Is it Time for Thyme?

Largely due to its anti-inflammatory and anti-bacterial properties, the herb thyme — which is found with other herbs in the produce section of most food stores — may well earn itself a place in the skin care section of your local drug store.

Researchers from Leeds Metropolitan University in the U.K. steeped thyme, marigold, and myrrh in alcohol to make what’s called a tincture, and then tested them on the bacteria that cause acne. They all had greater antibacterial effect after five minutes compared to lab specimens exposed to plain alcohol, but thyme was the most potent.

In fact, the thyme tincture was more powerful than standard concentrations of benzoyl peroxide, which is the active ingredient in many acne products. The new findings were presented at the Society for General Microbiology’s Spring Conference in Dublin.

“If thyme tincture is proven to be as clinically effective as our findings suggest, it may be a natural alternative to current treatments,” researcher Margarita Gomez-Escalada, PhD, says in a news release. “The problem with treatments containing benzoyl peroxide is the side effects they are associated with,” namely a burning sensation and skin irritation.

“Herbal preparations are less harsh on the skin due to their anti-inflammatory properties, while our results suggest they can be just as, if not more, effective than chemical treatments,” she says.

But some U.S. dermatologists are quick to caution that while intriguing, this research is still preliminary, and thyme-tinged acne treatments are not yet ready for prime time. Alan Shalita, MD, is the distinguished teaching professor and chairman of the department of dermatology at SUNY Downstate Medical Center in New York calls the results, “intriguing.”

Shalita still favors traditional products: “Choose a cleanser with salicylic acid followed by a mild benzoyl peroxide leave-on product,” he says. “If that doesn’t work, see a dermatologist for prescription medications.”

Michele Green, MD, is less cautious. She is ready to call on a compounding pharmacist to develop a thyme-based acne treatment right now. “Benzoyl peroxide is drying and irritating, and an herbal treatment could be fabulous,” she says. Green is a dermatologist at Lenox Hill Hospital in New York City.

 

Other dermatologists weighed in: 

Joshua Zeichner, MD, says that time will tell if thyme holds promise as an acne treatment. “More research needs to be done to evaluate thyme, but it is an exciting prospect and would be a welcome addition.” Zeichner is an assistant professor of dermatology at Mount Sinai Medical Center in Manhattan.

Don’t try thyme at home. “How it works in the lab setting is very different than how it works on your skin,” he says. Amy Forman Taub, MD, agrees. She is the medical director of Advanced Dermatology and an assistant clinical professor of dermatology at Northwestern University Medical School, both in Chicago. “We always need more treatments for acne because there are so many people who suffer with it.”

Is thyme the solution for these people? Taub isn’t sure. “We are far away from developing a preparation that contains thyme, but this is interesting,” she says.

The Yawning Mystery

Why is it that when someone in the room yawns, you suddenly need to yawn as well?  Have you ever seen this behavior roll through an office like a “wave” at Dodgers stadium?

Believe it or not, this phenomenon has been studied quite a bit over the years, with the ultimate conclusion pointing to the human nature of “empathy.”  Empathy is considered a subconscious instinct meant to bring us together in support of our fellow humans.  Yawning implies boredom, sleepiness or fatigue– all of which are not behaviors widely accepted in public.

However, additional studies have shown that baboons (more so than monkeys) also yawn contagiously. It seems to be an ancient form of communication and we may be showing a remnant of that as humans.  This same theory is cited as the reason why –when awakened suddenly– we seem prepared to push off a predator… a leftover behavior from being in caves with predators around us.

Would you believe even dogs– both domestic and wild– yawn contagiously? Again, this appears to be an evolutionary behavior which has not yet left them; perhaps yawning was some type of defense mechanism in the fields.

Of note, recent studies show that “only” 80% of humans will yawn in a contagious manner. Perhaps the other 20% are forerunners who have mutated away from this leftover evolutionary instinct.

So, depending on how you look at it, you’re either an empathetic person holding firm to your survival instincts or you’re an evolutionary “leader,” tossing off the shackles of your ancestors.  Want to know the answer?  Did you yawn while reading this?  There you go.

Samme

Dumb but Not Stupid

Dear Samme,

I am a 51-year old woman in the market for a new doctor. I’d like to get your opinion on something, and see if you can refer me to a Caduceus physician who has better sense.

Last week during my annual check-up my family doctor (not at Caduceus) recommended that I take a vaccine called “Prevnar.” He said that because I had asthma as a child, and used to smoke, I may be at higher risk for pneumonia, and the Prevnar might prevent that. He doesn’t realize that I did not just fall off of a turnip truck! There is this feature on my computer called “Google,” and I wisely looked up Prevnar. I found out that this is a pediatric vaccine meant for children six weeks to five years of age! You can imagine how angry I was!

Two years ago, when my husband was 50 years old, his physician game him “Pneumovax” for the same purpose– preventing pneumonia. My exhaustive Google search revealed that was the correct recommendation from his doctor. Unfortunately, his doctor retired, and I must now find a new doctor for both of us.

Samme, since you are never wrong — and you can prove it — I know you are equally angered by my physician’s attempted to give me a pediatric vaccine. I would love to hear your take on this and and direct us to the physician referral services at Caduceus.

Signed,

Dumb But Not Stupid

Dear Dumb,

Samme does not think you are dumb or even stupid, but uptight, yes.  So, take Samme’s advice and have a nice glass of red wine, put on Miles Davis in the background, and go outside and watch one of the beautiful sunsets we have here in Orange County. Your family doctor is 100% correct, and you would do well to make him your husband’s physician, as well.

Yes, it is true that Prevnar has traditionally been a pediatric vaccine to prevent 13 different types of the strep bacteria pneumonia, as well as preventing ear infections.  However, on December 30, 2011, the US Food and Drug Administration announced it was approving Prevnar for use in persons age 50 and over to prevent pneumonia caused by Streptococcus.  In multiple studies they found that Prevnar and Pneumovax were equally effective in preventing the strep pneumonia that plagues our senior citizens.

As for our physician referral services, our website is a good place to start.  Perhaps Samme can talk your current doctor into joining Caduceus because he’s clearly on top of his game.

Samme

SammeSez: Prevnar is now approved for preventing strep pneumonia in adults greater than age 50.

New Services in 2012

New Services in 2012

In a Fit Over Being Fit

Dear Samme:

I am a fit 65-year old man who has been fighting with Medicare the past six months. My brother (who is 67) is with a Medicare Advantage plan in Northern California. As part of his membership, they cover a membership in a fitness club as one of their benefits. He goes to the fitness club four times each week and is now more fit than I.  He believes it’s helped his golf game, as well as his overall sense of well-being.

I selected Medicare because I wanted to have the most possible choices in which doctors I see, and did not want to be burdened with the referrals that the Medicare Advantage HMOs have. But, I think Medicare should cover a fitness membership, too.  I mean, why does my older brother get all of the breaks? Mom even gave him his own puppy when we were kids—it’s just not fair! Our whole lives he’s been getting more than I get.  I have written and called Medicare, but they state they have no plans of offering fitness club membership.  I know that if they would that I would be healthier and cost less money in the long run.  I think that is true for almost all of their Medicare members.  Samme, I know they will listen to you. Tell them! Please! If they offer fitness memberships they will have healthier enrollees! I am counting on you, Samme!

In a Fit Over Being Fit

Dear In a Fit,

You and Samme have a lot in common; Samme’s mom always let my older brother have the warmer concrete to lie on in the summer.  I totally know where you’re coming from.

Please mail my answer straight to Medicare: in a January, 2012, article published in the respected New England Journal of Medicine,  it was shown that Medicare Advantage (“MA”) plans that offer fitness membership benefits have a healthier group of members, overall.

They studied 11 MA HMO plans that had fitness memberships against 11 that had no such benefits. When they reviewed the health data of over 5000 patients, there was a dramatic difference in overall health, activity and walking ability in the MA plans which offered the fitness club memberships.

MA plans are required to pay for the basic Medicare services; however, they are allows to add selective marketing tactics to attract members.  This study confirms what you and I already knew: while we are hearing Medicare may be going broke, they should spend money to make money, and cover our membership dues!

 Samme

 

Entering the Dangerous World of ….

I have to admit that I’m a fan of mystery and suspense stories. I get a little freaked out with clowns (“It”) and don’t go for the real slasher flicks, but a good mystery read or an old Hitchcock flick is a treat.

When I saw an article that called out the most “dangerous” room in the house, I took a peek. Published by the Centers for Disease Prevention and Control, the article stated that approximately 235,000 people report to the ER annually with injuries sustained in this particular room. I assumed this would be a story about the dangers in the kitchen: we see a lot of cuts and burns every day in our same-day visit program and at our after-hours locations. Many budding culinary wizards carry scars from their experiments in the kitchen.

However, the answer was “the bathroom.”

As a Hitchcock fan, I should have known this. No one showers alone without the quiet thought of “Mother” visiting you at your most vulnerable moment.

We docs know that the shower/tub is a primary location for slips and falls. And, let’s face it: there is nothing “soft” in that environment to cushion a fall. I often recommend that my patients install safety rails to protect against such an accident. But to think that the shower trumps the dangers of knives and fire in the kitchen?

Then, I saw the darker side of the bathroom: yes, the toilet.

No kidding:  “using” the toilet actually trumped “leaving the tub” in the stats. Although slips IN the tub and shower were responsible for one-third of the injuries, 14% were from “using the toilet.”

The increase of age did correlate with the number of injuries, but the degree to which women’s accidents outpaced those of men was shocking: 64% to 36%. 64% of all recorded injuries were women. How to explain the gender gap? Is it indicative of which sex has better hygiene? Is it indicative of men simply not reporting injuries? In this case, I agree with the author: along with the age factor it’s indicative of men’s general increased muscle mass (strength) and possibly women’s loss of bone density. Yet another reason to include walking, running and/or weight lifting in your daily schedule.

Another interesting fact: head injuries in the bathroom were highest among the 15-24 year old group. “Alcohol may be a factor,” says the author. “You bet,” says Samme.

So, aside from making sure that there is no can of Hershey’s syrup nearby, I plan to take greater care when entering “the most dangerous room in the house.”  Keeping myself active to stay strong, using rubber mats in the tub, and installing a safety rail or two seem to be reasonable ways to prevent becoming a statistic.

To read the full article, click here

The Brouhaha About Dr. Oz

Like many professions, it is considered unethical for physicians to openly criticize one another in a public forum. With physicians, this is an especially delicate issue. There may be two or three ways to get to a particular outcome with a patient; who am I to say that there is only one “right” way?

I waited a few months before addressing the Mehmet Oz, MD (“Dr. Oz”) brouhaha because I did not want to fuel the fire. A few months ago, a physician wrote a fairly critical piece on Dr. Oz entitled, “How Dr. Oz Has Been Corrupted By Fame.” Now, if the title had been “How Lindsay Lohen Has Been Corrupted By Fame,” we might just yawn and casually glance at the story. However, Dr. Oz is a VERY popular physician, whose media career  was launched by Oprah Winfrey. Ms. Winfrey’s show has been a launching pad for many “professionals,” and has yielded lucrative contracts for all involved. Unlike “Dr. Phil,” (who holds a doctorate in philosophy, NOT medicine, psychology or even pharmacy), Dr. Oz is a practicing cardiovascular surgeon. Dr. Oz tweets, has a Facebook page, and makes a lot of television appearances. Most of the time, his advice is spot-on and he is an excellent and engaging communicator.

What appears to have triggered this piece was Dr. Oz’s online “Real Age,” website in which participants answered a number of questions regarding behavior, with the end result being an assessment of their age, based on risk factors. What you may not know is that the participants’ personal information was then sold to the sponsoring pharmaceutical companies who then began to market these people. Additionally, based on their answers, specific drugs were recommended to the participants as a way to address the condition.

You already know how I feel about Big Pharma and its influence over physician publications. So, Dr. Oz lost a few points in my book, as well.

Additionally, the author of the critical piece also took issue with types of topics Dr. Oz tackled on his show. I’ve provided the link to this article because it is informative. If you read this short piece, be sure to read the comments below it. There is much information to be gained from reviewing the comments.

So, is Dr. Oz a bad doctor? One can argue that his skill set as a cardiovascular surgeon could be better used for treating more patients, but he does have the ability to establish a seemingly “real” connection with listeners and viewers. His information about dietary choices is typically stellar. We do need more credible voices addressing lifestyle choices; our nation is killing itself with its chairs and mouths. Dr. Oz often ventures into areas which are not his strength (pediatric vaccinations, really?), but I also know that his audience looks to him as the “all-in-one” physician. All physicians can take a few lessons from Dr. Oz in how to establish a connection with patients.

Physicians can be the greatest source of good, evidence-based health information. Unfortunately, a growing number of people turn first to the internet and television for health information. Dr. Oz has successfully bridged the divide with his charisma, his scrubs, his Crocs, and Ms. Winfrey. I take issue with the pharmacy connection and will continue to caution my own patients about that influence in all media. However, all of the “good” that Dr. Oz disseminates does not excuse his willingness to partner with the pharmaceutical companies to take what would be considered Protected Health Information and use it to market the participants. That is a line which should never be crossed by any physician.

So, has fame corrupted a well-trained cardiovascular surgeon? Certainly, absolute power corrupts absolutely, but is this the case with Dr. Oz?  Decide for yourself:

http://www.kevinmd.com/blog/2010/02/fame-corrupted-dr-mehmet-oz.html

Symptoms of Adult Attention Deficit Disorder

Have you ever read an article about a disease or syndrome and started to think you may be closer to the subject than you realized?  You know, you read about skin rashes and suddenly you feel a spot on your skin that really needs a good scratch?  You read about lupus and your mild morning stiffness becomes more noticeable? You often spend the next few hours noticing a number of bodily changes previously unnoticed.  It’s not unusual; it falls into that category labeled, “A little knowledge can be dangerous.”

You know I read a lot of medical journals;  I read articles issued by my peers and other authors, too,  and you know I ask a lot of questions.  Wearing the mantle of never being wrong can be a heavy load.

The following article about the ten signs and symptoms of adult attention deficit disorder really stopped me in my tracks:

No. 1: Problems Getting Organized

For people with ADHD, the increased responsibilities of adulthood — bills, jobs, and children, to name a few — can make problems with organization more obvious and more harmful than in childhood. While some ADHD symptoms are more annoying to other people than to the person with the condition, disorganization is often identified by adults struggling with ADHD as a major detractor from quality of life.

No. 2: Reckless Driving and Traffic Accidents
Attention deficit hyperactivity disorder makes it hard to keep your attention on a task, so spending time behind the wheel of a car can be difficult. Because of this, ADHD can make some people more likely to speed, have traffic accidents, and lose their driver’s licenses.

No. 3: Marital Problems
Many people without ADHD have marital problems, of course, so a troubled marriage shouldn’t be seen as a red flag for adult ADHD. But there are some types of problems that are particularly likely to affect the relationships of those with ADHD. Often, the partners of people with undiagnosed ADHD take poor listening skills and an inability to honor commitments as a sign that their partner doesn’t care. If you’re the person suffering from ADHD, you may not understand why your partner is upset.

No. 4: Extreme Distractibility
Attention deficit hyperactivity disorder is a problem with attention regulation, so adult ADHD can make it difficult to succeed in today’s fast-paced, hustle-bustle world. Many people find that distractibility can lead to a history of career underperformance, especially in noisy or busy offices. If you have adult ADHD, you might find that phone calls or email derail your attention, making it hard for you to finish tasks.

No. 5: Poor Listening Skills
Do you zone out during long business meetings? Did your husband forget to pick up little Jimmy at baseball practice, even though you called to remind him on his way home? Problems with attention result in poor listening skills in many adults with ADHD, leading to a lot of missed appointments and misunderstandings.

No. 6: Restlessness, Problems Relaxing
While many children with ADHD are “hyperactive,” this ADHD symptom often appears differently in adults. Rather than bouncing off the walls, adults with ADHD are more likely to exhibit restlessness or find they can’t relax. If you have adult ADHD, others might describe you as edgy or tense.

No. 7: Problems Starting a Task

Just as children with ADHD often put off doing homework, people with adult ADHD often drag their feet when starting tasks that require a lot of attention. This procrastination often adds to existing problems, including marital disagreements, workplace issues, and problems with friends.

No. 8: Chronic Lateness
There are many reasons adults with attention deficit hyperactivity disorder are usually late. First, they’re often distracted on the way to an event, maybe realizing the car needs to be washed, and then noticing they’re low on gas, and before they know it an hour has gone by. People with adult ADHD also tend to underestimate how much time it takes to finish a task, whether it’s a major assignment at work or a simple home repair.

No. 9: Angry Outbursts
Attention deficit hyperactivity disorder often leads to problems controlling emotions. Many people with adult ADHD are quick to explode over minor issues. Often, the person with ADHD feels as if they have absolutely no control over their emotions. Many times, their anger fades as quickly as it flared, long before the people who dealt with the outburst have gotten over the incident.

No. 10: Prioritizing Issues
Attention deficit hyperactivity disorder can wreak havoc on planning, too. Often, people with adult ADHD have difficulty in prioritizing, failing to meet big obligations such as a deadline at work while spending countless hours on something insignificant, such as getting a higher score on a video game.

Do You Have Adult ADHD?
Only a qualified health professional can make an accurate adult ADHD diagnosis, but there are some self-screening tests that may help you decide whether to consult a medical professional about your adult ADHD symptoms. Since many different conditions can cause adult ADHD-like symptoms, these tests alone can’t diagnose adult ADHD.

If, after talking with a qualified health professional, you or your loved one is diagnosed with adult attention deficit hyperactivity disorder, you’ll need to work together with your doctor to design the best treatment plan.

Now, by a show of hands (paws, tails, etc.), how many of us know several people with adult ADHD? How many of us are married to adults with ADHD? What percentage of your co-workers are clearly affected with ADHD? Yeah, me, too.  In fact, I may be the only one who doesn’t have at least four of the ten symptoms.

My point is that every single listed symptom– on its own– is not a symptom of a disorder.  #5 could cause #2 and #3. Fatigue could cause #7, #8, and #5.  In fact, a true ADHD patient would need to have several of the listed symptoms on a consistent basis to warrant an evaluation.

My intent is not to minimize the impact of ADHD on a person or the people around the person with the condition; I’ve seen the catastrophic impact it can have on a family.  My hope is, as with all health concerns, you evaluate carefully any symptoms of behavior you believe may point to ADHD. Then, consult a professional and get some science-based input.

So, relax my friends, family, and co workers… it’s not time to worry just yet.

It’s Time for Tough Love, Cousin

This post weighs heavily on me:  one of my distant cousins is at the center of a cinema controversy in which his actions may actually harm children.   In my role at Caduceus, I promote healthful activities, steer our patients away from gimmicky “treatments,”  and am a voice of reason when medical journals become marketing tools for corporations. It’s a sad day when something like this hits so close to home.

I’m talking about the  mega-star Rango, starring in the current hit movie named after him.  The box office numbers are impressive, and the movie is pretty good family fare. However, many characters (recent count was 60) in the movie are smokers –  cigars and cigarettes.  Thankfully, Rango is tobacco-free, but his presence in this movie is disturbing.

Although Rango and I didn’t grow up next door to each other, we have hung out now and then.  When I heard about his upcoming movie I was ecstatic – he’s always been the “talented one” in the family and we all hoped he’d get a big break– especially after the let-down of the failed Pixar project.   I’m not sure how the producers could support on-screen smoking, but they did;  it’s even harder to understand why Rango did.

There are numerous studies that have shown the influence that smoking “actors” or “characters” have on young children. Aside from the confirmation that smoking is directly related to several types of cancer, one of the reasons that cigarette ads were removed from newspapers, billboards and magazines was a result of those studies.  Current president of the American Academy of Pediatrics,  O. Marion Burton, MD, calls on-screen smoking, “…one of the biggest media dangers to children.”   In May of 2007, on-screen smoking became a factor in the ratings assigned to all movies. Rango carries a PG rating, and the smoking characters are a reason for that rating.

Children already get exposure to smoke in the form of second-hand smoke, which is proven to be detrimental.  Does watching on-screen, smoking characters actually influence adolescents and teens to consider the deadly habit? The producers of “Rango,” argue that the Rango character has a positive influence in that he is the one NOT smoking.

“Previous studies have confirmed a link between smoking in movies and the initiation of smoking by adolescents, ” states Susanne Tanski, lead researcher at Dartmouth Medical School. “It’s true that ‘bad guys’ are more often smokers than the ‘good guys’  in the movies, but, episode for episode, even youths who saw a negative character smoking were more likely to start smoking.”

Aside from worrying about how much second-hand smoke my cousin inhaled during the making of the movie, I’m now confronted with a personal dilemma: do I continue to promote the movie as a proud cousin or do I boycott the movie and make a point of discussing the dangers of smoking with my youngest patients? The choice is clear: I must always honor my first calling, which is to guide my patients to better health… and this will involve a long conversation with cousin Rango, too.

Goodness, is it February already?

It would be easy for me to use the excuse of “hibernation” for my extended silence, but the truth is that I took a little vacay over the holidays to spend time with the “missus” and my little snakes.

We were pretty busy at Caduceus in January:  we launched the new website (I insisted that I not be at the bottom of the page this time) which allows new patients to complete registration forms online from the comfort of their homes;  Eleanor Kelly, MD, joined the Caduceus family and sees patients in her Irvine office;  we increased physician availability in our new optometry/ENT suite (Eyes, Ears & Etc.);  we expanded our office hours in the primary care offices (Yorba Linda and Laguna Beach) and pediatrics (Caduceus4Kids); and went “live” with the first part of our conversion to an all-digital medical practice (“EMR”). Our new laboratory (“KOS”) is under way in Yorba Linda, and the construction of our third office in Irvine (corner of Jamboree & MacArthur) continues.

After re-reading that paragraph, I think it’s time for another vacay.

Let me know how you are doing with your new year resolutions; what’s working the best for you?