"A kinder, gentler nation"

A kinder, gentler nation......

Such words are like a whisper blowing through the leaves of our memory. Did a president once say that or is it a figment of my imagination?

The recent passing of George H W Bush and John McCain remind us of words of hope and kindness that harken back to the days of not just inspiration but aspiration too.

I wonder what words our children hear these days. There is never anything positive, inspirational or affirmative that comes out of the current administration.

We all need inspiration no matter how old we are and hopefully it comes from the top.

Today's children will grow up to think that it is normal to be constantly antagonistic, ballistic and untruthful. And we sit by.

So whatever your political affiliation I think you can mourn, as I do, the passing of more than just a President.

Call it nostalgia but maybe its up to us to try to pull out the nobility, truth and honesty that hopefully still resides in our children.

A wonderful living example of humility is Jimmy Carter but then what?

 We desperately need Presidents who allow us to have aspirations not just for ourselves but for our communities as well. Presidents who will at least talk about the goodness of people.

'Tis the season of giving, I hope you are all volunteering and giving to your favorite charity and that you can see past this barren winter back to a time when the leaves were in full bloom. When there was at least a promise of something kinder and gentler ........

What doctors don't tell you about menopause may harm you!

The AARP magazine 2 months ago had an article (September 2018) about this.
Really? I thought when I read it Nah, not my patients. I talk to them all the time about menopause, I've even written two books on the subject!
Well just in case you missed it, here's the bottom line from the article:

An 18 year follow-up look at the WHI study (the study that scared everyone about hormones in the first place) that was published last year in JAMA reported that women ages 50 to 59 who took hormone replacement therapy (HRT) had a lower mortality rate than those who did not.

Women in their 50's who took HRT were less likely to die of heart disease, cancer or any other cause than those in the no-HRT group. (Did you hear that guys? read that again!)

Women on HRT for an average of 8 years had better cardiac health and improved blood flow through their heart chambers than those not receiving therapy.

Women who stopped HRT had a 55 percent higher risk of hip fracture than those who continued treatment.

So that encapsulates the good news. But then the article also quotes a doctor from Yale who says "doctors are not helpful".
It also states that 3 out of 4 women who seek help for symptoms don't receive it. (No? where in the world are they going? come see me!).

An interesting reference was made to a Yale study that estimates 91,000 women between the ages of 50 and 59 died prematurely from cardiovascular disease between 2002 and 2012 because they had hysterectomies and were not prescribed hormones.

This article is a start, hopefully main stream media will pick it up and run with the subject, you never know. I love the illustrations that came with the article, you should really take a look at it.

One disappointment for me is that they made no mention of the safer more natural alternative bioidentical HRT but as I said it is a start. If you want to read more in depth about it, order a copy of my book: Sex, Sanity and Sleep from Amazon or Barnes and Nobles or stop by the office.

The Spanish version is coming out next month (Just in time for Xmas :)

Why would you give someone a gift card for a doctor's office?

Season's Greetings !

Here's why a gift card from a doctor's office is a good (and healthy) idea:

There are many services you may not immediately think of that someone can use their gift card for:

Vitamins, face products, supplements, Botox and filler, skin tag removal, Weight loss, Genetic testing, Vitamin testing, Hormone replacement and Anti-aging just to name a few.

So let's say your favorite person needs to lose weight or get rid of frown lines but you are not sure how to bring it up, give them a gift card!
Also if you give us a heads up when you purchase it and tell us what exactly you have in mind we can politely steer them in that direction.

What better way to express love and concern than to help improve their health?

Meanwhile remember, to be grateful is to be happy. I hope you enjoyed Thanksgiving and I wish you a very merry holiday. Drive safely and don't eat too much :)

Clinical: Weird symptoms that no one can diagnose?

When your symptoms seem 'weird' to both you and your doctor always consider Lyme disease.

I had a man in his late 40's who I have seen once a year since 1990 for a physical. Apart from basket ball mishaps no other problems. All of a sudden he popped up complaining of an itchy rash along his belt line and we assumed he had developed a nickel allergy. I gave him a steroid cream and the rash went away but not the itching. His body had itching all over, off and on, with low grade hives. That weekend he was out to dinner with his wife and felt like he was going to pass out, was he dehydrated? It was, after all the height of summer. I ran an ECG on him and it was different from the ones he had been getting annually. Thank goodness he had been so consistent with his physicals.
The EGC was the final clue and I ran a Lyme disease test on him. It was the highest I have ever seen!
Within two days of starting treatment, he began to feel like his old self.

His new normal had consisted of fatigue and constant itching and 'weird symptoms' that changed from day to day.  Based on his blood test I would assume that he had had Lyme disease for quite awhile.
He had no recollection of a tick bite, joint pains or a target lesion on his skin which are the classic symptoms of Lyme infection. Sometimes its just a general feeling of not being well, or generalized body aches and malaise. It is always good to check.
In the meantime, prevention is better than cure. Check yourself and your pets for ticks when you come in from the outside especially if you have been in the yard or hiking. Insect repellants may also help.

Flu shots are here, should you get one?

The answer is probably yes, since there are minimal downsides and they are covered by almost every insurance (they have figured out that it costs them more if you get sick).
But that's too easy an answer, so let's look at it a little more closely.

What are the pros: you hopefully will not get sick if you are exposed to influenza. On the other hand  if you do, it will be less severe than if you have not been immunized. You will save the discomfort of being sick and the time off work, and the cost of trying to get better.

A case in point: yesterday, a plane load of passengers had to be diverted at JFK and were not allowed to enter the terminal because about a third of the passengers (all coming from Dubai) were sick, coughing, feverish and vomiting. It turned out they all had the flu. Ask Vanilla Ice, he was on the plane!
These people were all deplaning in New York, 10 of them were sent directly to the hospital from the airport.
This is an extreme case and that was a long flight, with almost 400 people sharing the same air, but it proves without a doubt that Influenza has arrived and it can be very contagious.

Does a flu shot guarantee someone will not get the flu? No. But isn't it better to have some protection than none? 

So, why would someone not want to get the flu shot? I'm not sure but I can tell you this, it would not be for medical reasons. I have never seen a patient allergic to the shot and when I ask my allergy colleagues they too have difficulty recalling ever having seen someone who was allergic as well.

Some people are scared of needles. Some like to proclaim that they have never had the flu before as if that means they don't have to worry about it.

Young children, the elderly and the people who have compromised immunity are strongly encouraged to get the flu shot. The sooner, the better and if you will be flying during the holidays, take that into account.

To be honest I have already had mine.

I'm happy to say that flu shots are now readily available in our office and you don't need to have an appointment to get one. So think about it and come on in.

Of interest, there is on-going research to create a vaccine that covers every strain, so that hopefully in the next few years once you get immunized you wont have to get it annually. But until that is available, get your annual flu shot with a smile knowing that you have done something proactive to keep yourself healthy this winter.

A new road sign............................South Africa

A different kind of road sign

If you ever have the opportunity to go to South Africa grab it with both hands and don’t think twice.

Cape Town is the most beautiful city in the world, it has to be seen to be believed. The whole of South Africa is phenomenal but especially the Cape area. From the vineyards to the beaches, from the mountains to the wildlife it is all amazing.

For your first trip it is well worth going with a tour company because you will see so much without having to worry about the logistics of getting around and experiencing everything.

I have attached one of my favorite road signs followed by a series of pictures, I took this month (June) with my phone.

Unfortunately, I can’t share enough shots to do the country justice but hopefully it will give you a little flavor of the awesome beauty of the place.

If you want to go and/or have questions I am always available to answer them. Enjoy!

Watch out!

37 pound weight loss in 6 weeks. How can you beat the HCG diet?!

Here is a new testimonial I received this month. It is always gratifying when my patients take the time to say thank you but most importantly allow me to share their stories to help others. This patient lost nearly 40 pounds in 6 weeks! The HCG diet really is unbeatable. I love it because my patients get real results and keep the weight off.


"June 14, 2018

 Dear Dr. Tuakli,
I first want to thank you and your staff (Ester and Cindy) for all the encouragement and support that you provided throughout my journey on HCG. It was great to come in every week and be greeted with a cheerleading squad, even on those weeks when I did not lose as much as I would have liked.

March 6, 2018 was the beginning of a transformational change. I was 200lbs, not feeling great physically or emotionally and had just gotten to a place where I just needed something to provide a spark, a jump start.
HCG provided that spark and jumpstart that I needed.
I would definitely refer and recommend others to try it. However, it’s important that they be in a place of readiness.

I have done many diets over the years, but it wasn’t until this moment that all things clicked. As of the date of this letter I have lost 37 lbs and I feel amazing. It is a lifestyle change, it’s not an overnight fad, and you must do the work.
I would not change anything, and would do it again. Thank you for everything.

Sincerely N.R"

Doctors commit suicide too!

Doctors have the highest suicide rate.

Patients may be surprised to realize that doctors get depressed and commit suicide. But what may be even more surprising is the fact that doctors have the highest rate of suicide in the country. Physicians in America have the highest rate of any profession: twice the number of suicides as the general population. 

According to Medscape: physicians have at least one completed suicide daily despite the fact that they are surrounded by other medical professions. 

A doctor at the CDC recently killed himself by drowning. This illuminates the fact  that if you don’t  seek out the signs or ask, depression can be masked.  

If you suspect someone maybe suicidal you must act.

 54% of people who commit suicide have no known prior mental health condition. 

The commonest method is with firearms, followed by hanging or strangulation. Montana has the highest incidence of suicide and Washington DC the lowest, in the United States.

I had planned to write this blog a couple of months ago when I read about a doctor and a  final year medical student, at the same hospital in New York, committing suicide in the same week. 

I didn’t get around to it because I was extremely busy and getting ready for my safari to South Africa.

But, in less than the 2 weeks that I was gone: two well known celebrities hung themselves. It is becoming an urgent issue: according to the CDC the rates are definitely increasing, having risen 25% since 1999.

Whenever someone kills themselves I always think about what a waste of a life it is, and I often wonder if they are aware of the pain and suffering they bring to their loved ones and friends. 

The people left behind feel like failures, they feel helpless and empty, soul searching for what they could have done differently.

Doctors, clearly, must do a better job of suicide prevention both for our patients and ourselves. Doctors are taught the symptoms of depression which should give them an advantage yet they too succumb to suicide. How much more people who don't understand what they maybe going through. It is up to us to assure them that the cloud will lift, even if it doesn't feel like it.

Please look at the suicide prevention website or call the national suicide prevention lifeline for more information and educate yourself.

In a nutshell: if you are depressed seek assistance from your doctor immediately. If you are on anti-depressant medication follow up with your doctor regularly even if you think nothing has changed. 

Learn the signs of depression and if your friends, family or co-workers exhibit them, encourage them to get help. Do not be afraid to ask people you care about, you will not give them an idea too commit suicide if they haven't already considered it.

Depression is like any other medical condition and there should not be a stigma attached to it. By understanding the condition and removing the stigma, people will be more willing to share how they are feeling with others.

Dr. Anne Schuchat, principal deputy director of the CDC said there are simple steps anyone can take to help someone at risk. "Beginning a conversation, helping keep them safe, helping them connect and then follow up with them," she said. "We don't think every single suicide can be prevented, but many are preventable."

How to get help: In the US, call the National Suicide Prevention Lifeline at 1-800-273-8255. The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

Together we can all save lives!

MY TAKE ON THE ROYAL WEDDING !!!

My take on the royal wedding

Here’s a fun one!

Many may wonder why a doctor is writing about the royal wedding.  Here’s why:

Most of my patients do not realize that I am British by birth and spent the formative years of my life singing God save our gracious Queen! Now I am literally an African–American Brit but the interest in the royalty is indelibly ingrained in my brain. (I even went to London for William and Kate's wedding.)

Secondly, it was after all so beautiful ….. happy and glorious (oops, starting to sound like the national anthem again!)  These are things we all need these days.

So, as someone with a perspective from both sides of the Atlantic ocean, kindly allow me to voice my opinion.

It was nice to see an occasion without cell phones and selfies for a change. Although Camilla did manage to distract herself with the program (and us with her hat)!

Meghan looked fantastic and she comported herself regally albeit in isolation.

The dress was, as Harry said, ‘Amazing’ it could not have been more beautiful and the ‘Queen Mary tiara’ my word! I would pay for a touch of that exquisite piece of jewelry.

I have never really been interested in going to see the crown jewels but I might change my mind  and join that long line now.

The chapel at Windsor was such a good choice it was so much more cozy than Westminster Abbey and it was a good excuse to keep the number of invitations down but I can tell you as a Brit that chapel has never seen anything like it!

Tut tut ! a choir with braids, a woman without a hat on, people singing “stand by me” in the Queen’s church?  oh well, at least there was no drumming.

Speaking of music it was impeccable from start to finish. I loved all the choices and that 19 year old cellist was incredible and so poised (a little too much expression for the royal taste but no matter). Both choirs were pitch perfect.

The wedding itself went off without a hitch but yes there were some wrinkles. We wouldn’t be human if we didn’t mention them right?

The first was Doria, the mother of the bride. As a mother my heart ached for her through out the ceremony. She was so alone, I think she had to mentally go somewhere else.

As a mother I can only imagine how she felt, she had no one to lean on. No one even talked to her as she sat and watched her daughter go through the incredible spectacle.

Did no one there feel a little compassion for her? No one to talk to and she certainly didn’t have a shoulder to cry on. (Doria call me next time!)

Despite being in a strange place with even stranger people Doria conducted herself with immense dignity as she watched her daughter’s pomp and circumstance and held back the tears, knowing that cameras were trained on her every expression. By golly, she could have been royal herself.

I would have just let the tears flow. I give her credit, no gaudy make up or trying to upstage anyone, just a quite self assurance. I hope her daughter is a chip off the old block, she is going to need to be.

Yes, poor Meghan with only one family member at her wedding. Outside of the glitz and glamour of royalty at the end of the day, there is some loneliness there but now she has Harry and hopefully she can create a new family.

It truly is a fairy tale, for a child of such a dysfunctional family (girl I feel your pain!), to end up in the British royal family is a miracle that could only happen…. in America!

I give Meghan credit though.  The English would have invited them just to save face, in spite of the fact that their behavior was making her unhappy. Good for you Meghan for sticking to your guns!

While I am at it let’s talk about the preacher, oops! He was supposed to be Episcopalian but obviously  he is rather far removed from the Church of England. No one saw him coming.

Something tells me the gentry are still shuddering. I’ve heard his sermon described by the British as ‘rousing’ a gentle way of saying a little too animated.

His theme was love, if he mentioned it once, he said it a thousand times. Or as they say in the States….I wish I had a nickel every time he said the word.

But his point is well taken, the people of the world desperately need to heal. And let’s hope that love can do that, Lord knows we need it. Ten more young lives lost in Texas to gun violence just the day before.

I’m not sure what all the talk about fire was about but I can tell you it was a little too much for the British, they don’t do a lot of talking in church and never, ever shout!

I was pleased that he spoke ad lib, why does the Archbishop of Canterbury have to read from an elaborate document even when he has said the same words a million times?

I will end here, suffice to say, it was a great spectacle and for an hour, a billion people world-wide could focus on something beautiful and positive. We, unlike the royal family allowed ourselves to exhale and smile.

Congratulations to the new Duke and Duchess of Sussex, I loved every minute of it!

I wish we could celebrate something  so grandly apolitical every month, its refreshing.

But before I get carried away, let’s just pray for a peaceful week ………….

(comments welcome, please forward).

A moving call for Gun Control

Guns claim thousands of lives annually, particularly in the 15 to 35 age bracket.

Doctors agreed years ago that gun violence and its control was a major public health issue, yet we too are guilty of doing nothing to stop it.

Unfortunately, we needed yet another wake up call. The latest being provided by the students of Majory Stoneman Douglas High School in Parkland Florida.

I attended the March for Our Lives in Washington today and it was very moving.

It was made all the more real by children speaking about how violence has affected their lives and essentially robbed them of their childhood.

As I listened with my throbbing headache from constant tears, I witnessed the promise of what America could be.  All races and all ages peacefully and respectfully coexisting, rallying to speak the truth and attempting to shake the status quo.

I can only hope that they have finally given voice to the unheard mass of gun violence victims. The voice we usually hear is that of the gun lobby.

On this beautiful spring day it was so emotional to see the often maligned youth willing to give up their Saturday and protest for a good cause. I hope we adults can help them keep the ball rolling.  In my opinion no civilian has a legitimate need for an assault weapon and if you are not old enough to drink you shouldn’t be old enough to carry a gun.

A change in gun control laws is way overdue. Here’s hoping the days of mass shootings are over.