We are currently at a point in human history where we lead the most sedentary lives.  Even 20 years ago, if you wanted to deposit a check at the bank, you would have to physically walk to the bank.  Now most of our chores can be accomplished sitting at the kitchen table.  While this may suggest progress and innovation improving our lives, this also means we are burning the least amount of calories per day in the history of mankind!

Are you eating the same or more than you did in the 1990’s?  If so, then you may need to cut back on your calories to account for the cutting back on physical activities.  Are you exercising?  If not, you should start now.  Exercise used to be considered a “luxury” in the past, but now I would say it is a necessity.  Incorporate exercise into your life and make it a high priority just as you would make meals, sleeping, and drinking water.

The other day, I was on the subway and noticed that there were many people listening to music on their headphones.  Some were listening to music so loud that I could clearly hear their music 5 feet away.  Its a scientific fact that when we are born, we have a set number of “hair cells” in the ear that vibrate at certain frequencies.  Unfortunately, these hair cells do not regenerate.  This is why everyone’s hearing will get worse as they age.  Listening to loud music can destroy hair cells to the point of permanent damage.  Did you ever go to a loud concert or dance club only to find your ears “ringing” the next morning?  This is a sure sign that you have sustained damage to your hearing.

Here are some suggestions on how to preserve your hearing for the future:

• Set your electronic device or smartphone to a lower maximal volume.  This is usually a feature in the “settings” of the device.  This way, even if you increase the volume of the music program, you will be protected from dangerous sound waves.  For the first week or so, you may be tempted to go back to the previous volume, but our ears can get used to the lower (safer) volume.
• Use earplugs when going to a place with loud noises.  Anyone who mows the lawn or uses a leaf blower needs to use good quality ear protection (and don’t forget goggles for eye protection).
• Avoid standing near speakers during concerts or in clubs
• There are many apps for smartphones that can measure the volume of sounds around you and let you know when it is unsafe.  Try them, it may make you want to replace products such as blenders or hair dryers for newer models that produce less noise.
• Limit the amount of speakers in your living room.  We all have come to appreciate “surround sound”, but that can sometimes be too much of a good thing.  Over time, we become accustomed to higher volumes.  Try cutting back on the volumes.

A day at the beach or a picnic in the park is one of my favorite summer pastimes.  Just remember to make sure you take the appropriate precautions to protect yourself from the sun.  Excessive ultraviolet ray exposure (UVA and UVB) can cause premature aging of the skin, skin cancers such as melanomas and basal cell carcinomas, and painful sunburns.

Here are some tips to protect yourself this summer.

• Choose a sunscreen with SPF 30 or higher.  Be sure to look to see that there is UVA and UVB protection.
• Use water-proof sunscreen if you will be diving into the ocean or pool, reapply after toweling off
• Apply sunscreen liberally.  If you are using sunscreen lotion, apply about a shot-glass size amount at least every 6 hours in the sun.  Don’t forget your ears or the top of your head if you are bald.
• If you are using sunscreen spray on a windy day, the sunscreen droplets may scatter and give you inadequate coverage.  Spray it on your hands and rub on your body instead.
• Remember that your lips can get burned too!  Buy lip balm with SPF 30 or higher and remember to reapply after you eat.
• Wear a wide-brimmed hat to protect your face.
• Try to avoid being in the direct sun between 11AM-3PM when the sun’s rays are strongest
• If you plan on using insect repellant, apply the sunscreen first then the insect repellant afterward.  There are also some combination sunscreen and insect repellents on the market.
• Wear sunglasses to prevent your eyes from being damaged.
• Drink plenty of fluids.  You should drink at least 1 glass of non-alcoholic beverage every half hour while you are in the full sun.  Stay ahead of your thirst.  By the time you are thirsty, you are already starting to become dehydrated.

Summer is a great time to replenish your vitamin D and get some exercise.  Stay safe in the sun!

The body is in many ways similar to a bank when it comes to calories.  When you eat something, your body extracts the calories from food much like making a cash deposit in your bank.  You will either burn them off doing physical activities or store them in the form of fat.  Calories never “disappear” on their own without being used in some way.

You need to be mindful of your caloric intake.  Just like many banks have apps where you can see your debits and credits, there are apps that can track your calories.  I recommend the myfitnesspal.com app.  It is available for many different smart phones and tablets.  When you set up the app, it calculates your estimated calorie needs.  Then comes the fun part.  You enter each food into the app as you are eating them.  The myfitnesspal app has a huge selection of food and you can even choose the items by brand name.  For example, I ate a Chobani Fat Free Greek Yogurt with Blueberries this morning, and the app posted the exact calories (130) into my food diary and subtracted them from my daily calories.   This eliminates the extra step of reading the nutrition labels each time you eat something.  As you check the app throughout the day, you can see how many calories you have left in the day before you “accumulate debt” and start storing extra calories.  The goal is to end up with “0” or if you have a weight loss goal “negative” for the day.  I have been using this app and I find it extremely helpful to find out lower calorie alternatives to the food I’m eating.  For example, if you wanted to splurge and eat a full size bag of m&m’s, you would first realize it is a lot of calories, but myfitnesspal will also show you foods that are similar and you can pick a lower calorie alternative.  For example, a snack size bag of m&m’s would be half the calories.  This allows you to learn new healthier options so that in the future you can make wiser food choices.

Another aspect of this app that helpful is the ability to add in exercise.  It give a rough estimate of how many calories you burned.  For example, if you ran on the treadmill, you can enter the time and the distance and it will take those calories burned and add to your daily allotment of calories.  You learn pretty quickly that its difficult to burn off calories even though you’ve been huffing and puffing for half an hour on the treadmill!  Was that slice of chocolate cake last night worth it?  These are realizations that come about with tracking your calories.  Try the app for at least two weeks and you will learn more about what you are eating and get motivated to exercise.  If you are looking to lose weight, this is one effective way to get started.

The recent scandal in the United States VA healthcare system where patients had to wait months to see their primary care providers, which can include physicians, physician assistants, and nurse practitioners, highlights what will likely be a growing trend.  There just aren’t enough primary care providers to handle the population in the United States.  How did this happen?  In a previous blog, I have discussed the issue of Primary Care Shortage.  Briefly, it comes down to the fact that our medical system has “rewarded” aspiring medical students with large educational debt by paying more for specialists’ services and less for preventative and primary care visits.

Many people also have a lack of knowledge of what a primary care provider even does.  Most people think they must go to a dermatologist when they have any kind of rash or to an orthopedic surgeon if they have musculoskeletal pain but this is wrong.  The majority of these medical issues can be treated by Primary Care Providers.  As a primary care physician, I have the same access to dermatologic creams as your dermatologist does.  Even better, I can get to see you sooner and the co-pay is generally half of that charged by specialists.  The average wait time to see a dermatologist in a city like New York can be up to 3 months!  The average time to see a Primary Care Physician can be as little as 2 days.  In my personal experience, I would say I have correctly diagnosed and treated 98% of rashes that come through my door.  I refer to a dermatologist only if I feel that a biopsy needs to be done when the diagnosis is in question.

The situation with the VA is a reflection of the medical system in the United States as a whole.  The solution is not an easy one, but starts with society’s recognition of the most important member of the healthcare system, Primary Care Providers, and the realization that prevention is the key to better health and cost-effective healthcare.