Is a Neti Pot Right for You?

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

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.

What to Know About the New COVID-19 Variant

As our concierge primary care doctors in Jupiter have said more than once over the past couple of years, we may be done with COVID-19, but the coronavirus isn’t done with us.

It’s still spreading, it’s still sickening and killing people, and it’s still learning how to survive. That’s why the latest report from the Centers for Disease Control and Prevention (CDC) didn’t surprise many health experts.

Late last month the CDC estimated that about 40 percent of current cases of COVID-19 are caused by the latest omicron relative, known as XBB.1.5. In December, XBB.1.5 more than doubled its share of COVID-19 cases each week, rising from about four percent of new infections in the first week to about 41 percent by the end of the month.

“For a few months now, we haven’t seen a variant that’s taken off at that speed,” Pavitra Roychoudhury, director of COVID-19 sequencing at the University of Washington School of Medicine’s virology lab, told CNN.

Latest Mutation

Mehul Suthar, who studies emerging viral infections at the Emory University School of Medicine in Atlanta, told USA Today that XBB.1.5 appears to be about five times more contagious than earlier omicron variants, which were five times more contagious than the original virus.

“The numbers start adding up,” he told the paper.

For you who are trying to keep up with the “scrabble variants,” (so-named because these letters tend to produce higher scores in Scrabble) the XBB.1.5 is related to the XBB variant, which is a recombinant of the BA.2.10.1 and the BA.2.75 sublineages.

While scientists still aren’t sure whether the XBB.1.5 causes more serious illness than its predecessors, NBC News reports that studies performed in the lab have found that XBB appears to be more contagious.

“It’s clear that there are immune evasive properties of XBB,” Isaach Bogoch, an infectious disease physician and epidemiologist at the University of Toronto, told NBC News.

In other words, the virus is evolving to get around the antibodies we’ve built up from vaccines and infections with previous strains.

Improving its Abilities

CBS News reports that the XBB.1.5 variant also contains an additional mutation called S486P, which Chinese scientists say appears to offer a “greatly enhanced” ability to bind to cells. In addition, XBB is resistant to various monoclonal antibody drugs used to treat infections.

“The mutation is clearly letting XBB.1.5 spread better,” Jesse Bloom, a computational virologist at the Fred Hutchinson Cancer Center, told CNN.

“It’s got a better ability to get into cells,” Roychoudhury added.

“We’re projecting that it’s going to be the dominant variant in the Northeast region of the country and that it’s going to increase in all regions of the country,” Dr. Barbara Mahon, director of the CDC’s proposed Coronavirus and Other Respiratory Viruses Division, told CBS News.

The question is how much of this spread is due to XBB.1.5’s enhanced abilities and how much can be attributed to the increased travel and social gatherings over the holidays.

To Worry or Not?

Another looming question is whether it will make people sicker. The data so far are unclear.

While XBB.1.5 shows an ability to evade immunity, Bogoch told NBC News that even if cases begin to rise significantly, he doubts there’ll be the dramatic spike in hospitalizations or deaths we saw in previous waves.

In addition, other parts of the immune system can work to protect against the virus, and vaccines along with prior infections should offer some protection from severe disease.

“We might certainly have a wave, but it’s just much less likely to be as deadly or overwhelming to healthcare systems compared to earlier waves before we had this degree of hybrid immunity,” he said.

Still, experts worry that the falloff in vaccination boosters could create problems.

“We aren’t in 2020, but people still do need to take this seriously and protect themselves,” the CDC’s Mahon told NBC.

Get Protection

One way to protect yourself, which most people are resisting, is to wear masks in public because it’s safer to avoid getting infected at all, Suthar told USA Today.

“The ‘it’s OK if I get infected’ attitude is not the most viable,” he said, adding that he still wears a mask when in public indoor spaces.

And all of the experts are concerned that less than 15 percent of the population has received the latest boosters against the coronavirus. Although they aren’t designed for the XBB.1.5 variant, they will offer some degree of protection.

Michael Osterholm, who directs the University of Minnesota’s Center for Infectious Disease Research and Policy, told CNN he sees reason for hope from the updated bivalent boosters, which target the original coronavirus as well as the omicron strains BA.4 and BA.5.

“They still provide a level of immunity that may not prevent you from getting infected but may have a significant impact on whether you become seriously ill and die,” he said.

“I mean, right now, the most recent data we have shows that for those who have the bivalent vaccine, they have a three-fold lower risk of dying than those who don’t,” he added.

There’s a Reason Why You’re Feeling SAD

If you’ve been feeling down, sleepy, or hopeless, even with all the holiday merriment going on around you, our primary care concierge doctors in Jupiter want you to know you’re not alone. Health experts estimate that seasonal affective disorder (SAD), or the “winter blues,” affects about five percent of the U.S. population.

SAD is more than just the “winter blues,” according to the American Psychiatric Association (APA). The symptoms can be distressing and overwhelming, and can interfere with daily functioning, the APA reports. 

Affecting more than 10 million Americans, symptoms of the condition usually begin in October or November and begin to subside in March or April. However, some patients don’t feel fully back to normal until early May.

SAD may begin at any age, but it typically starts when a person is between the ages of 18 and 30 and seems to affect women more than men.

Symptoms

The APA lists the following symptoms associated with SAD:

  • fatigue, even with excessive amounts of sleep
  • weight gain associated with overeating and carbohydrate cravings
  • feelings of sadness or depressed mood
  • marked loss of interest or pleasure in activities once enjoyed
  • loss of energy
  • an increase in restless activity (e.g., hand-wringing or pacing)
  • slowed movements and speech
  • feeling worthless or guilty
  • trouble concentrating or making decisions
  • thoughts of death or suicide or attempts at suicide.

The severity of such symptoms can vary from person to person, and not everyone will experience all these symptoms.

Likely Causes

While no one is certain what causes SAD, the lower amounts of sunlight in fall and winter are believed to lead to a biochemical imbalance in the brain, impacting the body’s circadian clock, which triggers sleep and wake cycles.

This process affects the output of serotonin, the so-called “mood” hormone. Studies have shown that the circadian-related output of serotonin drops markedly with the decrease in light during the winter. It also increases the level of melatonin, a hormone secreted by the pineal gland that regulates the sleep cycle.

The cause of SAD may have an ancient survival connection, as humans learned to restrict activity when food sources were scarce. The tendency may still be hardwired into our biology, and people can experience symptoms on a sliding scale from barely noticeable to full-blown clinical depression.

Risk factors include a family history of SAD or another form of depression, having major depression or bipolar disorder, and having lower levels of vitamin D. Vitamin D is believed to promote serotonin production.

Treatment

SAD can be effectively treated in a number of ways, including through the use of light-box therapy, which employs specially built full-spectrum lamps to alleviate symptoms. The NIMH reports that this type of therapy has been a mainstay for treating SAD since the 1980s.

In this treatment, a person sits in front of a very bright lightbox (10,000 lux) every day for about 30 to 45 minutes, usually first thing in the morning, from fall to spring. The light boxes, which are about 20 times brighter than ordinary indoor light, filter out the potentially damaging UV light, making this treatment safe for most people.

However, those with certain eye diseases or people taking certain medications that increase their sensitivity to sunlight might need other treatment types.

Other approaches include the use of antidepressants such as Paxil and Prozac, or cognitive behavioral therapy (CBT), a type of talk therapy aimed at helping individuals learn how to cope with difficult situations. In addition, the U.S. Food and Drug Administration (FDA) has also approved another type of antidepressant specifically for SAD: bupropion. In extended-release form, it is taken daily from fall to spring to prevent major depressive episodes.

Self-care

Meanwhile, there are steps you can take to help mitigate milder cases.

1. Stay active outdoors

Exposure to early morning light has been shown to be the most effective at reducing symptoms, as has regular exercise. An early morning walk or run might be all you need to help alleviate your symptoms.

2. Let in the light

If you can’t get outside, at least let the sunshine in as much as possible. Open blinds and drapes first thing in the morning, and keep them open all day. If you can, arrange your home or office so you’re exposed to as much sunlight as possible during the day (but remember that the sun’s harmful UV rays can penetrate glass, so use sunscreen if you’re actually sitting in the sun all day).

3. Eat right

Simple carbs and sugars wreak havoc with your blood sugar, thereby affecting your mood. Lean meats, fruits, vegetables, nuts, and complex carbohydrates will help to keep your brain functioning properly.

4. Take it easy

Don’t try to do too much, which can add to feelings of being overwhelmed. Do what you can, and postpone the rest, or ask friends and family for help with your to-do list.

5. Stay connected

Studies have shown that connecting with others helps improve mood: volunteering, getting together with friends and family, and participating in group activities, are some possibilities.

If your symptoms are interfering with your daily life, let us know. We can help evaluate your symptoms and recommend the right therapy.

Are You Sick? How to Tell Which Virus You Have

As most of us have shed our pandemic masks in favor of returning to less restricted socializing, some of the viruses we didn’t have to deal with for the last two winters have resurfaced—with a vengeance.

According to the Centers for Disease Control and Prevention (CDC), seasonal flu activity is “elevated across the country.” The respiratory virus RSV is 10 times higher than normal, and more than 40,000 new cases of COVID-19 are being reported daily.

So if you’re sick, our concierge primary care doctors in Jupiter want to help you figure out which of these highly contagious viruses may be causing your symptoms, and what to do about them.

The ‘Tripledemic’

The flu season began six weeks earlier than normal this year, with at least 880,000 reported cases as of the end of October, including 6,900 hospitalizations and 360 flu-related deaths. This is the highest number recorded since the 2009 H1N1 swine flu pandemic.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early [there],” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News. So officials weren’t especially surprised when it hit early and hard here, too.

At the same time, the respiratory syncytial virus, or RSV, has been flooding children’s hospitals with cases. And while the media’s attention has largely been focused on children, RSV can also hit older adults and those who are immunocompromised.

Meanwhile, COVID-19 cases have leveled off, but as of the end of November, the CDC was reporting 281,000 new cases and 2,222 deaths a week, with cases expected to rise this winter.

And, of course, without universal masking, colds are also making a comeback. To make matters worse, it is possible to be infected with more than one virus at the same time.

Similar Symptoms

With all these viruses hitting at once, it’s doubly difficult to know which one you have, because all of them have overlapping symptoms.

“At this stage of the pandemic, it’s really difficult to differentiate between the flu, COVID, common colds, and even seasonal allergies,” Céline Gounder, an infectious disease specialist, epidemiologist, and senior fellow at the Kaiser Family Foundation, told CNBC’s Make It.

“I, even as an infectious disease specialist who’s been practicing for a couple of decades now, cannot differentiate just on an exam,” she said. “You really need to do a test.”

Early on, it was easier to tell the difference at least at least with COVID-19, because of such distinctive symptoms as loss of smell and taste and red eyes or toes. But Gounder explained that because most people now have some degree of immunity, either through vaccination or infection or both, our bodies aren’t reacting the same way. Second, the newer variants are behaving differently than the original strain.

Ways to Tell

It helps to know which virus you have because they are not treated the same. With COVID-19, you can receive antiviral therapies, which can short-circuit the severity of the illness. But the antiviral treatments you can get for the flu are different.

As for RSV, Vandana Madhavan, clinical director of Pediatric Infectious Disease at Mass General for Children, told HuffPost that doctor’s offices are overrun right now, and if you bring your child in for mild symptoms that might otherwise get better at home, there’s a risk they could pick up something else while they’re there.

So how do you tell? As Gounder pointed out, there’s no way to know for sure, but here are some typical symptoms of each.

Common cold:

  • sore throat
  • runny or stuffy nose
  • coughing
  • sneezing
  • headaches
  • body aches

Flu:

  • sore throat
  • runny or stuffy nose
  • muscle/body aches
  • cough
  • fever or chills
  • headache
  • fatigue

COVID-19:

  • sore throat
  • runny or stuffy nose
  • muscle/body aches
  • cough
  • fever or chills
  • headache
  • fatigue
  • diarrhea
  • nausea/vomiting
  • difficulty breathing or shortness of breath

The CDC notes that this list does not include all possible symptoms. Symptoms may change with new COVID-19 variants and can vary depending on vaccination status.

RSV:

  • runny nose
  • decrease in appetite
  • coughing
  • sneezing
  • fever
  • wheezing

The CDC reports that these symptoms usually appear in stages and not all at once. In very young children with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties. Almost all children will have had an RSV infection by their second birthday.

What To Do

With any type of respiratory virus, it’s important to keep from spreading the virus to others, especially those who may be immunocompromised or are otherwise at higher risk. There are tests for COVID-19 and the flu, but not for the common cold or RSV.

Stay home if you are sick and get in touch with us if you have any questions.

Call 911 if you see any signs of an emergency, especially with COVID-19, including:

  • trouble breathing
  • persistent pain or pressure in the chest
  • new confusion
  • inability to wake or stay awake
  • pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
  • if you think it may be an emergency

As the number of cases of all these viruses rise, it’s smart to take precautions. Wear a mask in crowded, poorly ventilated places, wash your hands frequently, eat well, and get plenty of sleep. 

And get your flu vaccine and a COVID-19 booster if you haven’t had one recently (there is no vaccine for RSV or the common cold).

Study Finds Reliable—and Drug-Free—Treatment for Anxiety

There’s no doubt that the last three or so years have raised anxiety levels among all of us. But anxiety disorders are more than just the normal reaction to stress. They are persistent feelings of fear or anxiety that regularly interfere with a person’s life.

According to the National Institutes of Mental Health (NIMH), nearly 40 million Americans—or about 18 percent of us—are currently living with a diagnosable anxiety disorder.

That’s why our primary care concierge doctors in Jupiter were so pleased to learn about a study released this month, which found that mindfulness is just as effective at treating anxiety disorders as commonly prescribed medication.

What are Anxiety Disorders?

According to NIMH, anxiety disorders fall into five primary types:

Generalized Anxiety Disorder (GAD) is characterized by chronic anxiety, and exaggerated worry and tension, even when there is little or nothing to provoke it.

Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, unwanted thoughts (i.e., obsessions) and/or repetitive behaviors (compulsions) such as hand washing, counting, checking, or cleaning.

Panic Disorder is characterized by unexpected and repeated episodes of intense fear when there is no obvious reason for it, accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Social Phobia (or Social Anxiety Disorder) is characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. 

It is also possible to have more than one anxiety disorder at the same time.

Anxiety disorders are so common that this month the U.S. Preventive Services Task Force (USPSTF) recommended that doctors screen all adults under the age of 65 for such issues. The task force estimates that anxiety disorders affect as many as 40 percent of women and 25 percent of men at some point in their lives.

Drug-Free help

Those who suffer from anxiety disorders are often desperate for relief. The standard treatment involves the use of anti-anxiety drugs such as Lexapro and cognitive behavioral therapy.

Now, a study published this month in the journal JAMA Psychiatry found that eight weeks of intensive instruction in the practice of mindfulness meditation worked as well as Lexapro at reducing anxiety. That is, both groups showed about a 20 percent reduction in the severity of their anxiety.

Mindfulness is a type of meditation popularized more than 40 years ago by Jon Kabat-Zinn, in which practitioners learn to focus fully on what’s happening at the moment, as opposed to ruminating over the past or worrying about what might happen in the future.

The practice typically begins with breathing exercises, and full-body scans for relaxation, then learning how to let go of intrusive thoughts.

Instead of stressing over a particular thought, “you say, ‘I’m having this thought, let that go for now,’ ” lead study author Elizabeth Hoge, director of Georgetown University’s Anxiety Disorders Research Program, told Consumer Reports (CR).

“It changes the relationship people have with their own thoughts when not meditating,” she said.

The Time Issue

Critics have raised concerns with the length of time it takes not only to learn the new skill, but also the time commitment it requires.

“Telling people who are that overworked they should spend 45 minutes a day meditating is the ‘Let them eat cake’ of psychotherapy,” Joseph Arpaia, an Oregon-based psychiatrist specializing in mindfulness and meditation, wrote in an op-ed in JAMA accompanying the new study.

He says he’s found less lengthy approaches to using mindfulness to treat anxiety, including a technique he calls the “one-breath reset” to help patients become less anxious.

But Hoge told CNN that she hopes her study prods insurance companies to pay for mindfulness training.

“Usually, insurance companies are willing to pay for something when there’s research supporting its use,” she said.

“If they know it’s just as effective as the drug which they do pay for, why don’t they pay for this, too?”

Drug vs. Drug-free?

Another issue raised by Joy Harden Bradford, a psychologist in Atlanta who hosts the podcast Therapy for Black Girls, is the question of medication vs. meditation.

“The thing I would hate to have to happen is for people to pit medication against the mindfulness-based resources,” she told NPR, adding that someone with panic attacks might have a quicker reduction in symptoms with Lexapro than with waiting weeks before they fully absorb the mindfulness practices.

It’s worth noting, however, that Lexapro, like other anti-depressant drugs such as Paxil and Prozac, can take several weeks before serotonin levels in the brain begin to normalize. There’s also the issue of side effects, which are associated with any medication.

CR reports that 10 patients in the 200-participant study who were taking Lexapro dropped out due to the side effects they experienced, including insomnia, nausea, and fatigue. None of those in the mindfulness group dropped out because of side effects, although 13 patients reported increased anxiety.

Hoge told CNN that her study showed that meditation could be prescribed as an alternative for those who experience severe side effects from medication.

“Lexapro is a great drug,” she said. “I prescribe it a lot. But it’s not for everyone.”

Even Arpaia agreed in principle.

“It’s always interesting to see meditation work, and it works as well as medication,” he said.

running

Does Running Really Ruin Your Knees?

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.

BREAST CANCER

What to Know During Breast Cancer Awareness Month

Long-time cancer-screening activist Katie Couric, 65, announced last month that she’d been treated for breast cancer. Within days came the news that WNBA star Tiffany Jackson had died of the disease at age 37.

These two stories help to highlight Breast Cancer Awareness Month in October, both the importance of screening and the fact that even young women can this deadly disease.

So our primary care concierge doctors in Jupiter want to offer you some facts you may not have known about breast cancer and what to look out for.

Some Little-known Facts

  • Breast cancer is the most common form of cancer in women in the U.S., except for skin cancers, according to the American Cancer Society (ACS). And contrary to common belief, 85 percent of American women who are diagnosed have no family history of the disease.
  • This year, about 287,850 new cases of invasive breast cancer will be diagnosed in women, with about 51,400 of those being ductal carcinoma in situ (DCIS). Nearly all women with this early stage of breast cancer can be cured.
  • About 43,250 women will die from breast cancer.
  • But it’s not just women. The ACS reports that in 2022, about 2,710 new cases of invasive breast cancer will be diagnosed in men, and about 530 of them will die from it.
  • And Yale Medicine reports that breast cancer is the most common form of cancer in women ages 15-39.

Screening Guidelines Vary

Although different organizations offer different guidelines for cancer screening, in general, regular cancer screening can catch cancer before someone has symptoms. This allows a small, localized area to be removed, hopefully before it can spread.

The U.S. Preventive Services Task Force (USPSTF), for example, recommends mammography screenings every two years (biennial) for women ages 50 to 74 years, while the ACS recommends such screenings annually for women ages 50 to 54 and every other year after that.

As for the standard clinical breast exam, the International Agency for Research on Cancer (IARC) states: “There is inadequate evidence that clinical breast examination reduces breast cancer mortality.” The American College of Physicians agrees. Even the ACS doesn’t recommend clinical examination to screen for breast cancer, preferring to emphasize mammography as the preferred method of detection.

The American College of Obstetricians and Gynecologists (ACOG) says, “Decisions between screening with mammography once a year or once every two years should be made through shared decision-making after appropriate counseling.” In other words, the benefits of annual mammography for those with average risk haven’t been firmly established, so it’s up to the woman and her doctor to decide on the frequency.

Different Outcomes

Katie Couric co-founded the organization Stand Up to Cancer after the death of her first husband, Jay Monahan, from colon cancer, so she was an advocate for regular cancer screenings. Still, her diagnosis stunned her.

Couric told CNN that she went for a mammogram in the summer, which found her breast cancer.

“I think those words, ‘It’s cancerous or you have cancer’ do stop you in your tracks,” she said. But her doctor told her it was treatable, so she underwent a lumpectomy in July, followed by radiation.

Unfortunately, as in the case of Tiffany Jackson, breast cancer is more likely to be found at a later stage among women under the age of 45, and is often more aggressive and difficult to treat.

She was originally diagnosed with stage three breast cancer in 2015 and thought her treatment had been successful.

But studies show that women who are first diagnosed before age 35 have between a 13-38 percent risk of recurrence that spreads to other parts of the body, while in women ages 50 and over, that risk is between 4-29 percent.

What To Do

Besides having the recommended mammographies, for both men and women of all ages, it’s important to know the risk factors for the disease as well as the early signs.

Risk factors include:

  • getting older
  • having dense breasts
  • a family history
  • hormonal changes
  • excess alcohol consumption
  • environmental factors, including exposure to radiation
  • obesity and overweight
  • beginning periods before age 12 and menopause after age 55
  • becoming pregnant at an older age or never being pregnant
  • taking hormones, including birth control pills and hormone replacement therapy
  • physical inactivity
  • night-shift work
  • smoking

It’s important to become familiar with your breasts, so you’ll know what symptoms to look for.

Warning signs include:

  • new lump in the breast or underarm (armpit)
  • thickening or swelling of part of the breast
  • irritation or dimpling of breast skin
  • redness or flaky skin in the nipple area or the breast
  • pulling in of the nipple or pain in the nipple area
  • nipple discharge other than breast milk, including blood
  • any change in the size or shape of the breast
  • pain in any area of the breast

The CDC cautions, “Keep in mind that these symptoms can happen with other conditions that are not cancer,” so don’t panic if you see any of them. But do contact us right away if you do see such changes.

Remember, the sooner breast cancer is caught, the easier it is to treat.

flu season

Experts Predict a Severe Flu Season, So Get Vaccinated Now

If you hear the word “vaccine” and automatically think of COVID-19, our concierge primary care doctors in Jupiter don’t blame you. But there’s another virus lurking on our shores: the annual influenza outbreak, which deserves our attention now.

You can be forgiven for thinking we no longer had to worry about the flu because, for the last two years, it all but disappeared. This is largely due to all the hand washing, social distancing, and mask-wearing we practiced during the pandemic.

But unfortunately, those sensible health precautions are pretty much behind us now, and all signs point to a worse-than-normal flu season. In fact, we’ve already seen scattered reports of cases around the country. And remember that many cases go unreported because people typically recover at home without being officially tested and recorded.

Ominous Signs

The reason experts are expecting a more severe 2022-23 flu season is that they’re looking to Australia, which undergoes its flu season before ours. 

That country is just concluding its worst season in five years, with cases reported to be three times higher than normal. Their season also began two months sooner than it typically does, meaning it is expected to arrive sooner than usual here, as well.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News late last month.

“Influenza, as we all have experienced over many years, can be a serious disease,” he added, “particularly when you have a bad season.”

Dr. Frank Esper, a pediatric infectious disease specialist at the Cleveland Clinic, echoed those warnings.

“This year we expect it to be a very big flu season and that the flu season [will be] even worse in the younger groups [than] it was in years past,” he told Cleveland’s Fox8. 

We’re Not Prepared

For the last two years, we have rightly been focused on avoiding COVID-19, which has killed well over one million Americans to date. But influenza also presents a danger, especially to very young, pregnant women, those with chronic conditions, and the elderly.

In 2019, the last year that we actually had a notable flu season, nearly 61,000 Americans died from the flu, including 129 children. There were approximately 42.9 million cases of the flu, with 647,000 of those requiring hospitalizations. And that was considered a mild season (although it was the longest season in a decade, beginning in October and ending in May).

In addition, because of the demise of COVID-19 restrictions in general, we could get hit even harder.

“The thought is when the COVID pandemic hit, we started masking up and everyone started socially distancing, schools were closed for a whole year,” Esper said.

“Flu just nose-dived. It almost got to the point where there was no flu.” 

But because we haven’t been exposed to it lately, we are even more vulnerable to its effects, making it harder to fight off.

“Usually, we see the flu every year. Our immune systems are ready for it. When you haven’t seen the flu in two or three years, that means our immune systems may be a little slower,” he explained.

Double Whammy?

Then there’s the possibility of a “twindemic,” or a severe flu season that strikes at the same time as an uptick in coronavirus activity. This is a distinct possibility because both viruses tend to increase circulation when people spend more time indoors in the colder months, and immunity from earlier vaccinations or infections is beginning to wane, especially in those who haven’t had a recent coronavirus booster.

In fact, we’ve already seen an increase in COVID-19 cases across the country in the last two weeks, according to data provided by the Mayo Clinic.

So the Centers for Disease Control and Prevention (CDC) reports that getting a flu shot this year is recommended as “the first and most important step in protecting against flu viruses,” while at the same time reducing the burden of flu hospitalizations and deaths.

“An influx of hospitalizations from COVID-19 and the flu could stress the healthcare system and impact staffing if any healthcare workers are out sick,” Soniya Gandhi, associate chief medical officer at Cedars-Sinai, told Cedars-Sinai Newsroom.

The Time is Now

Because of all the signs that the flu season here could start early, it’s important to receive your vaccine as soon as possible, since it takes at least two weeks to achieve full immunity.

“The bottom line is that you don’t want to wait until you’re already going to be at risk of getting influenza to get vaccinated,” Dr. Albert Ko, an infectious disease physician and professor of public health, epidemiology, and medicine at Yale School of Public Health, told NBC’s TODAY.

And we’ve seen with COVID-19 that vaccines work to reduce the severity of such illnesses, not only in individuals but also in those around them who either can’t receive the vaccine or who don’t respond well to it.

Remember that if you haven’t yet received your omicron booster, you can get both shots at the same time, one in each arm.

“The flu and COVID-19 vaccinations are important on a personal level, and they’re critical from a public health standpoint,” Gandhi said.

belly fat

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

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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