Depression Clinical Pearls


not always easy to recognize in one’s self or others

Ever wonder if someone you know suffers from depression? Some red flags could include: presence of sleep disturbance (too much or to little), decrease interest, inactivity, guilt real or imagines, low energy or atypical energy, unable to concentrate, change in appetite.

Want to check if someone with depression or on antidepressants is suicidal? Try to tease out of them what is their plan, what would is the intent  and search/be suspicious of past attempts.


Risk factors for suicide in depressed people include;

older age

white male

Native American

living alone

chronic pain


In US a suicide occurs every 15 minutes, world-wide every 40 seconds

Once diagnosed treatment should be for 9-12 months


Family history of suicide is not a risk factor

Failed attempts make it unlikely person really wants to kill him or herself


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Children in Stressful Home & Diabetes

A Swedish study just published shows stress in children ages 3-14 have a higher risk for Diabetes type I. Data revealed a 3 x greater risk for developing childhood Diabetes.

It is well-known that stress has negative effects on the body especially by increasing cortisol levels. A legion of illnesses in adults surface with emotional strain. Stress exposures were measured in over 16,000 children and defined by a death, divorce separation, conflict in home, severe accident. finding revealed stress brings out diabetes type I. Type I also called juvenile Diabetes occurs when the immune system destroys the pancreas cells (beta cells) that make insulin. Insulin breaks down sugars the body takes in or makes or other substances.

Hereditary factors can play a role in some people with Type I Diabetes but both parents have to pass gene to child. Many people at risk do not get the disease, hence environmental factors like stress, cold weather, diet, viruses  seem to precipitate it happening. Children who were breast feed and those that ate solid food at a later age seem not to get juvenile Diabetes. The importance of environment is brought out by the fact that in twins with inherited genes, one got Diabetes other did not. This illness is more common in whites. Want to learn more?

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Breast Cancer Screening

FACT: Millions of women receive false-positive results annually, and 20,000 are over treated to an estimated cost of $4 billion.

The United States Preventive Services Task Force (USPSTF) has floated recommendations for when and at what age to get a mammogram. Benefits versus dangers are at the base of the recommendations.

Out for comments (30 days) are:

– women at average risk and ages 50-74 should have screening every 2 years

– most benefit is in screening women 60-69 implying they may have it annually.

– women at average risk and ages 40-49 not have mammograms

(Senate had to pass legislation requiring insurers to cover women in this age group when this was in the last – 2009 USPSTF recommendation)

Interestingly breast self-exam is again not mentioned. The Task Force recommendations balance cost and # of cases found with over diagnosis of breast lesions (false-positive rate of 11%) that have no consequences over a lifetime.

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Allergy Essentials

Is your quality of life affected by allergies? They can get so severe that one survey of suffers (A. Vogel, U. of AZ) showed surprising numbers: 44.6% had to skip a social invitation and 81.2% had to alter their exercise schedule.

There are many possible culprits:

– pollen/mold spores are lowest December thru February

– seasonal illnesses especially respiratory illness caused by viruses in fall and winter trigger asthma and sinusitis

– outdoor pollution including winter temperature inversions, make air quality poor especially with particulates and nitrogen dioxide.

– indoor pollutants are worst in winter with closed windows and doors.

Personal experience knowledge and practicing as a physician I know everyone’s allergen and reaction is different not just in degree but also in response to aging. What helps one person doesn’t another even from same allergen.

Please do not buy into one fix for everyone. You can do much without OTC pills or ‘shots’ from a doctor. Boost your immunity, use natural means: get some exercise, eat healthy, and sleep well. Butterbur an herb was found to help after being extensively studied. Natural strategies include rinsing/opening your nasal passages: xylitol based spray (I like ‘saline mist’ can not overdue its use); some use may use neti pot. Many friends find a solution in consuming local honey as it contains tiny amounts of pollen that acts as a vaccine.

An anti-inflammatory diet has a role: garlic, salmon oranges apples drink green tea to name a few. Don’t forget the teas with licorice rosehip or nettle can be helpful.

If you are into supplements to boost immunity or to act as anti-inflammation you must start a few weeks before ‘season’ begins. My ‘cure’ is Vitamin C at a megadose (3,000 mg/day). There is no chance of overdosing (although may get loose stools) it is a water-soluble vitamin and if your body does not need it will be eliminated in your urine.

There are more natural approaches including probiotics,  bromelain and quercetin to name a few, explore what may help your allergies. Have a listen to my podcast on this topic (iTunes  or RSS feed).Take control of your allergies, I use Web MD Allergy App it is a helpful tool. Check out your smartphone’s App store for an App that you find useful. You get the idea investigate and in this condition less is more in the case of allergies and natural is best!

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Body Cameras in Medical Emergencies

Screen Shot 2015-03-23 at 11.47.41 AMDrama – who does not become engaged watching events unravel in real time?

Everyone is now expecting police to wear ‘body cam’ many say it can help defend them against grievances. If you call 991 and EMS personnel arrive wearing a body camera -how would you feel? Fire fighters use helmet cameras. A personal camera can be built into one’s sunglasses similar to  Goggle glass.

I jotted down a few points to  think about.

Would a paramedic wearing a body cam violate or erode your trust? Who or what entity would have control of your videoed encounter? Does your hospital medical record include the video and when you request a medical record copy would  a copy of the video be included? Might copy fees go up for medical records that include a video. POI many states have a law allowing medical record coping fees.

Then there is HIPAA that gives patients a right to privacy and ability to amend medical information, could you ever delete a frame or two from your video?

Stay informed about your communities EMS delivery system.



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Tetanus Booster – Mystery Date

IMG_2946Do you recall when your last ‘tetanus shot’ was? Actually it is a tetanus booster. If you have had all initial vaccines all you would in time is a ‘boost’ to your immunity. Immunity does not last for life for certain vaccines.

How to recall when? We almost all have a ‘Smartphone’ if not a health recording app so lets put them to use.

Just the way you have an I.C.E. (In Case Emergency) contact in your phonebook ADD a contact ‘Tetanus’ and for the phone number input date.

You never know when you are going to incur a break in your skin from an injury. The rough rule of needing a tetanus booster is ’10 years for ‘clean’ cuts, 5 years for ‘dirty cuts’.

It is simple to take the guesswork out of your next medical encounter and avoid a ‘shot’ as well as cost.

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Keep Health Concerns in Perspective

newsAre you always searching for health headlines? There are more scary ones than encouraging ones, addressing the air you breathe to the food you eat, all promoting ‘fear’. Realizing that your body can be vulnerable no matter every perfect step you take for health can help you maintain a mentally healthy perspective.

Fear and stress can go hand in hand to decrease the benefits of a healthy meal.  As you metabolize the meal your mental health can interfere with digestion and absorption as food travels in your system.

Listen to your body, be grateful for your health, and realize you can get sick! Some health matters are out of our control.

Mental health (check Doc’s meditation blog) is critical, stressing and fearing for your health will not save you.



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Dry Saunas Can Lower Heart Problems

finland-saunasYes, I blog allot about the heart – what is good and bad for it – perhaps it is because in the USA over 550,000 die each year from heart attack the Number 1 cause of death. FYI – stroke is No. 5!

Now for what Finnish researchers* have found – dry sauna use impacts the risk for sudden cardiac arrest (heart suddenly stops) as well as coronary artery disease. Following men age 42-60, researches noted those using sauna 4 times a week for over 19 minutes despite presence of cardiac risk factors (smoking HBP, cholesterol level, weight) had a statistically significant positive effect on long term survival.

Worth the time form this evidence however exactly what is it about the sauna experience perhaps a meditative state that we know contributes to total health.


*JAMA Intern Med. Published online February 23, 2015. doi:10.1001/jamainternmed.2014.8187


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Hot Flashes/Nite Sweats

Like many other conditions certain groups of women have different menopausal experiences. I am talking years! If you start with menopause symptoms (sx. nite sweats, hot flashes) before actual menopause your sx will last longer. If sx start post menopause, they will be short lived (@3.1 yrs.). Japanese women have a shorter duration versus African Americans whose sx can last 10 years post menopause.

Antidotal findings correlate alcohol use with increase of sx. Should you have lifestyle disruption seek medical help including looking for natural antidotes.

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Coffee Is Good for Your Heart!

Out of South Korea comes a study that correlates a positive effect on the heart for coffee drinking young MH900448673and middle-aged people. Those without any signs of heart disease who drank 3- 5 cups of coffee a day faired better in scanning for calcium deposits (higher calcium score more plaque blocking the heart artery). Researchers measured the calcium deposits in the coronary arteries (heart) of individuals with an average age of 41.3 (followed for 2 years) and found statistically significant lower scores pointing to the benefits of caffeine. Noted was that coffee increases insulin’s sensitivity. The insulin made by the pancreas acts in an improved manner on the blood glucose (sugar). In addition, coffee decreases the bad LDL-cholesterol in the blood.

Hence the inverse relationship between caffeine consumption and associated cardiac risk was found correcting for age, sex, as well as education level, exertion level, smoking, family history, alcohol consumption, and diet of fruits, vegetables, and red and processed meats.

 IMPORTANT: More than 5 cups/day had a detrimental effect on calcium scores.

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