EAT, DRINK and BE MERRY!!

Eat, Drink and be Merry!

No really, I mean it. No one wants to think about health all the time.

If they do, it becomes a little obsessive and takes the fun out of life and that creates its own problems.

Sometimes as a doctor I feel as if I am the bad guy. People expect me to give them gloomy news and lectures about being healthy which are assumed to be boring. Worse still, they have a look on their faces like they have been called into the principal’s office and expect to be punished.

It’s not my job to be a parent or disciplinarian. In addition to the obvious role of treating medical conditions, I am available to give advice and be a resource when it comes to wellness and preventive medicine but only when someone wants it.

Being healthy should never be a chore, it should be something that we happily embrace and enjoy the benefits of. 

Things that you do to improve your health should be invigorating and put a smile on your face.

It is important to have hobbies and activities that you enjoy and indulge in regularly. I like to travel, it helps me recharge and open my mind to new things.

Everything is good in moderation, so please eat, drink and have a Merry Christmas and a Healthy and Happy New Year.

Dr. Tuakli

Quick notes: How to lose weight over the holidays

I said in a prior blog: the best way to lose weight is not to gain it in the first place. So here are some tips to help you maintain and hopefully lose weight during the holidays.

Chromium: double the amount you take and take it before the two heaviest meals of the day.

Chia seeds: these provide fiber and a feeling of fullness to prevent you from eating too much.

CoQ10: A great anti-oxidant that is very important in aging. It helps generate natural energy so you can keep moving.

Acidophilus probiotics: To keep your gut working well.

Apple Cider Vinegar: some find it curbs their appetite.

Drink 1 to 2 glasses of water before you sit down to that big meal, warm water is better than cold.

Get enough sleep

Figure out what exercise you can comfortably do daily over the holidays, even if it is just a walk around the block. Knock it out early in the day.

Last but not least, 'purge the pantry' after the big dinner and gift-giving there will be a lot of weight generating food and treats in your house (aka 'left-overs'). Get rid of them quickly and efficiently before they become a temptation  and you feel you need to 'finish' them off for days and weeks to come.

Best wishes for the season, have a healthy and happy new year!

Dr. Tuakli

How to avoid traveler's diarrhea

This is the first of a series of blogs about staying healthy while you travel.

The commonest cause of illness in people who travel is diarrhea and except for specific kinds of diarrheal diseases like typhoid and cholera there are no shots to protect you from it. The main reason people get diarrhea when they travel is because they become exposed to bacteria that their system is not used to. It is not because the people in the host country are dirty, when they come here they get diarrhea too.
The good news is that you can pretty much avoid diarrhea altogether if you follow certain precautions.
There are three stages of prevention, first is primary prevention where you avoid exposure to the bacteria altogether. Secondary is what to do if you do get diarrhea and tertiary is antibiotic medication if the diarrhea doesn't stop.

Step one: Take a mega acidophilus capsule once or twice a day, only take it with cold liquids. So you don't kill the live bacteria.
If you are going to a third world county take a tablespoon of peptobismol liquid every evening before dinner. Be aware that peptobismol can turn your tongue black so rinse your mouth after taking it, also know that it will give you black stools which are harmless.
Handling water is very important, only drink bottled water and make sure you don't buy it on the street. If you don't have access to bottled water, drink boiled water. Never put ice in your drinks and avoid salads because the lettuce and tomatoes may have been washed in dirty water. Only eat cooked vegetables and peeled fruits. Also avoid dairy products.
Have a liberal amount of hand sanitizer available at all times.
Sometimes despite your best efforts you still develop diarrhea.

First let's define diarrhea. Diarrhea is either defined by frequency or consistency. If you have six bowel movements a day and that is not your norm you have diarrhea, on the other hand just one bowel movement a day that is running out of you like water is also diarrhea. If you believe you have diarrhea you should move on to step two.

Step two: Take two capsules of Loperamide as soon as you think you have diarrhea and one after each loose stool (this is with the prescription strength). If your diarrhea persists longer than 24 hours immediately move to step three which includes taking a prescription antibiotic. It is very important to avoid dehydration especially in warmer countries so increase your fluid intake. Local sodas (unopened without ice) are good for this.

My goal for my patients when they travel is to make sure they do not need to access medical care for any reason. The level of healthcare services vary greatly in other countries and you certainly don't want a medical mistake to lead to your demise. Be wise and be safe.

Don't forget your sunblock and insect repellant.

Bon voyage

Travelogue: Madeira Portugal

Madeira, Portugal

This travelogue is about a small island off the coast of Portugal, later I will tell you why I recommend it but before I do let's talk about getting there.
As always when you see a deal that is too good to be true, it usually is. We traveled to the Azores, as that area is called, on TAP which is the Portuguese national airline. The price at first glance was unbelievable especially since we were going to be staying at a 5 star hotel.
The airline only flies out of Boston and Newark so we drove to New Jersey. Not a bad 3 hour ride. The price did not include any baggage beyond a handbag! Extra luggage cost $120 round trip and then there was the seat at the back across from the toilet. It cost another $45 per person, each way, to upgrade the seats. All I can say is beware the cheap deals they may end up costing more in the long run. We could have flown out of a closer airport for the same amount of money.
We wondered about racial profiling since we seemed to be the only people searched on the way in and I was again double screened in Lisbon. I'm OK with it if that is what it takes to be safe :)
I must say I did not sense any racism at all while my husband and I were in Madeira. The people were very gracious and welcoming.
Madiera is a beautiful island and like its people it is serene and calm. There were no hoards of tourists since it was late fall (Thanksgiving) but still the weather was very pleasant. The largest number of tourists seemed to be from England and not surprisingly almost everyone spoke English. It apparently does not appeal so much to young people because it doesn't have sandy beaches and major discotheques.

It has a wonderful relaxed atmosphere and no one is in a rush. There were an amazing number of restaurants everywhere, this is testament to the fact that their major industry is tourism. If you like sea food you are in luck, we saw very few cows on the island.
If you really want to enjoy Madeira you should go on a couple of island tours and then rent a car. You can criss cross the island and back in a day, the roads are great and the system of tunnels exciting. Up in the hills it is nice to see the homes and traditions. We bumped into a funeral procession walking from the church to the burial ground in Santana.
Many people go on lavadas which are walks that follow the irrigation system on the hillsides but even if you dont go on a lavada you will still get your steps in. We averaged 12,000 a day just walking downtown for dinner each day. If you are conditioned to avoid desserts Madeira is not for you, between afternoon tea and the dessert shops it is very hard to resist, I gave up trying after 2 days, I was so grateful for those steps!
Shopping: Madeira is famous for its wine, apart from this it is definitely not a shopping capital. It has a huge mall and the usual boutiques but certainly doesn't rival Madrid or Rome. Its a good place to buy lingerie, funny enough, much better quality, selection and price than in the US.
Spoiler alert: Black Friday sales are universal now as a result of globalization. The people have no idea what Thanksgiving is but they do sales on Black Friday, we noticed it in Rome last year too. Works for us!

Dance like no one is watching!

Seasons Greetings!

Dance like no one is watching, make a point of enjoying the Holiday season!

It’s hard to believe yet another year has sailed by in what seems like a blink of an eye. As always we must look forward to the opportunities inherent in a new year. I am proud to say 2018 will be my 29th year in practice.

If you are looking for gifts for the season 'Good Health' never goes out of fashion and we have lots of things and gift certificates  that you can give the ones you love. If you have money left in your HSA or flex spending account use it on something really worthwhile like our special deals or put it towards co-pays for next year.

Our year end specials for 2017 include:

10% off HCG Weight loss program

10% of Fillers and Botox

10% off all face products including Beautox

2 bottles of Stop aging skin therapy for $100 save $20

$200 off VIP program through December 31^st

5% off Anti-Aging program

5% off new HRT (Hormone replacement therapy) consult

All vitamins are 10% off through the end of the year

Also remember it is going to be a bad flu season, if you still haven’t had your flu shot get one now, it is free with your insurance! Stop by and get some Air Defense for the entire family.

I will be out of the office from December 19^th thru 26^th so call now for any appointments or refills. The office will be open from 9 AM to 5 PM except for Xmas and New Year’s day.

Let’s make 2018 the best yet!

Enjoy the season, stay warm and be well.

Dr. Tuakli

10 REALLY Good Reasons to Take Your Blood Pressure Medicine

 Good Reasons to take your Blood Pressure medicine:

High blood pressure is called the ‘silent killer’ because most people have no symptoms and so they don’t know when their blood pressure is high.

Most people on dialysis are either there because of high blood pressure or diabetes or both.

A stroke can cause blindness, paralysis and death and it tends to come without warning.

Your heart can only beat so many times against high pressure and then it gives out.

There is no such thing as blood pressure that cannot be controlled.

A normal blood pressure is a pre-requisite for a long and healthy life.

Your chances of staying independent as a senior are much better if you take care of your blood pressure when you are younger.

High blood pressure causes blindness even without a stroke.

Over 90% of people who take blood pressure medicine have no side effects.

Blood pressure medicines are generally very reasonably priced, if your doctor has you on one that’s too expensive request it be changed. You get a lot of bang for your buck when you treat your blood pressure.

Let me know if you need more ................:)

Nadu Tuakli MD

What's new with Blood Pressure?

Here's what is new with Blood Pressure?

Hypertension is a very prevalent condition in the US in the over 60 population over 65% are considered to be hypertensive.

Blood pressure is the leading risk factor for CV (cardiovascular) morbidity and mortality which is the number 1 cause of death in women and  number 2 in men. Other risk factors include diabetes, obesity and smoking.

In the African American population hypertension rates are higher,  it presents earlier and tends to be more severe that in Caucasians. They also have the highest incidence of kidney disease, cardiovascular disease and stroke from it than other ethnicities.

Every few years a group of experts (gurus) get together to make recommendations about how to diagnose, treat and manage HTN. This group is put together by the NIH and they are called the Joint National Commission  or the JNC.  The latest  recommendations are those of the JNC8 published in 2014. Before that was 2003 (JNC 7) so you can see that they don’t meet too often, once or twice a decade.

Be that as it may, the current guidelines have taken us backwards in terms of defining hypertension. There was a time when the goal for blood pressure was 120/80 and still is, for some very high risk people however for most people here are the new numbers:

If you are over 60 you are not hypertensive until your BP is  >150/90, under 60 they suggest you begin treatment when your pressure is over 140/90. Also new is an acknowledgement that we should not be over treating blood pressure in the elderly.

Black patients, elderly and diabetics are at greatest risk of hypertension complications.

The JNC8 also addressed treatment of blood pressure and suggested different starting medications for African American and Caucasian patients because they work differently.

JNC 1 through JNC 4 recommended a step wise approach to blood pressure treatment but now one can start with a variety of medications and if one is not working adequately after a month of use they suggest another medication be added. A third one may be needed if maximum doses of the first two do not control the blood pressure.

The best blood pressure measurement is the one you do outside the office! Some actually recommend that the elevated blood pressure be confirmed outside to avoid ‘white coat syndrome’ before starting treatment.

Some insurances will pay for a 24 hour ambulatory blood pressure monitor to confirm what a patient’s blood pressure is when they are up and moving around.

There is the DASH diet which people with hypertension should try to follow, cut down salt intake and drink adequate amounts of water.

Always have your blood pressure checked at least twice a year and if you are on medication at least monthly at home.

People on blood pressure medication need to have their blood checked periodically for kidney and liver function and diabetes.

At the end of the day high blood pressure is a serious condition and should be handled as such. It should not be taken lightly as it causes a lot of premature death.

SHOULD EVERY WOMAN TAKE HORMONES?

OK enough is enough, almost every woman over the age of 45 should be offered hormones and many who are younger. There I said it! 

Why is that so hard to hear? Let alone believe?

I am tired of avoiding telling women the truth because people are so afraid of the word ‘hormone’. Hormones are critical for every function in the body but somehow or the other we have been brainwashed into thinking there are good and bad hormones, with the sex hormones like estrogen, progesterone and testosterone being the 'bad' ones.

Women represent the greatest proportion of people aged 65 and over, a total of almost 58%.  And guess what ?  EVERY woman is going to be menopausal at some point. So this is really a topic of epic proportions that is why I cannot understand why it is so ignored.

Millions of women and their partners put up with emotional swings, with paralyzing anxiety and depression. They are a shadow of their former selves because no one will tell them that taking hormones will fix it.

Millions have given up having a satisfying sex life because they have been told that it is part of the normal aging process not to want sex and for intercourse to be uncomfortable.

Millions of women are forgetful and can’t sleep because their hormones are out of whack . They get prescriptions for sleep aids and anti-depressants because no one explains to them that there is another way. One that is safer and way more natural with no side effects.

When women sleep at night they function better in their profession, get along better with their family and colleagues and they can find the motivation to exercise. Exercise leads to a better mood, less weight and less diabetes. Their blood pressure is better, so they have less risk of stroke and disability.

Women who are on hormones feel less pain whether it is from arthritis or a whole host of other issues.

They look better because there is less fat deposition around their mid section, the skin, eyes and everything else is less dry and they seem happier and more calm.

So what’s the down side? None, seriously. If you use bio-identical hormones, there really isn’t one. Yet fear mongering keeps women in a vice so tight they are afraid to allow themselves the benefits of  hormone replacement.

I have written books and given talks to try to get the word out there. Yet still, very few women are aware of the potential life changing benefits of hormone replacement. If men stood to gain as much as women from this therapy I am sure it would be front page news.

Yesterday Harvard ( JoAnn Manson et al JAMA 2017:318(10) 927-938)  after studying the outcomes of 27,000+ women, published a new article saying that hormone therapy is safe and does not shorten a woman’s life. Let's keep our fingers crossed, maybe the news feeds will pick it up and maybe this time women will have the opportunity to hear more about it.

If you find this post informative please do other women and their loved ones a favor and share it.

Yours in health

Dr. Tuakli