Is a Neti Pot Right for You?

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

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

What is a neti pot?

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

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

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

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

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

How do they work?

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

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

Safe Use

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

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

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

To safely use and care for your device:

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

Does it Work?

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

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

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

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

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

Nature Can Heal in More Ways Than One

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

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

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

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

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

The Study

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

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

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

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

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

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

Confirming Prior Research

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

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

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

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

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

Nature Deprivation Hurts

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

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

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

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

Make the Connection

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

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

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

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

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

Damar Hamlin Brings CPR Into the Spotlight

, News, Sports

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

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

What happened to Hamlin?

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

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

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

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

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

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

Hamlin was Lucky

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

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

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

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

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

Rapid Response

Which is what happened with Hamlin.

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

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

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

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

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

A Simple Technique

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

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

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

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

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

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

There’s a Reason Why You’re Feeling SAD

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

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.

Coronavirus Pandemic

New Guidance on COVID-19 Can Be Confusing

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

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

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

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

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

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

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

A new approach

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

According to The Washington Post:

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

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

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

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

Isolation changes

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

Additional CDC guidance on isolation includes the following:

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

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

What about boosters?

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

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

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

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

The mask question

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

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

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

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

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

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

is kratom safe

Use Caution with Kratom

, , , , , , Healthy Living, Medications

Our concierge primary care doctors in Jupiter know that many of our patients are interested in over-the-counter (OTC) alternative treatments for their ailments.

One of the more popular of these is kratom, an herb that has been used for centuries in Asian countries as a way to reduce fatigue and ease various aches and pains. In this country, it is sold in drinks or as supplements and is said to treat such common conditions as anxiety, depression, and opioid withdrawal.

One report estimated that as many as 16 million Americans also use kratom for pain relief in such chronic diseases as lupus, multiple sclerosis, fibromyalgia, rheumatoid arthritis, and other similar conditions.

Testimonials from users include such claims as, “Kratom gave me my life back after being addicted to pain pills;” “It has helped me enormously with chronic back pain;” and, “It got me off a 20-plus-year addiction to narcotics and opioids.”

On the other side are statements like these from a former user who told The Washington Post that “kratom was fun—it was like having morphine and cocaine at the same time”—until he got addicted. Withdrawal, he reported, was like “getting ripped apart by fishhooks.”

Agencies fighting it

Various agencies including the U.S. Food and Drug Administration (FDA), the World Health Organization (WHO), and even the U.S. Drug Enforcement Agency (DEA) have spent the last several years trying to ban it. Six states have already done so, with several others considering it. It is still legal in Florida, but may be banned or controlled in some localities here.

In April, the FDA released a statement warning consumers not to use the herb, Mitragyna speciosa, commonly known as kratom:

“FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence.”

FDA

Opponents have been buoyed in their arguments by several studies linking kratom to serious side effects.

One such study in 2019 reported that the number of phone calls to U.S. poison control centers regarding adverse effects from kratom have soared, from 13 calls in 2011 to 682 in 2017. Reported effects of kratom overdose included rapid heartbeat, agitation, high blood pressure, seizures, coma, kidney failure, and 11 deaths during the study period. Two of those deaths were attributed to kratom alone, while the other nine occurred in people who combined kratom with other drugs.

Another study on kratom use disorder (KUD) by the National Institute on Drug Abuse (NIDA), published in the Journal of Addiction Medicine in March, found that over half of 129 past and current kratom users showed no signs of addiction. But 29.5 percent met the diagnostic criteria for KUD, which includes increased use, tolerance, withdrawal, unsuccessful attempts to quit, and cravings.

Counter-arguments

Proponents attribute these adverse reports to a profit motive on the part of drug companies, overly restrictive U.S. drug policies, and poor research. They say it has been used successfully for thousands of years in Southeast Asia without a problem.

Advocates also maintain that, in these times of widespread and deadly opioid addiction, kratom is an acceptable alternative and that its dangers have been wildly overblown.

In a recent editorial published in the Scientific American, Maia Szalavitz, an author and journalist who focuses on science, public policy, and addiction treatment, writes that kratom “does appear to be far safer than all illegal and most prescription opioids.” She referred to a Centers for Disease Control and Prevention (CDC) study in 2016 and 2017 of some 27,000 kratom-related overdoses. Of those, kratom was implicated in less than one percent of overdose deaths.

“Moreover, in nearly all overdose deaths associated with kratom, it was accompanied by stronger drugs that kill more often, so it is not clear that it actually played a major role or even any at all,” she wrote.

“For example, around two-thirds of the 152 deaths the CDC studied also involved illicit fentanyl and its analogues, which are thousands of times more potent. In only seven cases was kratom the only only substance identified—and even here, researchers cannot rule out the possibility of undetected drugs,” she added.

Caution warranted

Nevertheless, most medical experts warn that kratom use can have adverse consequences. According to the Cleveland Clinic, “kratom’s potential for serious side effects outweigh its potential benefits.”

It lists the following most common side effects of kratom:

  • aggression
  • altered mental status
  • anxiety and irritability
  • constipation
  • delusion and hallucination
  • drowsiness and sedation
  • dry mouth
  • frequent urination
  • itching
  • nausea and vomiting
  • tongue numbness

More serious side effects can include:

  • cardiac issues, such as heart attack, abnormal heart rhythms, and high blood pressure
  • encephalopathy (brain disease)
  • hypothyroidism (underactive thyroid)
  • insomnia
  • liver damage and liver failure
  • loss of appetite
  • psychosis
  • respiratory depression (difficulty breathing)
  • seizure
  • tremor
  • weight loss

In addition, people going through kratom withdrawal may experience:

  • muscle spasms
  • pain
  • rhabdomyolysis (a condition leading to kidney damage when muscles disintegrate and release a protein into the blood)
  • rigidity
  • seizures
  • tremors

Think twice about kratom

While proponents hope more research will eventually vindicate kratom as a useful supplement, the medical community generally holds that its side effects more than outweigh any potential benefits. It can be especially dangerous when combined with other legal and illegal drugs.

While it’s up to you, we would suggest that our patients not take the risk of using this substance. If you’re thinking of using kratom for any reason, please discuss it with us first. We may be able to help you find other safer treatment options.

Skin Cancer Awareness

What to Know About Sunscreens

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

Because May is Skin Cancer Awareness Month, our primary care doctors in Jupiter want to remind you of the dangers of sun exposure and remind you of the best way to avoid it.

It’s important to know the facts about skin cancer and the sun, along with exposure to tanning beds, because the National Cancer Institute (NCI) estimates that this year 99,780 people in the U.S. will be diagnosed with melanomas of the skin, and that 7,650 people will die from this most deadly form of cancer.

But a proper use of an effective sunscreen can prevent most skin cancers.

Read more
pandemic over

Is the Pandemic Over? Not Quite

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

Dr. Anthony Fauci’s comment that we are “certainly, right now, in this country, out of the pandemic phase” of COVID-19 sparked numerous questions to our primary care concierge doctors in Jupiter.

It also seemed to cause a great deal of confusion and misconceptions around the country at large, at least until he clarified his statement the following day.

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omicron news

What We’ve Learned About the Omicron Variant

, , , , , , , Disease, Health Basics, Healthy Living, Preventative Health, Vaccinations

As we’ve just passed the second-year anniversary of the SARS-CoV-2 pandemic, our concierge primary care doctors in Jupiter think we should take a moment to reflect on how far we’ve come in dealing with this often-deadly disease.

It may not seem like it, because we still have to wear masks many places and haven’t fully returned to pre-pandemic life, but we have made progress.

For instance, we know more about how it spreads (through the air, especially in enclosed spaces), and how to protect ourselves (safe, effective vaccines and high-quality masks). And even though we’re still in the grip of of this still-relatively new coronavirus, and we’ve also found effective ways to treat it (monoclonal antibodies and anti-viral drugs).

Omicron a good thing?

And, believe it or not, the omicron variant of the virus may have turned out to be relatively good news, even though over 2,000 Americans a day are still dying from it.

But because it appears less lethal than its predecessors, omicron may make the pandemic more manageable.

The Centers for Disease Control and Prevention (CDC) released the results of a study late last month showing that the omicron variant—which is now the dominant variant both here in the U.S. and around the world—causes less severe illness, fewer hospitalizations, and requires less time in isolation following exposure.

This is partly due to the large numbers of people who have been vaccinated and/or infected with COVID-19, as well as to the fact that the virus appears to concentrate its effects in the upper airways instead of settling deep in the lungs.

The downside is that omicron is far more transmissible than earlier variants or the original virus. This is why so many people are catching it, and why—due to the sheer numbers of infections— hospitals are still being overwhelmed and an average of 2,200 people a day are still dying from the coronavirus.

Light at the end of the tunnel?

But an NBC News analysis of COVID-19 case numbers at the end of January showed that Florida is one of the many states where omicron is no longer surging.

And chief White House medical advisor Anthony Fauci said in an interview with ABC’s “This Week” that he expects the wave to subside in “most” states by the end of February.”

“As we get into February . . . it is very likely that most of the states in the country will have turned around with their peak and are starting to come down with regard to cases and then obviously hospitalizations,” he said.

While cautioning that “our work is not done,” Hans Kluge, regional director of the World Health Organization (WHO) for Europe, released a statement two weeks ago that offered a glimmer of hope to a pandemic-weary world.

“The pandemic is far from over, but I am hopeful we can end the emergency phase in 2022 and address other health threats that urgently require our attention,” he said in a statement.

“This pandemic, like all other pandemics before it, will end, but it is far too early to relax,” he added.

Effective weapons

One recent setback in the fight against SARS-CoV-2 was the finding from the CDC, confirmed by the drugs’ manufacturers, that two of the most common monoclonal antibodies used to keep at-risk individuals out of the hospital do not work against the omicron variant.

But again, there’s good news on that front, as well, because one monoclonal antibody—sotrovimab—is effective, and is still available at most hospitals even though Florida’s outpatient centers have closed.

Those who have mild to moderate symptoms of COVID-19 (fatigue, cough, loss of smell or taste, fever) or have underlying risk factors (those over 65, diabetes, obesity, kidney, heart, or lung disease or those who are immunocompromised) can check with area hospitals to see whether they’re offering this treatment.

In addition, other effective weapons in the arsenal against COVID-19 include the intravenous antiviral treatment remdesivir and the newly authorized oral antiviral drugs, Paxlovid or molnupiravir.

Still work to do

Two years in, we still don’t have all the answers, and until more people in this country and around the world are fully vaccinated, SARS-CoV-2 will not be fully manageable.

Each person who remains unvaccinated not only puts themselves at risk, but others around them, as well. And each infection offers the virus another chance to mutate.

Speaking of mutations, you may have heard of another new mutation of the omicron virus that some are calling “son of omicron” or “stealth omicron” because it’s so difficult to detect in PCR tests.

The new variant, designated BA.2 (omicron is BA.1), was first reported in California in November. It has since been seen in isolated cases in Texas as well as other countries. However, while remaining cautious, at this point most virologists don’t think it’s more dangerous or more transmissible than omicron BA.1. We’ll let you know if we learn otherwise.

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