Surviving Spring Allergies Without Gaining Weight

, , , , , Health Basics, Healthy Living, Medications

With the fresh air of the ocean and year-round warmth, you might be surprised to find that Florida is one of the top hot spots in the country for spring allergies. You might also be surprised to learn that some of the over-the-counter (OTC) allergy medications you automatically reach for to stop the resulting sneezing and sniffling can cause you to gain weight.

So our concierge primary care doctors in Jupiter want to tell you the differences between the various types of antihistamines and suggest other ways of battling spring allergies.

‘Pollen Storm’

As NBC News reported last month, a growing number of adults in their 30s, 40s, and 50s who’ve never had allergies before are experiencing them now.

“What I see is people coming in for the first time, especially over the last five, seven years or so,” Dr. Clifford Bassett, an allergist at NYU Langone Health in New York City, told NBC.

“They will always say, ‘I don’t understand how this is happening to me,’ ” he added.

The culprit appears to be climate change, the network reported. As CO2 levels rise, plants and trees produce more pollen, coupled with earlier spring blooms from trees. This is driving a longer season, with more severe reactions from sufferers.

“The pollen season right now is about three weeks longer than it was 30 years ago, and there’s about 20 percent more pollen in the air,” Dr. Neelu Tummala, an ear, nose, and throat specialist and co-director of the Climate Health Institute at George Washington University, told the network.

Dr. Stanley Fineman, an allergist at Atlanta Allergy and Asthma and a spokesperson for the American College of Allergy, Asthma & Immunology, calls the phenomenon a “pollen storm.”

“The pollen counts, particularly this season, have been much, much higher than we’ve seen in the past,” he told NBC.

COVID, Cold, or Allergies?

And since the dawn of the SARS-CoV-2 pandemic, now people are wondering whether their stuffy or runny nose, loss of taste or smell, and itchy, watery eyes are symptoms of COVID-19.

For instance, the loss of the senses of taste and smell can also happen with allergies and colds when the nasal passages become blocked.

In the past, doctors would say that if you’ve never had allergies before, your symptoms are likely something else, such as a cold or other type of virus. But because more people are now experiencing allergies, that’s not necessarily a reliable indicator.

Experts generally agree, however, that fever, chills, and body aches typically indicate viruses, while the telltale symptom of allergies is itching.

“The biggest symptom I would suggest is the itchiness of the eyes, nose, and throat,” Bassett said. “You don’t get itchiness if you have a cold or if you’re having a sinus infection.”

Nevertheless, it’s best to get tested if you’re experiencing new symptoms.

“We’ve definitely had patients come to our clinic who thought they were having allergies, but they had COVID instead,” Dr. Michelle Pham, an allergist, and immunologist at USCF Health in San Francisco, told NBC.

The Risk of Weight Gain

Depending on the severity of your symptoms, there are several ways to treat allergies.  One of these is oral antihistamines.

But a 2010 Yale University Study that found those who regularly took antihistamines weighed more than those who didn’t gave some allergy sufferers pause. The researchers cautioned that it wasn’t clear whether those who were already overweight were more prone to allergies, and thus more likely to take antihistamines.

According to the non-profit Obesity Medicine Association, however, “Histamine decreases our hunger by in part affecting the appetite control center in our brains, and it makes sense [that] an anti-histamine would have the opposite effect. These drugs can interfere with the ‘I’m full’ signal coming from the rest of our bodies and lead to overeating.”

In fact, some antihistamines—particularly cyproheptadine—are prescribed for children and pets to increase appetite.

But not all antihistamines have this effect. The Cleveland Clinic explains that so-called first-generation antihistamines were approved in the 1930s, but had more serious side effects, including drowsiness, dry mouth, and rapid heart rate. The second-generation antihistamines, approved in the 1980s, carry far fewer side effects. They also don’t relieve nasal congestion the way many first-generation antihistamines do.

What To Do Instead

If you want to try to do without antihistamines, first, avoid exposing yourself as much as possible to pollen.

  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Keep windows closed, in the home and car.
  • Wear a mask, hat, and sunglasses if you need to be outdoors.
  • Use a vacuum equipped with a HEPA filter.

Next, rinse frequently with a saline nasal spray or a neti pot to clean out pollen in your sinuses.

Finally, try switching to second-generation antihistamines. These include:

  • azelastine (Astelin)
  • loratadine (Claritin, Alavert)
  • cetirizine (Zyrtec)
  • desloratadine (Clarinex)
  • fexofenadine (Allegra)

If OTC medications aren’t working, be sure to let us know. There are prescription approaches that may help.

Keep in mind that, even if your allergies have been manageable in the past, with the stepped-up pollen levels accompanying global warming, you may need more intensive therapy.

“Before, you could get away with just using an intranasal steroid,” Tummala told NBC, “and now you have to do a neti pot rinse and then the steroid,” she said.

Yes, COVID-19 Remains a Threat

, , COVID, Health Basics, Healthy Living

Our primary care concierge doctors in Jupiter dislike being the bearers of bad news, but it’s important to know that the COVID-19 virus is still active, still mutating, and still killing people: as many as 250 Americans a day, primarily those who are immunocompromised and older adults.

That equals roughly 90,000 of us every year. This figure is well below the height of the pandemic when 4,000 Americans a day were dying. But the number isn’t insignificant if it impacts you or someone you love.

It’s also important to remember that, even if an infection doesn’t result in death, the long-term consequences even for younger, healthy people can be severe and/or debilitating.

Newest Variant

The latest omicron subvariant, XBB.1.5, now accounts for nearly 80 percent of COVID-19 cases being diagnosed in the U.S., according to the Centers for Disease Control and Prevention (CDC).

In addition, the World Health Organization has identified a new subvariant, XBB.1.16, known as Arcturus. The CDC reported last month that it is now responsible for about seven percent of coronavirus infections, up from about four percent the previous week.

The good news is that Arcturus doesn’t appear to be any more deadly than previous omicron variants. While a change in the spike protein might mean it could spread more rapidly, there’s no indication that cases will be more severe.

“We’ve seen this in the past,” Paul Hunter, a professor of medicine at the University of East Anglia in Britain, told The Washington Post.

“You look at the virus and it’s got mutations that should make it more virulent, but then, in reality, you don’t see that,” he said.

“It will probably become the dominant variant for a while in the U.S. and Europe and most countries around the world, but I don’t see it driving up severe infections more than we’ve seen in recent waves,” he added.

Still Dangerous

That doesn’t mean Arcturus or the currently dominant XBB.1.5 are benign, however.

COVID-19 remains the third leading cause of death in the U.S. Florida is currently seeing 17 new cases every day per 100,000 population, the highest in the nation (Kentucky is second, at 13 new cases per day per 100,000).

These numbers are likely undercounted because so many people have abandoned getting officially tested for COVID-19, are testing at home and not reporting positive cases, or not getting tested at all.

And it’s not just older Americans who are impacted. The CDC reported last month that the 18-29-year-old age group “has accounted for the largest cumulative number of COVID-19 cases compared to other age groups.”

NBC’s Today Show recently reported on a new study by Cedars Sinai Hospital in Los Angeles, which found that the age group hit hardest by post-COVID-19 heart attack deaths was people between 25 and 44. This cohort saw a 29.9 percent relative increase in heart attack deaths over the first two years of the pandemic.

“Young people are obviously not really supposed to die of heart attack,” Susan Cheng, a cardiologist at Cedars Sinai and co-author of the study, told Today in February.

“They’re not really supposed to have heart attacks at all,” she said.

In addition, a National Center for Health Statistics survey showed that nearly 20 percent of adults who had a COVID-19 infection continue to have the debilitating symptoms of long COVID.

Remember the Vulnerable

Unfortunately, most of America seems to have moved on from the pandemic. People are going about their lives as if SARS-CoV-2 was just a bad dream they’re happy to have awakened from.

“Get all the shots you wish, take all the precautions you wish, but the health of us out there are done sacrificing for the weakest of health or brain,” wrote one anonymous commenter last month on The Post website.

This attitude of “stay home forever” rankles journalist Jeanine Santucci, as she recently wrote in USA Today.

A young mother with type 1 diabetes, she is at higher risk from COVID-19. She is fully vaccinated and has loosened her self-quarantine over the past three years, now seeing friends outdoors unmasked if they have a negative COVID-19 test. She ventures out in public with an N95 mask and a portable air purifier but resents the general lack of masking in indoor public spaces.

But she called the “stay home if you’re at risk” approach “cruel” and unfair.

“The main reason I am still taking this seriously, and I hope you will, is that our country’s most vulnerable people deserve to be part of society,” she said.

Protect Yourself and Others

“With the removal of mask mandates in health care settings and essential places such as pharmacies, public transit, and grocery stores, immunocompromised people are made outcasts,” Santucci added.

“But simply putting on an N95 when you go out makes us safer. It shows us you care that we’re alive.”

Given the prevailing attitudes from both government and the general public that if you want to avoid getting COVID-19 you’re pretty much on your own, we recommend continuing to take precautions when you’re in public spaces.

This means any place that is not well-ventilated, including your own home if you have visitors whose infection status is unknown. Wear a mask in crowded settings, and stay up to date on your vaccinations.

As Santucci wrote, “I hope you’ll take into consideration just how much is at stake for you, and the fact that you’re also making a risk calculation for vulnerable people like me when you do.”

Is Exercise Better Than Drugs for Mental Health?

, , , , , Concierge Medicine, Health Basics, Healthy Living, Lifestyle, Preventative Health, Uncategorized

If our primary care concierge doctors in Jupiter could prescribe a single treatment for a host of different health concerns, it would be exercise.

For example, one study published in the journal BMJ compared exercise alone versus drug therapy alone and found that for heart disease, diabetes control or prevention, stroke rehabilitation, and treatment of heart failure, regular physical exercise was just as effective as prescription medications in treating many of these conditions.

And according to the Mayo Clinic, some of the disorders that benefit from regular exercise include:

  • Heart disease – In addition to strengthening the heart muscle and lowering blood pressure, exercise can help you be more active without experiencing chest pain or other symptoms.
  • Diabetes – Regular exercise can not only help insulin more effectively lower your blood sugar level, but also help control weight and boost energy.
  • Asthma – Exercise has been shown to control the frequency and severity of asthma attacks.
  • Back pain – Regular low-impact aerobic exercise can help increase the strength of your back muscles and improve endurance and muscle function.
  • Arthritis – Exercise is the primary approach to reduce pain, help maintain muscle strength in affected joints and reduce joint stiffness.

What About the Brain?

It makes sense, then, that the benefits of exercise would also impact the brain.

And that’s just what a new study, published in February in the British Journal of Sports Medicine, revealed. Researchers from the University of South Australia correlated data from 1,039 studies involving more than 128,000 volunteers.

They found that physical activity was 1.5 times more effective for managing depression than either counseling or the leading medications typically prescribed for the disease.

The review showed that exercise interventions that were 12 weeks or shorter were the most effective at reducing mental health symptoms, showing how quickly physical activity can make a difference, Science Daily reported.

“Our review shows that physical activity interventions can significantly reduce symptoms of depression and anxiety in all clinical populations,” lead researcher Dr. Ben Singh said in a statement.

“We also found that all types of physical activity and exercise were beneficial, including aerobic exercises such as walking, resistance, training, Pilates, and yoga,” he said. 

“Importantly, the research shows that it doesn’t take much for exercise to make a positive change to your mental health.”

Even a Little Bit Helps

This last finding is important because one of the hallmarks of depression is a lack of energy. So asking them to engage in the Centers for Disease Control and Prevention’s (CDC) recommendation of 150 minutes of moderate physical activity every week is akin to asking them to climb a mountain with a broken leg.

Another study, published this month in the journal JAMA Psychiatry, offers similar reassurance that any regular movement can make a difference.

For this study, the researchers looked at 15 studies involving more than 190,000 subjects.

They found that people who engaged in brisk walking for a total of 2.5 hours a week had a lower risk of depression than those who didn’t exercise at all. 

“Most benefits are realized when moving from no activity to at least some,” the study authors wrote. 

“Our findings, therefore, have important new implications for health practitioners making lifestyle recommendations, especially to inactive individuals who may perceive the currently recommended target [of 2.5 hours a week] as unrealistic,” they added.

How Does it Work?

There are several reasons exercise has such a positive effect on depression and anxiety, according to Dr. Antonia Baum, an assistant clinical professor of psychiatry and behavioral sciences at George Washington University, who was not involved in these studies.

It can improve blood circulation to the brain and have a positive impact on inflammation and the body’s immune response, she told U.S. News, noting the connection between heart health and depression. There may also be intangible benefits such as getting stronger or feeling empowered or gaining a sense of well-being.

Yet another recent meta-review of 41 studies involving 2,265 people with depression found that almost any type of exercise substantially reduces symptoms of depression, The Washington Post reported.

“We found large, significant results,” said study leader Andreas Heissel, an exercise scientist at the University of Potsdam in Germany.

Although more exercise produced greater results, “Something is better than nothing,” Heissel noted.

Small Moves

Jennifer Heisz, a neuroscientist and an associate professor in the Department of Kinesiology at McMaster University in Ontario, Canada, who was not involved in these studies, was even more encouraging.

“Any movement, every movement, every step counts,” she told U.S. News.

“It doesn’t have to be as much as you need for physical health,” she added. “You can get by with half of that, and this is very consistent with the literature.”

Heisz suggested that people try to move a little every day, even if it’s just a five- or 10-minute walk, or a two-minute movement break every half hour for those who sit all day.

“That’s how simple we need to get, especially for people who are not moving at all, and to acknowledge that there is this additional barrier of motivation for people who are suffering from depression,” she said.

One final word: It’s important not to try to treat depression yourself. We can help guide you through different approaches or even recommend other professionals that can help.

If you have thoughts of harming yourself, dial or text the new national suicide hotline number 988 for immediate help.

Progestin-Only Birth Control Slightly Increases Breast Cancer Risk

, , , , , Uncategorized

Our family practice concierge doctors in Jupiter have heard from some of our patients that they’re concerned about a new study regarding the safety of certain contraceptives.

In fact, many observers think this study’s findings are reassuring, and should not unduly alarm women.

According to the Centers for Disease Control and Prevention (CDC), among women ages 15 to 49 in the U.S., about 14 percent of those using contraception use oral contraception, and around 10 percent use long-acting devices like IUDs.

Contraceptive Risks and Benefits

Since their inception, birth control pills have been associated with various risks to the women who take them.

In 1960, the U.S. Food and Drug Administration (FDA) approved the first birth control pill, Enovid. It combined two types of hormones designed to prevent ovulation: estrogen and progestin. According to Planned Parenthood, it contained far more hormones than were needed to prevent pregnancy, which is why it was also responsible for occasional severe side effects and increased the risk of heart attacks and strokes.

Later forms of the pill, as it came to be called, used much lower formulations, but they are still implicated in a slightly increased risk of breast cancer, heart attack, strokes, blood clots, and liver tumors.

Many see these risks as being outweighed by the benefit of preventing unwanted pregnancies. In addition, studies have found a decreased risk of ovarian, endometrial, and colorectal cancers in long-term users of the pill, as compared with non-users.

Birth control pills are also prescribed for women with excessive bleeding and/or painful periods, apart from their use in pregnancy prevention.

Another UK study of more than 46,000 women who were followed for up to 39 years showed that their use of the pill not only didn’t increase their risk of mortality but also appeared to have increased longevity.

The New Study

Progestin-only formulations in various forms of birth control were thought to lower the risks of complications because estrogen is known to increase the incidence of the most common side effects.

Progestin-only pills thicken the mucus in the cervix, preventing sperm from reaching an egg. One form of the progestin-only pill can also stop ovulation.

“We’ve known for a while that estrogen and progestin birth control pills, oral contraceptives, have a slightly increased risk of breast cancer,” Dr. Jennifer Ashton, a board-certified OB-GYN, and ABC News chief medical correspondent said on “Good Morning America” when the new study was released.

“What we didn’t know is the newer forms of progestin-only pills, IUDs, injectable implants, what their associated risk, if any, was in comparison,” she explained.

The study that made the news last month was published in the journal PLOS One. Researchers in the U.K. analyzed data on nearly 10,000 women who had been diagnosed with invasive breast cancer between 1996 and 2017.

They then compared these subjects’ profiles with more than 18,000 women who did not have breast cancer.

“On average, 44 percent of women with breast cancer and 39 percent of matched controls had a hormonal contraceptive prescription, with about half the prescriptions being for progestagen-only [i.e., progestin-only] preparations,” the study authors wrote.

Explaining the Results

The findings “suggest that the 15-year absolute excess risk of breast cancer associated with the use of oral contraceptives ranges from eight per 100,000 users (an increase in incidence from 0.084 percent to 0.093 percent) for use from age 16 to 20 to about 265 per 100,000 users (from 2.0 percent to 2.2 percent) for use from age 35 to 39.”

In other words, those who use the progestin-only forms of contraceptives have about the same slight risk of breast cancer as women who use the combination pill.

They also found that the longer a woman is off hormonal birth control, the lower the risk.

Claire Knight, a senior health information manager at Cancer Research UK, which provided core funding for the study, told CNN that hormonal contraception is a personal choice, as “there are lots of possible benefits to using contraception, as well as other risks not related to cancer.

“Women who are most likely to be using contraception are under the age of 50, where the risk of breast cancer is even lower,” she explained.

Reassuring Users

Gill Reeves, a co-author of the study and professor of statistical epidemiology at the University of Oxford, told The Washington Post that “it may be reassuring to know that these newer contraceptives that women are using in increasing numbers do not have any untoward effects that might be unexpected. 

“They do seem to behave pretty much like traditional contraceptives,” she added.

Ashton, who was not involved in the study, stressed that it’s important to recognize how slightly the use of hormonal contraceptives raises the risk of breast cancer.

“It’s about individualizing the risk-benefit and option risk for the woman,” she told GMA.

“If you talk to any OB-GYN, they will say, we have a line: ‘Pregnancy is much higher risk than any associated risk with birth control pills or hormonal contraception.’ ”

“For anyone looking to lower their cancer risk, not smoking, eating a healthy balanced diet, drinking less alcohol, and keeping a healthy weight will have the most impact,” Knight told CNN.

All the experts suggest that women discuss the risks and benefits with their doctors.

What to Know About the Newest Migraine Drug

, , Health Basics, Medications, Uncategorized

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

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

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

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

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

What is a Migraine?

A migraine is not technically a headache, but a neurological disorder that includes a constellation of symptoms, with a painful, long-lasting headache at the center. Its main symptom is a severe throbbing pain or pulsing sensation in the head, which feels like a very bad headache, usually on one side of the head, but in a third of migraine attacks, both sides are affected.

It is often—but not always—preceded by what is known as an “aura,” strange tricks of vision that can encompass anything from a blind spot in the vision to flashing or shimmering lights to wavy or zigzagging lines.

Migraines are also usually, but not always, associated with such symptoms as nausea, vomiting, and extreme sensitivity to lights and noises, and can also include a pins-and-needles sensation in the arms and legs or a weakness or numbness on one side of the face or body.

One or two days before the onset of a migraine, patients often experience subtle body signals (called “prodrome”) that can alert them to an upcoming migraine. These changes can include neck stiffness, constipation, increased thirst and urination, food cravings, frequent yawning, and mood swings from depression to euphoria.

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

The Nasal Spray Advantage

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

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

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

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

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

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

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

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

Some Reservations

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

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

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

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

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

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

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

Kraus concurred.

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

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

Common COVID-19 Misconceptions Linger Three Years Later

, , COVID

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

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

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

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

Understandable Confusion

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

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

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

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

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

COVID-19 Facts

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

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

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

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

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

Vaccine Facts

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

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

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

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

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

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

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

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

Here’s to Your Heart Health

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

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

Surprising Heart Facts

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

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

About Heart Disease

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

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

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

Common Symptoms of Heart Disease Include:

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

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

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

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

Increasing Risk

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

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

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

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

diabetes
overweight and obesity
unhealthy diet
physical inactivity
excessive alcohol use

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

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

Lowering Risk

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

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

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

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

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

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

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

Is a Neti Pot Right for You?

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

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

What is a neti pot?

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

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

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

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

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

How do they work?

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

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

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

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

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

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

Some Cautions

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

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

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

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

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

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

Safe Use

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

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

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

To safely use and care for your device:

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

Does it Work?

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

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

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

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

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

Nature Can Heal in More Ways Than One

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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.

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.

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