormones, or pesticides on their feed.

Likewise, “cage-free” birds are able to freely roam a building, room, or enclosed area with unlimited access to food and fresh water during their production cycle. “Free-range” birds are provided shelter in a building, room, or area with unlimited access to food and fresh water, as well as continuous access to the outdoors during their production cycle. But neither of these terms reveals whether they have been raised without antibiotics or hormones.

So is organic better for you? In some of the ways we’ve listed above, yes. But only you can decide whether the extra expense is worth the small gains in nutritional value, as well as the larger impact on the environment and the animal’s welfare.

Coronavirus Pandemic

New Guidance on COVID-19 Can Be Confusing

, , , , , , COVID, Disease, Health Basics, Healthy Living, Lifestyle, News, Preventative Health, Vaccinations

Sometimes it seems as though we need a spreadsheet to keep track of all the changing information and recommendations on COVID-19.

  • Masks/no masks?
  • Boosters? Maybe not, maybe now, maybe later.
  • Quarantine? Yes, no, who, and how long?

Our primary care concierge doctors in Jupiter don’t mean to criticize the researchers and public officials who are responsible for keeping us healthy. The SARS-CoV-2 coronavirus is, after all, a disease we’d never seen until early in 2019. No one knew how to deal with it.

And thanks to the combined efforts of scientists around the world, we’ve made tremendous strides in the effort to combat it.

But one thing few counted on was “pandemic fatigue,” which meant many people rapidly grew tired of taking precautions and radically altering their lifestyles to help stem the spread of COVID-19.

Which may be what’s behind the latest guidance from the Centers for Disease Control and Prevention (CDC). (https://www.cdc.gov/media/releases/2022/p0811-covid-guidance.html) 

A new approach

This month the CDC relaxed many of its coronavirus recommendations, leaving measures to battle to limit viral spread largely up to individuals.

According to The Washington Post:

  • “No longer do schools and other institutions need to screen apparently healthy students and employees as a matter of course.
  • “The agency is putting less emphasis on social distancing—and the new guidance has dropped the ‘six-foot’ standard.
  • “The agency’s focus now is on highly vulnerable populations and how to protect them—not on the vast majority of people who at this point have some immunity against the virus and are unlikely to become severely ill.”

In releasing the new guidance, the CDC cited improved tools like vaccination, boosters, and treatments to better protect ourselves from the virus.

“We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation,” Greta Massetti, a CDC epidemiologist, said in a statement.

“This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives,” she added.

Isolation changes

In one fairly substantial shift, for example, the CDC no longer recommends quarantine if you’re up to date with your vaccines and have been exposed to COVID-19. Instead, you should mask for 10 days and get tested on Day Five.

Additional CDC guidance on isolation includes the following:

  • If you’ve tested positive and have a healthy immune system, regardless of your vaccination status, you should isolate yourself for five days. On Day Six, you can end isolation if you no longer have symptoms or have not had a fever for 24 hours and your symptoms have improved.
  • Once isolation has ended, you should wear a high-quality mask through Day 10. If you test negative on two rapid antigen tests, however, you can stop wearing your mask sooner.
  • Until Day 11 at least, you should avoid visiting or being around anyone who is more likely to have severe outcomes from COVID-19, including the elderly and people with weakened immune systems.

These changes stem from a new statistic, according to Massetti: 95 percent of the U.S. population has at least some level of immunity against the virus, either from vaccination or previous infection.

What about boosters?

As for booster shots, the U.S. Food and Drug Administration (FDA) finally decided last month against allowing adults younger than 50 to become eligible for a second booster vaccine (for a total of four mRNA shots).

Currently, only those age 50 and older and children at least 12 years old with impaired immune systems can get a second booster.

This is because the agency expects to have reformulated mRNA boosters available by next month that will contain components from both the original virus and its variants, as well as from the currently circulating (and highly contagious) omicron subvariants BA.4 and BA.5.

Meanwhile, the FDA still recommends that anyone under age 50 receive a single booster shot, and people older than 50 or those with weakened immune systems receive a second mRNA booster.

The mask question

No one likes wearing masks, especially in the heat. However, our primary care concierge doctors believe it’s better to err on the side of caution, especially if you’re immunocompromised or older than 65.

Especially given the new CDC guidance revisions, there’s no harm in wearing a mask in crowded indoor situations with poor ventilation.

It’s true that we now have effective treatments for COVID-19, but given the risk of long COVID—one recent study found that as many as one in every eight people who contracted it had lingering symptoms—what’s the point in taking unnecessary chances?

It’s up to you, of course, but in a recent interview with The Post, Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, compared the current state of the country to “the Wild West.”

“There are no public health measures at all,” he told the paper.

“We’re in a very peculiar spot, where the risk is vivid and it’s out there, but we’ve let our guard down and we’ve chosen, deliberately, to expose ourselves and make ourselves vulnerable.”

Lightning

Lightning: Deadly But Avoidable

Holiday Safety, Lifestyle

Labor Day is coming up, signaling the unofficial end of summer. Kids will be heading back to school and families will be trying to get as much outdoor fun into the waning days of the season as possible.

But as you go about your last-minute recreation, there’s a rare but deadly danger that our concierge primary care doctors in Jupiter want to warn you about: lightning.

Our state is known as the “Lightning Capital of the U.S.” More people die from lightning strikes in Florida every year than in any other state, and the southeastern coast of the state is second only to the Tampa area in reported fatalities.

That’s why we want to remind you that these tragic deaths can be prevented, as long as you know how to avoid them.

Recent deaths

Lightning kills an average of 23 people every year. So far this year, 12 people have been killed by lightning, including a 27-year-old man doing lawn maintenance in New Smyrna Beach, Florida, and a soldier on a training exercise at Fort Gordon, Georgia, both in July.

The most recent deaths occurred this month in Washington, D.C., in Lafayette Park just north of the the White House, as the victims huddled under a tree for protection from a sudden severe thunderstorm.

One was a 29-year-old bank vice president in town on business. The others were a Wisconsin couple celebrating their 56th wedding anniversary. All three were killed, while another woman who was also struck remains in critical condition.

They were struck by an unusual six-prong bolt that hit the same place within half a second, creating a ground current.

According to the National Weather Service (NWS), “When lightning strikes a tree or other object, much of the energy travels outward from the strike in and along the ground surface.”

“This is known as ground current. Anyone outside near a lightning strike is potentially a victim of ground current,” the agency adds.

Five potential paths 

A ground current discharge is one of five ways people can by struck by lightning.

The five are:

Direct strike – These most often occur to victims who are in open areas. While the most deadly type, it’s not as common as the other four.

Side flash – Also called a “side splash,” these occur when lightning strikes a taller object near the victim and a portion of the current jumps from the taller object to the victim.

Ground current – This type, mentioned above, causes the most lightning deaths and injuries, including to farm animals. 

Conduction – Lightning can travel long distances in wires or other metal surfaces, because the metal provides a path for the lightning to follow. This type is the way most people are killed indoors during a lightning storm, including when they’re taking showers, washing dishes, or talking on corded phones. 

Streamers – While uncommon, streamers can injure or kill when a side bolt separates or rebounds from the main or leader bolt and discharges.

Lightning safety rules

To stay safe from lightning, the NWS offers these guidelines to avoid being struck by lightning.

  • Appoint someone to watch the skies during your outdoor work or recreation. Check the latest thunderstorm forecast and monitor the NOAA Weather Radio.
  • When lightning is in your vicinity, go quickly inside a completely closed building. Do not consider carports, open garages, covered patios, or pavilions adequate shelter.
  • If no closed building is convenient, get inside a hard-topped, all-metal vehicle and be sure the windows are completely closed.
  • Do not take shelter under a tree, especially if it is tall and isolated.
  • Get out of the water. This includes pools, lakes, rivers, oceans, water rides, and even puddles. And leave the beach immediately if you see or hear a thunderstorm approaching.
  • Put down metal objects such as fishing poles, golf clubs, tennis rackets, tools, etc.
  • Dismount from tractors and heavy construction equipment. Do not seek shelter under the equipment.
  • Move away from metal objects such as metal fences, metal sheds, telephone and power lines, pipelines, etc.

Indoor safety

  • Avoid contact with corded phones.
  • Avoid contact with electrical equipment or cords. If you plan to unplug any electrical equipment, do so before the storm arrives.
  • Avoid contact with plumbing. When thunderstorms are occurring, do not take a shower or bath, wash dishes, or do the laundry.
  • Move away from windows and doors. Do not stay on the porch.

If someone is struck

Call 911 immediately.

  • Determine whether the victim is unconscious. Check to see if they are breathing, and gently roll the victim onto their back.
  • If the victim is not breathing, perform CPR until the paramedics arrive. (A reminder: Mouth-to-mouth breathing is no longer recommended to revive someone; regular chest compressions—between 100 and 120 a minute—are more effective.)
  • Always keep in mind the NWS directive: When thunder roars, go indoors.
pfas

How to Combat the Lingering Danger of ‘Forever Chemicals’

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

They’re called “forever chemicals” because they don’t break down fully in the environment, and this summer the Environmental Protection Agency (EPA) warned that they are more dangerous to human health than regulators knew.

Within weeks, the National Academies of Sciences, Engineering, and Medicine (NAS) weighed in with its own 300-page report on these chemicals, known as perfluoroalkyl and poly-fluoroalkyl (PFAS) substances, urging doctors to test high-risk patients for PFAS contamination.

Because of the heightened attention on these chemicals, our primary care concierge doctors in Jupiter want to summarize for you what we’ve learned about them, and offer tips on how to reduce your exposure.

The Problems with PFAS

In 1946, DuPont introduced its revolutionary non-stick product, Teflon. By 1950, studies by DuPont and 3M showed that PFAS could build up in the blood, but chose to keep these results secret, according to the non-profit Environmental Working Group (EWG).

Since 1998, when a class-action lawsuit against a West Virginia DuPont factory revealed the extent of the pollution from the factory, researchers have found probable links to such diseases as:

  • thyroid disease
  • high blood pressure
  • kidney cancer
  • testicular cancer
  • breast cancer
  • higher cholesterol levels
  • ulcerative colitis
  • weakened immune system 
  • vaccine interference
  • weight gain
  • changes in liver enzymes
  • decreased fertility
  • growth and learning delays in infants and children

The NAS report encourages doctors to conduct blood tests for these chemicals on patients who are worried about exposure or who are at high risk for exposure or who are in “vulnerable life stages”: during pregnancy, early childhood, and old age. 

They’re Everywhere

As we’ve seen with microplastics, PFAS can begin innocently enough and end up in unexpected places, including our water.

Recently, for example, Consumer Reports (CR) tested more than 100 food-packaging products from U.S. restaurants and supermarkets. They found dangerous PFAS chemicals in many of the products, including paper bags for french fries, hamburger wrappers, pizza boxes, molded fiber salad bowls, and single-use paper plates.

These chemicals are used in a wide variety of products, including waterproof and sweatproof makeup, nonstick cookware, cellphones, waterproof clothing, carpets, and—especially—fast-food containers, where their ability to make products grease-proof has led to their widespread use.

They are also used to make products water-repellent and resistant to high temperatures, as well as in fire-fighting foams used at military installations, floor wax, upholstery, and clothing. The qualities that make items containing PFAS so desirable, however, also make them long-lasting in the environment.

Lingering Threat

“These chemicals are ubiquitous in the American environment,” Ned Calonge, an associate professor of epidemiology at the Colorado School of Public Health and chair of the NAS committee that wrote the report, told CNN.

“More than 2,800 communities in the U.S., including all 50 states and two territories, have documented PFAS contamination,” he said.

Researchers have even detected them in the snows of Mt. Everest, apparently shed from climbers’ waterproof tents and parkas. 

“You are not just exposed in one place or one source,” toxicologist Linda Birnbaum, former director of the National Institute of Environmental Health Sciences and the National Toxicology Program, told The Washington Post. “They are everywhere.”

The problem is that these chemicals build up (or “bioaccumulate”) in the body over time. 

And according to the Centers for Disease Control and Prevention (CDC), which has been conducting studies of the U.S. population, PFAS has been found in the blood of nearly all people they’ve tested. Since the risk appears to rise with the amount of exposure, it’s important to try to limit the amount we come in contact with.

What You Can Do

Because PFAS chemicals are found in so many consumer products, they’re next to impossible to avoid. But there are ways to reduce the amount you’re exposed to.

“The most dangerous way that people are exposed to PFAS is through drinking water,” says Don Huber, director of product safety at CR.

That’s why the NAS report recommended filtering tap water as a major step consumers could take to protect themselves.

“The water filters that are most effective for PFAS are reverse osmosis filters,” David Andrews, a senior scientist for the EWG, told CNN, adding that some carbon-based filters can also reduce some levels.

“The important part is that you have to keep changing those filters,” he said. “If you don’t change that filter, and it becomes saturated, the levels of PFAS in the filtered water can actually be above levels in the tap water.”

The NAS committee also offered these tips:

  • Stay away from stain-resistant carpets and upholstery, and don’t use waterproofing sprays.
  • Look for the ingredient PTFE or other “floro” ingredients on product labels.
  • Avoid nonstick cookware. Instead, use cast-iron, stainless steel, glass, or enamel products.
  • Boycott takeout containers and other food packaging. Instead, cook at home and eat more fresh foods.
  • Don’t eat microwave popcorn or greasy foods wrapped in paper.
  • Choose uncoated nylon or silk dental floss or one that is coated in natural wax.
monkeypox

Why Monkeypox Is Not Like COVID-19

COVID, Disease, Lifestyle, News, Uncategorized, Vaccinations

Last month, the World Health Organization (WHO) declared the newly spreading monkeypox virus a global health emergency.

This has prompted many to fear we’re heading into another coronavirus situation, as our concierge primary care doctors in Jupiter have found from talking with our patients.

While this is a debilitating, painful, and—occasionally—deadly virus, there are many reasons why it’s very dissimilar to the SARS-CoV-2 virus, the virus that causes COVID-19.

The history is different

Although both originated as “zoonotic” diseases—that it, they began in animals and spread to humans—we have a far longer history with monkeypox, meaning we know more about it than we did when the coronavirus first appeared.

According to the Centers for Disease Control and Prevention (CDC), monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thereby giving the disease the name “monkeypox.” Its typical animal hosts, however, are rodents and other small mammals.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in humans in other central and western African countries.

Although relatively new to the U.S., a large monkeypox outbreak occurred here in 2003 as a result of imported rodents.

Transmission is different

Next, the ways the two viruses are transmitted are completely different.

Unlike the largely airborne transmission of SARS-CoV-2 through aerosols that linger in the air, the monkeypox virus can only be spread through close contact with an infected person or animal, or materials such as bedding or towels that are contaminated with the virus.

In addition, monkeypox appears to be far less transmissible than COVID-19. One study found that just three percent of those in close contact with an infected person would develop monkeypox.

It appears at this time to be spreading primarily among gay and bisexual men following sexual encounters, but anyone who comes into close and prolonged, direct contact with the pox sores can become infected.

Even women, and at least two children, have been reported to have contracted monkeypox, as a result of being in close proximity to men who have sex with other men.

The symptoms are different

Unlike the stealth infections of the coronavirus, it’s very apparent when a person is infected with monkeypox. As with COVID-19 and other viruses, they develop fever, headache or body aches, chills, muscle aches, and exhaustion.

These symptoms are also similar to those of smallpox, a cousin of monkeypox, with one difference:

“A feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes,” the CDC says.

Otherwise, however, both smallpox and monkeypox exhibit the same signature fluid-filled lesions (the so-called “pox”), which the coronavirus doesn’t produce. Some individuals have these sores all over the body, while others may have only a single lesion. This rash can be extremely painful.

The vaccines are different

When COVID-19 first appeared two-and-a-half years ago, it was a brand new virus (i.e., “novel” coronavirus).

We knew nothing about it, and at the time had no way to combat it in the form of either effective treatments or vaccines.

Because of our long history with monkeypox, however, we do have vaccines and antiviral treatments. Monkeypox and smallpox come from the same family of viruses (although monkeypox is not as severe as smallpox). That has allowed us to utilize the stockpile of smallpox vaccines and antivirals to fight monkeypox.

And, unlike the coronavirus vaccines, the vaccines for monkeypox are effective even after infection, if given within four days of exposure. Even if the vaccine is given as late as two weeks after exposure, it can still lessen the likelihood of severe illness.

Not to worry?

Does all this mean we don’t have to panic about monkeypox? Panic is never a good idea because it prevents thoughtful responses in a crisis. But at this time the monkeypox outbreak still appears to be confined largely to men who have sex with men and those who are closest to them and who may come in contact with the open sore or infected linens.

If you fall into one of those categories, it’s important to take precautions until the supply of vaccines and antivirals becomes sufficient to cover everyone at high risk of exposure, because cases are spreading rapidly in the U.S. At the end of July, the Centers for Disease Control and Prevention (CDC) reported more than 3,500 confirmed cases but noted that is probably a significant undercount.

Experts advise that, if you’re at risk, you temporarily reduce your number of sexual partners, reconsider sex with new partners, and exchange contact details with any new partners to enable follow-up, if necessary.

Infected people are encouraged to self-isolate from other humans as well as pets, and to wear a mask and long clothing over any sores.

Although there is currently a limited supply of vaccines in the U.S., the government has purchased 2.5 million doses, which should be available in the coming weeks. This means it isn’t yet enough available to offer shots to all high-risk individuals.

So until there is, take precautions, and let us know if you think your symptoms might be those of monkeypox. It’s a painful, debilitating, and sometimes deadly disease, but we can treat it if it’s caught in time.

health benefits of coffee

Coffee Scores Another Win for Improving Health

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

Besides water, our primary care concierge doctors in Jupiter are hard-pressed to think of another beverage that offers such a wide range of health benefits as coffee.

For example, research has found that regular coffee consumption has been linked to a lower risk of: 

  • heart disease and strokes
  • heart failure
  • melanoma
  • diabetes
  • liver and prostate cancer
  • Parkinson’s disease

Evidence piles up

Studies have also found that the caffeine in two cups of coffee a day provides significant protection against Alzheimer’s disease, as well as other types of dementia. A study released last year, for example, found that individuals who drank four to six cups of coffee or tea a day reduced their risk of stroke and dementia by 28 percent compared to those who did not drink either beverage.

Another study, published last year in the journal BMC Public Health, found that those who drink three to four cups of coffee a day (whether ground, instant, caffeinated or decaf) reduced their risk of chronic liver disease by 21 percent, compared with those who didn’t drink coffee at all.

A third study, also published last year in the American Heart Association (AHA) journal Circulation, found that drinking one or more cups of plain, caffeinated coffee a day was associated with a long-term reduced risk of heart failure.

The AHA researchers found that the risk of heart failure dropped between five percent and 12 percent for each cup of black coffee the subjects drank. The risk declined even more, to 30 percent, when subjects drank two or more cups daily in one of the studies. The study found, however, that decaffeinated coffee did not offer the same benefit. 

“The association between caffeine and heart failure risk reduction was surprising,” senior author Dr. David Kao, medical director of the Colorado Center for personalized Medicine at the University of Colorado School of Medicine in Aurora, said in a statement.

“Coffee and caffeine are often considered by the general population to be ‘bad’ for the heart because people associate them with palpitations, high blood pressure, etc. The consistent relationship between increasing caffeine consumption and decreasing heart failure risk turns that assumption on its head,” he said.

Latest findings

The most recent research, published last month in the Annals of Internal Medicine, found that people who drink a moderate amount of coffee, defined as up to 3 1/2 cups a day, were up to 36 percent less likely to die from any cause over the seven-year period of the study than those who did not drink coffee.

It didn’t matter what type of coffee the subjects drank—ground, instant, caffeinated, or decaf—or even if they added a modest amount of sugar: The results were the same.

According to Johns Hopkins, there are also many other benefits from daily coffee consumption. For example:

  • Coffee may help your body process glucose better, meaning you may be less likely to develop type 2 diabetes.
  • Coffee may lower the risk of developing Parkinson’s disease, and help those who have it control their movements better.
  • Coffee can help lower your risk of colon cancer.
  • Drinking dark-roast coffee has even been shown to decrease breakage in DNA strands, which helps protect against various cancers.

Some coffee caveats

It’s typical with humans, however, to think that if something is good for you, more of it is better. That’s rarely the case, including with coffee.

The U.S. Department of Agriculture’s (U.S.D.A.) Dietary Guidelines for Americans recommend no more than 400 milligrams of caffeine a day. An average eight-ounce cup contains 95 milligrams of caffeine.

Several studies—including those outlined above—have found that five cups of coffee a day appears to be the upper limit of safety. In fact, a 2009 study found a 17-21 percent increased risk of death among those who drank four or more cups a day.

Other possible negative effects of too much coffee include:

  • increased blood pressure
  • headache
  • heartburn
  • dehydration
  • increased heart rate
  • abnormal heart rhythm
  • anxiety
  • dizziness
  • insomnia

In addition, a 2017 study found that pregnant women who drink more than four cups of coffee a day were more likely to experience low birth rate babies, preterm births, and stillbirths.

Another study linked coffee consumption with the possibility of increased bone loss in postmenopausal women if their diets lack sufficient calcium intake.

Finally, those who are sensitive to caffeine may experience many of these side effects with even small amounts of coffee. Older adults also may not be able to metabolize caffeine as well they did when they were younger.

And anyone who is taking certain drugs (like ephedrine, used in decongestants) can experience increased blood pressure, along with a higher stroke risk, when they consume coffee as well. 

But if you’re not caffeine-sensitive, and you don’t overdo it, our primary care doctors urge you to feel free to enjoy that third or fourth cup of the day without guilt.

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