Benzodiazepines and benzodiazepine receptor agonists like zolpidem (ambien)are widely used to treat anxiety and insomnia, even though antidepressants are first-line therapy for anxiety disorders based on the evidence.

When benzodiazepines are used to treat insomnia, the effect wears off after a few weeks,and rebound insomnia has been reported with cessation of the drugs. Although patients report enhanced sleep with long-term use, there is no objective evidence to support.

Outpatients on long-term benzodiazepine therapy have the potential for a protracted, uncomfortable withdrawal syndrome that can last for months. Withdrawal symptoms are possible after only one month of daily use.

In addition to abuse and dependence, other major risks associated with benzodiazepine use include the following:

• Cognitive impairment. Benzodiazepines cause acute adverse effects: drowsiness, increased reaction time, ataxia, motor incoordination, and anterograde amnesia. It was also found that long-term use led to substantial memory decline that did not resolve three months after discontinuation
• Motor vehicle crashes. The risk of driving while on benzodiazepines is about the same as the risk of driving with a blood alcohol level between 0.050% and 0.079% (an alcohol level greater than 0.08% is illegal in all states)
• Hip fracture. Benzodiazepines increase the risk of hip fracture in older persons by at least 50%.In a study of 43,343 persons, zolpidem increased the risk of hip fracture by 2.55 times in those older than 65 years

In summary,many patients underestimate the degree of impairment caused by benzodiazepines.Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol. For these reasons, if used, benzodiazepines generally should not be prescribed continuously for more than one month. There are effective alternatives. Psychotherapy and antidepressants are the treatments of choice for anxiety disorders.

Full article here:
https://www.aafp.org/afp/2013/0815/p224.html

The waves of deadly viruses is becoming too often.First SARS,then MERS and now COVID-19.These are zoonotic diseases that start with animals and get transferred to human body.Plundering habitats of species that carry these diseases and worse consuming them mindlessly is what has brought us here.We need to show some serious respect to Mother Nature.

It is important to think global.One country cannot sit pretty and think we will not be affected from 1000s of miles away.It is in interest of All that every country and every community remains healthy.

We are so busy spending millions on trying to figure out how to get to Mars but are forgetting to take care of our beautiful planet.I was surprised to learn that according to one estimate,cost of finding one Coronavirus treatment safe to administer was USD 275-350 million.If you compare this to human suffering and economic losses,this is probably peanuts.

The current times warrant compassion,humility and common sense.Some social distancing and lot of hand washing would help.No need to panic and hoard.Causing pressure on supply chain means health care workers and social workers-the front line people being left vulnerable.

Let’s take a deep breath and hope this passes soon.May we all learn lessons of thinking global,sacrificing for greater good and paying attention to how each of us are contributing to calamities that are becoming too often.

Every time you visit your health care provider or a hospital, you will probably have some tests or imaging done. With Electronic medical records and advent of patient portals, it has become quite easy to access this information. However, it is important to remember that this is relatively a new transition from paper charts and some of your records are still buried in piles of papers somewhere. Also, different health systems do not have interface and hence they do not communicate with each other. So you could have seen a specialist doctor in next town over but his/her notes are not available to your internist and vice versa.

Keeping your own personal health record (PHR) allows you to actively and efficiently participate in your own care by providing vital information to your health care provider. It improves the quality of care you receive, cut down number of visits and unnecessary repetition of tests.

What is a PHR?
Your PHR is made up of many reports. The specific content depends on the type of ailments,it’s chronicity and healthcare you have received throughout your life.

Most health records include health history, physical exam notes, imaging, lab reports and immunization records.

I personally keep an Old fashion binder with important reports. Immunizations, imaging and labs are probably most important. While routine labs are very easy to repeat, specialized work up you had should definitely be kept for future. The way I look at it is this. We keep our home ownership documents, tax returns or insurance papers carefully compiled.We don’t just assume that because the IRS has it in their system, we do not need to preserve the tax returns. Similarly, it is best to be on top of information regarding your most important possession -i.e BODY.

When you need a PHR
By keeping your own records, you always have vital information available at your finger tips-even when you are travelling or if you change healthcare providers or your health care provider relocates or retires. It also helps you remain more engaged with the changing milieu of your body.
You can knowledgeably discuss your health, be aware of the trends of different aspects of your blood work. You are easily able to provide information to a new doctor even over the weekend.

Creating a PHR
To start your PHR, sign up for patient portals. This is the best way to have permanent access. You can easily print your records at home and file it.
Contact your healthcare provider’s office or the health information management staff at any hospital or facility where you received treatment and ask for an “authorization for the release of information” form.
Complete the form and return it, as directed. Some places do charge for copies.Your personal health record can be as simple as a file folder of records kept in your home. It can be kept in a home computer or external hard drive.

Top 10 PHR

1. Immunization records
2. Imaging records-x-ray, CT scan MRI/MRA, mammograms, ultrasounds
3. List of medications
4. List of doctors you see
5. Blood work
   6-procedures like colonoscopy, cystoscopy
6. Eye exam especially if you are diabetic

Selfless acts of kindness given without any expectation is probably the best gift you will ever give to someone else and yourself.Loving kindness promotes gratitude,empathy and compassion.

There are documented benefits to this.It stimulates the same neural circuitry as the chemical highs with drugs and sugar-resulting in significant sense of well being.It produces dopamine,serotonin,oxytocin reducing stress,pain and increasing sense of interconnectedness.This in turn helps with anxiety and depression.

You don’t have to go looking for opportunities to practice compassion.Charity and volunteering are wonderful starts.However,it could be something as simple as accepting the shadow side of a loved one or trying hard to see something good in a relative who always pushes your buttons.Lending your ear to somebody reminiscing the lost loved one or giving a break to the caretaker of someone battling a disease.Asking an individual struggling with failing memory about their fondest holiday memories or asking about favored holiday recipes to someone who has just moved to assisted living and is no longer able to host holiday gathering.Sharing holidays with somebody who is lonely even if it is not part of your faith.Including person with mental health issues even though they might put a damper in the holiday cheer.The opportunities are endless.

So instead of that spiked eggnog,let’s get high on kindness this year.

Human anatomy suggests that we were designed to be more of herbivores. Well-developed jaw, good side to side movement to chew the food, spade like dull and short teeth, presence of alkaline-carb digesting enzyme in stomach, long complex intestinal tract are proof of this.

Plant based diet is associated with Less risk of heart disease, hypertension, type 2 diabetes, osteoporosis, kidney stones, gallstones, fewer intestinal disorders, less incidence of certain cancers and reduce need for medications. It decreases levels of oxidative stress and inflammation, which are associated with the development of chronic disease. (Nutrition, 2004 and JACC, 2006)

Several studies show heart benefits, possibly due to lower inflammation, oxidative stress, blood pressure, LDL levels. (AJCN, 2009)

Analysis of five studies including 76,000+ subjects found rates of ischemic heart disease 34% lower in vegetarians than non-vegetarians. (AJCN, 1999)

In the Adventist Health Study II, a vegetarian diet was linked to lower CRP levels, a marker of inflammation. (Ethn Dis, 2011)

Harvard review of three cohorts and updated meta analysis (total of more than 442,000 subjects)Red meat linked with higher risk of type 2 diabetes, but when one serving swapped for nuts every day, decreased risk by 21%, substituting whole grains reduced risk by 23%. (AJCN, 2011)

Vegetarians have 12% lower overall rate of cancer (British Journal of Cancer, 2009)

Plant foods linked with protection against mouth, pharynx, esophagus, stomach, lung, pancreas, and prostate cancer; in particular, high fiber plant foods may protect in digestive cancers. (AICR)

Study linked plant-based diet to 20% lower breast cancer risk. (American Journal of Epidemiology, 2011)

It is likely that the various phytochemicals in fruits and vegetables work together to lower cancer risk.

Increasing evidence fiber rich, plant-based diet promotes healthy gut microbiota, linked to immune support and digestive health.

EPIC study found lower rate of hospital admissions and risk of death from diverticular disease among vegetarians. (BMJ, 2011)

High adherence to Mediterranean, plant-based diet linked with 48% lower risk of Alzheimer’s disease. (Archives Neurology, 2009)

I however need to caution the readers. Not all vegetarian foods are equal. Vegetarian diet should actually include nutrition dense plant based food not processed products without meat. Those eating a nutritious plant-based diet while also being more physically active fare even better.

I recently gave a talk on local radio channel where I talk about what is meditation, benefits and some tips to get started.

The etiology of obesity—defined as a body mass index (BMI) equal to or greater than 30kg/m2—is complex chronic, multifactorial disease which cannot be fixed by a simple pill. It is definitely not the sum total of “calories in, calories out”. For example, 25% to 50% is contributed by hereditary .Add to this-Environmental factors such as socioeconomic status, education, food availability, and marketing and now we have a tough to resolve conundrum.

Most people think obesity can be prevented by self-control and that individual non-compliance explains failure at weight-loss. It is almost like obesity is perceived to be a choice and not a serious chronic multifactorial disease that it is.

Even if somebody succeeds to lose some weight with aggressive diets, maintaining it is a major challenge since the body adjusts to lower metabolic rate. It is almost like your body sabotages to get you back to your original weight. It is important to understand that even 5–10% of body weight lost can give remarkable health benefits but commercial weight loss programs have made it all about reaching certain targets even if it is hard to maintain it. We abuse our bodies with all sorts of fad diets that go completely against the nature. The fact remains that we don’t know enough about obesity yet and how to tackle it. I read a fabulous article in Huffington post which compared it with times when we did not know what to do for simple thing like scurvy for almost forty years.

Obesity is significantly associated with a several negative health outcomes like diabetes, heart disease, sleep apnea ,depression  and  certain cancers to name a few. However, the stigma of obesity is a prominent factor that may contribute to and exacerbate some of the associated mental and physical issues. Experiencing weight bias can result in the avoidance of exercise in public for fear of being shamed for their weight and avoidance of seeking health care.

Weight is often viewed as a proxy for health and beauty. Even the public campaigns are more geared toward weight loss rather than gaining health. This needs to definitely change.

The Obesity society proposes following measures for health care workers to start:

How Can Weight Stigma Be Reduced?

1. Consider that patients may have had negative experiences with other health professionals regarding their weight, and approach patients with sensitivity.
2. Recognize the complex etiology of obesity, and communicate this to colleagues and patients to avoid stereotypes that obesity is attributable to personal willpower.
3. Explore all causes of presenting problems, not just weight.
4. Recognize that many patients have tried to lose weight repeatedly.
5. Emphasize behavior changes rather than just the number on the scale.
6. Offer concrete advice (eg, start an exercise program, eat at home, etc, rather than simply saying, “You need to lose weight”).
7. Acknowledge the difficulty of lifestyle changes.
8. Recognize that small weight losses can result in significant health gains.
9. Create a supportive health care environment with large, armless chairs in waiting rooms, appropriately-sized medical equipment and patient gowns, and friendly patient reading material