Index -- WPGYN Newsletter -- Volume 10, Issue 4, October 2013
Flu Season is Here
Health Apps, Gagdets, and Websites -- Oh, My!
Exercise Can Extend Your Life
X-Ray Exposure - from the Airport to the CT Scanner
My grandfather died of the flu in 1918 at the age of 30. Perhaps I would have had the opportunity to meet him if flu vaccines had been available then.
The Center for Disease Control (CDC) works with the Advisory Committee on Immunization Practices (ACIP) each year to make recommendations regarding vaccination for influenza. Every year many people die of the flu and many of these deaths are preventable. Like many things in medicine, vaccination for influenza becomes more complicated each year. Since last year, the CDC has licensed six new flu vaccines. The main differences are live vs. inactivated vaccine, trivalent vs. quadrivalent vaccines, normal dose vs. high dose vaccines, and an egg-free product for individuals with egg allergy. You can read the latest 48 page bulletin in the Sept 20, 2013 MMWR. Here are some highlights:
· Routine annual influenza vaccination is recommended for all persons aged =6 months.
· Vaccination should begin by October. The protection lasts 6-8 months, possibly longer in patients with good immunity.
· No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one product is otherwise appropriate.
· Postmarketing safety and effectiveness data are not yet available on the six new vaccines.
· It is anticipated that the high-dose may have better effectiveness in people with reduced immunity, such as those >65, but it may have more side effects. The quadrivalent vaccine includes an additional strain of Influenza B (Victoria/2008)
At Women Physicians, we offer Fluzone Intradermal, a trivalent standard dosage influenza vaccine. This is an inactivated vaccine which is active against influenza strains A (H1N1), A (H3N2), and B (Yamagata lineage/2012). This is a suitable vaccine for all healthy adults. You can drop by our office for a flu vaccine on weekdays from 9 AM to 12:30 PM or 1:30 PM to 5 PM. We are closed Wednesday afternoons.
Other vaccines— We also offer the pneumonia vaccine for those over 65 or at high risk and the shingles vaccine for those over 60 (or over 50 at high risk). All adults should have a T-DAP vaccine (tetanus, diphtheria, pertussis) within 10 years.
This being Silicon Valley, many of my patients are very tech savvy. I learn a lot from my patients and my Millennial Generation Y daughters from how to turn off my phone (I actually needed help) to how to encrypt all my computers (I am HIPAA compliant!). On the other hand, many of the BabyBoomers, like me, are somewhat slow to the party. And there’s room for both groups and everyone inbetween to improve their health by using some of the new technology. Turn off that video game app and turn on your fitbit! BTW, I have no financial relationships with any of the products I’ll be discussing.
There are multiple websites discussing favorite health apps. An app that makes it to every favorites list is MyFitnessPal. It’s also one with which I have personal experience as do 40 million other users. I often find myself recommending it to patients during their annual exams for various reasons, so I’d like to recommend it here, too.
There is both a smartphone app and a web-based version and they automatically sync together. Both are free. It allows one to track diet and exercise in a very simple yet sophisticated way. Users can enter individual foods or create commonly used recipes. A barcode scanner makes it easy to enter products. An amazing number of foods are in their database including prepared dishes from chain restaurants and branded foods such as store brands like Trader Joes. Fresh foods are also in the database, like bananas or kale. As you use the app, your most commonly eaten foods rise to the top of your search list. The daily food diary adds up your calories, carbs, fat, protein, sodium and sugar. You can also log your exercise and it will calculate the calories expended. I like to use my smartphone to record my eating and exercise throughout the day, and then go to the website for a final calculation in the evening. Periodically, I wander over to the report section to see how I’ve been doing for the last 7 days, 30 days, or 90 days. There is also an active community section with groups, message boards and blogs. You can invite a friend to share the information at your site and thus support each other or compete with each other.
How is this useful?
An obvious benefit is for those interested in weight loss. You can program in a daily calorie goal and fitness goal and MyFitnessPal will let you know if you are meeting your goals based on your intake of dietary calories and expenditure of exercise calories. It also lets you know what your weight loss (or gain) would be if you ate and exercised that way every day. You can log your initial weight and then log weights over time.
Another benefit is for those with metabolic syndrome, pre-diabetes, or the insulin resistance we often see with menopause. You can easily monitor your carbs and sugars. You may well find some foods contain more sugar and carbohydrates than you expected!
Those with hypertension will also find this is an easy way to keep track of sodium and potassium intake. One of the main concepts of the DASH diet for hypertension is increasing potassium and lowering sodium. Once again, it is an eye-opener to see how much sodium is in many processed foods. Sodium consumption is readily available on the main food intake page and potassium consumption is available on the reports page.
Finally, those with osteopenia or osteoporosis can use this as a tool to monitor their calcium intake. Rather than mg, the amount of calcium listed on most food labels is in %RDA (Recommended Dietary Allowance). The NIH lists the RDA for women 19-50 as 1000 mg and for women 51 to 70 as 1200 mg. I believe MyFitnessPal uses 1000 mg as 100% RDA, and today that level is considered adequate for postmenopausal women, too. To keep track of your calcium intake, you need to go to the reports tab and choose calcium.
Even for those of you with a healthy lifestyle, the increased self-awareness of using MyFitnessPal can be an eye-opener and help you develop better habits.
Another device I love is my Fitbit Tracker. This is a wireless-enabled wearable device that objectively measures activity levels.
The Fitbit Tracker uses a three-dimensional accelerometer to sense user movement. The Tracker measures steps taken, and combines it with user data to calculate distance walked, calories burned, floors climbed, and activity duration and intensity. I often have women tell me “I don’t really exercise, but I’m active all day.” This is one way to prove to yourself how active you really are—or aren’t. I find it to be very motivational. I love the badges for meeting challenges and the colorful interactive dashboard that rewards you with “Hoorays!” If you ever hear me huffing and puffing as we speak on the phone, it’s probably because I’m walking in circles or up and down stairs to meet my next goal.
There are different types of devices to choose from, each slightly different. I chose the Fitbit One for its sleep function and altimeter. The altimeter is useful if you walk (or bike-ride) in the hills as it converts vertical distance into floors climbed. Dr. Litwin and I once did a hike at Rancho that was the equivalent of 162 floors! It is not accurate for converting the activity of bike riding into calories but it does give me 14 floors for my daily bike rides to work. It also measures sleep quality: how long it takes to fall asleep, the number of wakenings over the course of the night, and the total time of actual asleep. Are you getting 7-8 hours sleep per night? The self awareness of what is actually happening with your sleep patterns is the first step toward fixing it.
I also like the fact that I was able to sync it to MyFitnessPal. With no extra effort or calculation, the number of calories I’ve expended is transferred to that site. Even for the technologically challenged, it is easy to download and register. The average price of the Fitbit is between $60–$130, depending on the model.
The Apple i-phone has a similar app to measure activity levels called Moves which is free. I don’t have an iPhone, so you’ll have to check that out on your own.
Other Great Medical Apps — These all received high ratings!
MedHelper (http://medhelperapp.com/) lets users track a family's worth of doctors appointments and prescriptions simultaneously. It organizes medication and treatment information, and automatically reminds users to take pills on time.
WebMDMobile (http://www.webmd.com/) provides access to the site's Symptom Checker, information on drugs and treatments, local health listings and more. First aid information is available regardless of a wireless connection.
At Ease (http://www.meditationoasis.com/) is designed to relieve anxiety and worry through a combination of voice-guided breathing meditations, exercises and journaling.
Glenn Harrold hypnotherapy—Many apps to purchase for 2.99 including hypnosis to sleep well, relax, improve weight loss, smoking cessation, or improved healing.
Diabetes Diary allows diabetics to record glucose readings, insulin doses and carbohydrate intake, supporting both mmol/L and mg/dL units for glucose readings and a fully customisable list of insulin types.
Propeller Health (http://propellerhealth.com/) allows asthmatics to tracks inhaler usage and wirelessly syncs it to a smartphone with environmental information.
Luminosity (http://www.lumosity.com/) uses games and quizzes to sharpen your brain and cognitive skills through daily exercises.
MindShift (http://www.anxietybc.com/) is an app designed to help teens and young adults cope with anxiety.
We all know exercise is good—but how good and how much do you need? A recent meta-analysis from Harvard supported previous studies suggesting 30 minutes a day of light exercise, like walking, has a significant effect on all cause mortality, extending life by about 3.5 years. You can get the same effect in half the time by running. And more is better.
Studies show exercise helps heart disease, diabetes, hypertension, Parkinson’s, osteoarthritis, depression, weight management, sense of well-being and more. So why doesn’t everyone exercise?
The biggest barriers I see are lack of time and ingrained habits. So think out of the box! Figure out how to work on the computer while you use the elliptical or treadmill! Walk while talking on the phone! Make walking dates instead of lunch dates! Walk the track at your child’s soccer game! Send me your unique ideas and I’ll share them in the next newsletter.
I often get questions about the risks of radiation. We are all exposed to radiation ranging from exposure during daily activities to exposure with imaging procedures. The following will give you an idea of your exposure from various things. Remember, it is the cumulative exposure that counts. And infants and children are more sensitive to the cancer causing effects of radiation that adults.
How important is this? According to the EPA, in a group of 10,000 people, we can expect about 2,000 to die of cancer from all non-radiation causes. The accumulated exposure to 10,000 microservients of radiation (23 mammograms), would increase that number to about 2005 or an additional 0.5/1,000 people.
A microservient is a unit that measures how radiation affects our health.
For comparison, smoking one pack of cigarettes per day is the cancer-causing equivalent of 80,000 microservients of radiation.
Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.
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