Almost everyone has heard about the importance of hydration.  What I am finding in my practice, however, is the lack of awareness of how to properly hydrate.  While this may sound trivial, the issue can be quite serious.  When you sweat, you not only lose water but you also lose significant amounts of sodium and potassium.  In our bodies, salt is what holds onto water;  think of all the times you have salty food and feel bloated afterward.  By replenishing the body only with water, you don’t significantly rehydrate as most of the water passes into the urine.   Thus, having low levels sodium and potassium can cause low blood pressure, fatigue and weakness. I advise my patients to drink Gatorade or Powerade to replenish the salt lost.  This is extremely important when exercising in hot weather.    

If you have high blood pressure or kidney problems, be careful not to drink too much sports drinks as the salt load can worsen these conditions.  For the same reason, sports drinks should not be consumed if you are not exerting yourself (e.g. sitting on the couch watching TV).  Sports drinks are also helpful for people with diarrhea to rehydrate.

Walk down any pharmacy “pain” aisle and you will find a confusing array of medications.  Generally, there are three main categories:  NSAID’s (Non-steroidal anti-inflammatory drugs), Acetaminophen, and topical medications.  The best medication for most minor aches and pains are NSAID’s as they will reduce the inflammation that is causing the pain.   The family of NSAID’s is sold under many trade and generic names including Motrin, Advil, Aspirin, Ibuprofen, Naproxen, Naprosyn, Alleve, and Midol. However NSAID’s should not be taken if you have a history of kidney disease.  NSAID’s can be toxic to the kidney, and if you have any pre-existing kidney disease you are putting yourself at tremendous risk.  Be sure to take NSAID’s with food as they are a common cause of stomach ulcers.

Acetaminophen (sold under the Tylenol or APAP names)  is good for reducing fevers and a good pain reliever, but it does not improve inflammation of muscles and tendons.  It is a good adjunct to NSAID’s if the pain is more intense.  Acetaminophen is toxic in doses higher than 4,000 milligrams for people with normal livers.  For people with liver diseases such as hepatitis, I would advise no more than 2,000 milligrams per day.  Be aware that acetaminophen is often found in combination with other drugs so be sure to add these into your tally of acetaminophen doses.  For example, the migraine medication, Excedrin, and some liquid cough syrups contain acetaminophen.  Tylenol PM is good if the pain is disturbing your sleep.

Topical analgesics are excellent for pain, and I feel they are underutilized.  These include icy-hot, Tiger Balm, Ben Gay, Arnica spray, Capsaicin, and Aspercream.  They will initially feel hot when applied at first, but eventually feel cool.  They work by numbing the area much like the way your tongue goes numb after eating spicy foods.  They have almost no effect on the kidneys or liver as they don’t really get absorbed into the bloodstream to any significant degree.  Just be sure to wash your hands thoroughly after applying them as it can sting even if a small amount touches your eyes.  If this occurs, flush your eyes with copious amounts of water in the shower.

Be sure to ask your doctor which pain reliever is right for you.  Do not take any pain reliever for more than 2 weeks as this may indicate a more serious problem and you should seek evaluation by a physician.  You do not want to risk permanent kidney and liver damage.

Benjamin Franklin once said, “The only things certain in life are death and taxes.”  Almost everyone has a financial planner, accountant, or does their own taxes.  Then, why wouldn’t you want your health status checked annually?  Let’s say you are unfortunate and your taxes get audited, wouldn’t an accountant who knows your finances be a great resource?

The same logic goes for your health.  You don’t know you need a doctor until something truly catastrophic happens.  By establishing a relationship with a primary care doctor (also called a general practioner, family medicine doctor, internist, internal medicine specialist), you have gained a partner who can advise you on ways to improve your health, detect chronic illnesses early, and rapidly treat acute illnesses early.

Let me illustrate this point with an example.  I once had a patient who called me complaining of a strange tingling pain on the skin over the right side of his back.  I immediately recognized the symptoms as early herpes zoster, commonly known as shingles and called in a prescription with the instructions that he take the medication immediately.  He did eventually develop shingles, but a very mild form as a result of his early treatment (less than 24 hours of initial onset).  He was very thankful when I saw him at a later date and recounted to me how a friend of his had gotten shingles, but had waited a week before getting help because that was the earliest he could get an appointment with a new physician.  That delay caused the painful rash to continue for six weeks compared with my patients milder form at two weeks.

Just like you should keep copies of tax returns, you should also keep track of your blood test results, surgical reports of biopsies, and a record of your medications.  Put your medical information in a place where it is easily accessible and secure, such as next to your passport, birth certificate, etc.  If you ever need to be rushed to the emergency room, you will save yourself the frustration of trying to remember all your past medical history as you are asked by the ER staff while you may not be feeling well.  I can’t tell you how many times I get the answer, “I take a yellow oval pill, a blue round pill, and a oblong white pill.”  Unfortunately, most doctors don’t know what a fraction of all the medications look like, and one medication can have multiple generic forms made in different countries with a whole array of colors, shapes, and sizes.

When you see your doctor, be sure to ask for paper copies of your lab results to keep for your records.  Though doctors are required to keep medical records, don’t rely on that in an emergency situation as the office may be closed or you may find yourself relocating at some point.  Your health is more important than your finances, and you should put just as much effort into maintaining it by getting regular check-ups.

Guest Author: Ellen Davis, NP, DNP

There is a common misconception that meditation can only be done in far off monasteries, hours at a time.  In fact, meditation can be practiced in your daily life, even at work.   Meditation comes in many forms.  We are going to discuss two simple types today that you can do at your desk or outdoors in a park on your lunch break.

• Guided Imagery Meditation– narrow your thoughts to focus on one image, visualizing an object or scene that is comforting and seeing yourself there.  Put yourself in that space and try to smell the scents (the saltiness of the ocean,etc.) feel the breezes, and hear the sounds.  There are websites where you can download a narrated meditation to start like The Healing Waterfall.  Even simpler, place a photo of your last enjoyable vacation on your desk, and imagine yourself there.
• Mantra Meditation– Close your eyes, and recite a phrase over and over.  In doing so, you decrease “mental chatter” and step away from the stresses on your computer.   Buddhist and Hindu traditions will often use “OM” or “Om Shanti” but you can feel free to use any phrase which brings peace and comfort.

These techniques are great and simple to practice whenever you feel stressed or overwhelmed at work.  They are also effective for preventing stress-related headaches.

Portion control is just as important as controlling the amount of fat in your diet.  The food portions that are served to us at restaurants, delis, and even by our own families are growing, and our waistlines are following.  In New York City, this is most obvious with the New York bagel.  They are HUGE.  The original size was close to a  Lender frozen bagel, about 200 calories.  Today, the typical deli breakfast staple has about 600 calories, and that’s before the cream cheese, jelly or butter!   If you have gotten a bagel in the Big Apple, you will also notice the amount of cream cheese is ridiculous.  They pretty much shmear a tub of cream cheese in the middle.  By simply eating just half of a bagel and maybe splitting one with a co-worker, you will avoid overeating.  You can also ask for the cream cheese to be put in a cup so that you can control how much you put on.

When I was a kid, a typical pizza pie could yield 8 slices.  Today, most pizza shops cut them into 6 slices.  That’s a big change!  If you must have pizza for an occasional splurge, ask to have your slice cut in half, and share with a friend or set aside for later if you are still hungry.

Dinner at my family’s house is usually “family style”, i.e. the food is placed in the middle and everyone serves themselves throughout the meal.  While this may seem quite benign  it is a recipe for overeating as it is difficult to see how much you have already eaten. For kids, they can learn to avoid the vegetables and splurge on fatty meats.   The healthy alternative would be to have each plate prepared with controlled portions.  A good rule is to divide the plate so that half the plate is filled with vegetables, one quarter with a lean protein, and one quarter with a starch like rice or potato.  Another way to look at it, limit your carbohydrates to a fist-sized portion, your protein to the size of your palm, and the rest should be vegetables.

Plate size is another important variable.   Our waistlines have grown with our dinner plates.  If you ever browse an antique store, you will find what appears to be a small salad plate by today’s standards was actually used as a dinner plate.  By changing the servingware in your household you will find that you will eat less because the plate will look more full.

Time is another factor in eating.  Our bodies are able to digest only as fast as our stomachs are able to empty.  I have observed that when I eat at a restaurant,  the waiters will often bring the dessert menu as soon as you put your fork down from finishing your entree.  They know that if they wait too long, the satiety from eating the main course will set in, and you will feel too full to think about dessert. Allow yourself time to enjoy and digest your food.  All too often, we are in a rush and end up eating way more than we should.  Assess your eating habits, how many times have you eaten a meal, then half an hour later feel “over-stuffed”?

Portion control may seem like a borderline obsession with food, but it is necessary task for maintaining good health.  Once you get started, you will find it gets easier.