Best Ways to Treat Lower Back Pain

, Health Basics, Healthy Living, Lifestyle, Preventative Health

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

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

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

The Latest Research

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

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

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

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

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

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

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

Non-drug Approaches

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

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

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

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

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

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

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

Another Non-traditional Approach

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

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

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

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

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

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

A Final Word

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

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

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

Live Longer with Blue Zone Foods

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

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

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

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

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

The five places are:

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

More than Diet

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

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

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

Blue Zone Meals

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

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

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

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

What Not to Eat

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

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

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

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

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

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

Time and Place Count, too

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

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

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

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

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

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

Small Moves

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

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

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

That includes social connections.

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

Here’s to Your Heart Health

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

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

Surprising Heart Facts

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

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

About Heart Disease

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

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

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

Common Symptoms of Heart Disease Include:

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

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

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

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

Increasing Risk

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

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

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

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

diabetes
overweight and obesity
unhealthy diet
physical inactivity
excessive alcohol use

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

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

Lowering Risk

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

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

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

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

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

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

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

Is a Neti Pot Right for You?

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

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

What is a neti pot?

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

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

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

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

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

How do they work?

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

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

Safe Use

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

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

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

To safely use and care for your device:

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

Does it Work?

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

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

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

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

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

Nature Can Heal in More Ways Than One

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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

, , , , COVID, Disease, News, Preventative Health, Vaccinations

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

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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

, , , , , , COVID, Disease, Health Basics, Preventative Health, Vaccinations

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

Health Basics, Healthy Living, Preventative Health

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?

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.

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