If you have a teenager at home, you likely know all too well about sleepy teens. Teenagers need on average about 9 to 10 hrs of sleep at night, but most of them aren’t getting this amount of rest consistently. Teenagers are growing, not just physically, but their brains are also developing, increasing their need for more sleep.
So, why are they not getting the recommended amount of sleep? Well, most teens brains are engineered to want to stay up late and sleep in. However, most middle schools and high schools start early, with most teens arriving to school each morning by 8 am and some as early as 7 am. This translates into early wake times. Sports, late evening practices, extra – curricular activities and increased amounts of homework often mean late nights for many teens.
Lack of sleep or sleep deprivation in teens can have significant consequence and affect them in a variety of ways. Teens lacking in sleep may often be more moody or irritable. Parents may also notice an increase in more risk – taking behaviors such as fast driving, smoking, and drinking alcohol with chronic sleep deprivation. There has also been an association between lack of sleep and an increase in reported car accidents and teens falling asleep at the wheel. School performance often suffers as well and should be a red flag if parents are noticing a change in their teen’s grades. Attention, memory, and decision making all are affected by not getting enough zzz’s.
So, if this sounds all too familiar with your teen, what can you do to help? Well, there are a number of actions parents can take to help their teens get the rest they need.
1. Sleep schedule: yes, teens can benefit from a sleep schedule. Having a nightly routine and sticking to it. A consistent bedtime and wake time can help.
2. Avoid oversleeping: (insert teen eyeroll). Sleeping in might just be your teen’s favorite weekend pastime. However, sleeping in until noon on Sundays is going to make it difficult to get to bed on time Sunday evening.
3. Early afternoon naps: If your teen is tired after school and he or she has time to nap before their evening practice or activity, a 30 minute nap can help provide some much needed rest.
4. Avoid screens: now, this is a hard one. Avoiding use of TV’s, smart phones and other screens at least 1 hour prior to bedtime is advised.
5. Avoid caffeine: teens should have limited caffeine consumption. Avoiding all caffeine during the afternoon and evening hours can help as well.
If your teen is persistently tired despite implementing some actions to increase their rest, or you notice excessive snoring, contact their primary care physician for further evaluation and recommendations.
Dr. Jennifer Teegarden
Patient: Hey doc, thanks for all your great care, but I have insurance now so need to cancel my membership.
Me: Sorry to hear you are leaving. Best of luck! Remember, we care for folks regardless of their insurance status and most of our patients HAVE insurance, so no reason to quit if you prefer to remain a member.
Patient: Ok, thanks. I really hate to leave, but don’t see the point of paying for membership when I have insurance. Will miss you all!
1 month later
Patient: Hey doc, I really need to get in for [insert any medical need], but I can’t find a primary care physician who’s accepting patients within the next 6 months. Do you have any recommendations?
Me: Not anymore.
Recently I got the news that another Family Medicine colleague was leaving primary care due to the misery that is traditional practice. Even her private practice setting couldn’t protect her from the outside forces that threaten the sanctity of the patient-doctor relationship. As is often the case, this physician was finally fed up with the bureaucracy, the endless check-boxes, the pressure to see more patients in less time and the drain on her personal and professional satisfaction in a career she worked so hard to achieve. And I don’t blame her one bit.
Healthcare, especially PRIMARY CARE is based on relationships. This means that doctors are not interchangeable cogs in a machine and that seeing “someone” is not the same as seeing YOUR physician who knows you, your preference, quirks and life circumstances through a relationship that is established over years together. There is nothing that can replace the value of being known – especially as this also helps to prevent misdiagnosis, over-testing and over-treatment and their downstream effects. In fact, studies continue to show that states with more primary care physicians are healthier and live longer, even when socioeconomic and lifestyle factors are taken into account.
Unfortunately, despite the proven effectiveness and overall cost-savings, primary care is undervalued in this country and many physicians have abandoned what used to be a fulfilling career. What has driven us to this point?
Arguably, one of the biggest drivers in our current healthcare crisis is Our Unhealthy Addiction to Health Insurance, which is summarized beautifully by one of our DPC colleagues, Dr. Jeffrey Gold. As Dr. Gold reminds us, “The main mistake that we have succumbed to as a society is that we have deviated from the original intent of health insurance. The true purpose of health insurance was to protect people against financial ruin in the event of an unexpected, major occurrence – just like car insurance, life insurance, and homeowner’s insurance. But things got murky when people were indoctrinated into the belief that good health insurance should “cover everything” because “everything in healthcare is expensive.”
Not only has the reliance on insurance resulted in an immoral spiraling of inflated pricing, more unnecessary testing, referrals and aggressive treatments, but it has also convinced people that TIME spent listening to patients and TIME to do a thorough physical exam is not worth paying for.
All of this had led to people forgetting that health insurance…is NOT…health care.
Think about that for a moment.
Health insurance is a product that helps protect against financial ruin in case of unexpected, expensive, catastrophic events. Health insurance companies are for-profit entities that are in the business of making money.
Health care is what you need when you are sick or injured. Health care is provided by medical professionals (doctors, nurses, etc) who have spend many years in continual training and are in the business of helping people.
While both are necessary (after all, home-owners insurance is certainly important in case of a fire), only one actually provides the care. Hint: it’s not the insurance company.
So, if personalized health CARE provided by a doctor who knows you and will be there for you regardless of your health, age, income, insurance or job-status is important to you, then invest in a Direct Primary Care practice. If supporting doctors who are willing to sacrifice their financial stability in order to provide real care to patients again, then invest in Direct Primary Care. If transparency in pricing and reducing unnecessary testing and treatment is important to you, then invest in Direct Primary Care.
I could go on and on, but instead, I’ll leave you with one of my favorite Margaret Mead quotes.
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.”
To your health!
There has been a lot in the news recently about voluntary recalls of Zantac (ranitidine). In short, the FDA found trace amounts of N-nitrosodimethylamine (NDMA), a probable carcinogen (cancer-causing compound), in some lots of the medication by several manufacturers.
While the headlines are scary, this topic deserves a little unpacking.
First, let’s gain a little perspective. According to the FDA, the levels of NDMA in many tested ranitidine products are similar to those consumed through "common foods like grilled or smoked meats.” For some people, this statement is quite reassuring, while others are thinking, “What?! My favorite grilled meat can cause cancer?”. Well, yes and no.
Cancer is caused when damages to DNA result in uncontrolled over-growth of a cell or tissue. Most of the time, our cells recognize the damage and either fixes the DNA or destroys the cells that have gone rogue. A person’s overall risk of cancer is based on a number of factors including genetics and environment exposures https://www.cancer.gov/about-cancer/causes-prevention/risk/substances. While some exposures can be avoided (tobacco smoke, excessive sun exposure), others are more difficult to avoid since they are present in the environment, including the air we breathe and the food we eat.
Health Suite 110’s stock of ranitidine was not affected by these recalls as we are stocked by a different manufacturer. That said, the FDA recommends “patients taking prescription ranitidine who wish to stop should talk to their health care professional about other treatment options. Consumers taking OTC ranitidine, which is used to prevent and relieve heartburn associated with acid indigestion and sour stomach, may consider using other OTC products approved for their condition. FDA’s testing of samples of alternatives such as Pepcid (famotidine), Tagamet (cimetidine), Nexium (esomeprazole), Prevacid (lansoprazole), and Prilosec (omeprazole) show no NDMA in these medicines”.
You can read more about the recall and specific lots affected on the FDA website: https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-and-press-announcements-ndma-zantac-ranitidine.
For patients who prefer to switch from taking Zantac, these medications are not all interchangeable. While Zantac, Pepcid and Tagament are all histamine-blockers (H2-blockers), things like Prevacid and Prilosec are proton-pump inhibitors (PPIs) and have different implications. H2-blockers are generally felt to be safe for long-term use, while long-term use of PPIs can increase the risk for C.diff, pneumonia and osteoporosis. If you require antacid medication on a daily basis, be sure to discuss with your physician. Sometimes there is an underlying cause that can be treated (H. pylori infection, obesity, food triggers) and other times the risk of taking a medication long term far outweighs the risks of not taking it, particularly for folks who have pre-cancerous changes in their esophagus from long term reflux (Barrett’s esophagitis).
Five Steps for Cancer-Safe Grilling
1. Marinate: Studies suggest that marinating meat before grilling can decrease formation of carcinogens.
2. Pre-Cook: If you are grilling larger cuts, you can reduce the time your meat is exposed to flame by partially cooking it in a microwave, oven or stove first.
3. Go Lean: Trimming the fat off your meat can reduce flare-ups and charring. Cook your meat in the center of the grill and make sure to flip frequently.
4. Mix It Up: Cutting meat into smaller portions and mixing them with vegetables can shorten cooking time.
5. Go Green: Grilling of vegetables and fruits produces no carcinogens. So, add veggies and cut down the amount of meats.
Kylie Vannaman MD
For some, the holidays are a time for gathering, joy, cheer, family, friends, peace and togetherness. For others, the holidays are instead filled with isolation, stress, depression, family turmoil, heartache, and loneliness. And maybe for the majority of us, it is a combination of the above.
During this season of thanksgiving, it can sometimes be difficult to maintain an attitude of gratitude. Some may feel it is only obtainable when all is going well. According to Robert A. Emmons, Ph.D (noted to be the world’s leading scientific expert on gratitude and a professor of psychology at the University of California, Davis, and the founding editor-in-chief of The Journal of Positive Psychology), one of the five myths about gratitude is that it isn’t possible or appropriate in the midst of adversity or suffering.
“Some argue that it’s impossible to be grateful in the midst of suffering. When life is going well, when there’s abundance—sure, then we can be grateful. But what about when we’re facing hard times? I believe not only is gratitude possible in those circumstances—it’s vital to helping us get through them. When faced with adversity, gratitude helps us see the big picture and not feel overwhelmed by the setbacks we’re facing in the moment. And as I’ve suggested above, that attitude of gratitude can actually motivate us to tackle the challenges before us. Without a doubt, it can be hard to take this grateful perspective, but research suggests it is possible, and it is worth it.”
Gratitude has been studied in patients after heart attacks. Gratitude at 2 weeks after a heart attack was associated with a higher self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) and improved emotional well-being 6 months later. It was concluded that gratitude may help recovery from a heart attack and that interventions promoting this positive construct could help improve adherence and well-being.
In another study of asymptomatic heart failure patients, gratitude journaling decreased lab results related to heart failure morbidity such as inflammation.
Here is a TED talk I recently watched which involves a physician and her journey with gratitude while caring for a son with an incurable and terminal illness. Can you apply her experience to your own life’s situations? - https://www.youtube.com/watch?v=HHTmiHB6aXk&feature=youtu.be&list=PL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZhttp%3A%2F%2Fyoutu.be%2FHHTmiHB6aXk%3Flist%3DPL9wE6J5iLNROCZYibeUCT9vWStvOc6EOZ
But how can I develop more gratitude?
I recommend a review of the following article by Dr. Emmons titled 10 Ways to Become More Grateful - https://greatergood.berkeley.edu/article/item/ten_ways_to_become_more_grateful1
Lastly, how can I be better prepared for the upcoming holiday season (and any “season” of life)?
I often recommend guided imagery, which is a form of meditation, as a way to practice mindfulness. By reconnecting with ourselves and being present for a short period of time, we can be better prepared for the stressors and challenges of life.
To see if guided imagery is right for you, try listening to guided imagery audio for free on this Kaiser Permanente website - https://healthy.kaiserpermanente.org/health/care/!ut/p/a0/FchBDoMgEADAt_iAzYZEYfFmhH6hhdsGiZIIGELt99seZ9DjC33hO-3cUy18_uxCLD22md9bqnCnLVZ8okd_Nd4zoysVAocj_o9bT-GM6IzVap2MBamlBCGsgEWPBohoUkKp8UErXjnTZxmGL2IKPpI!/
If you find these audio sessions helpful and would like more, I recommend resources from the following website - https://www.healthjourneys.com
“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. It turns problems into gifts, failures into successes, the unexpected into perfect timing, and mistakes into important events. It can turn an existence into a real life, and disconnected situations into important and beneficial lessons. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow. Gratitude makes things right.”
Dr. Charles Willnauer
We usually think of “dementia” as simply memory loss, but it is much more than that. The term “dementia” is defined as having memory loss AND difficulty in one other area such as:
These symptoms must interfere with independence and quality of life to be considered to be consistent with dementia.
What causes this horrible disease?
There are several diseases that affect the brain which can result in dementia.
What tests should you have?
The first step is to have a conversation with your primary care doctor. There are a few blood tests you might discuss, like thyroid levels, B12, and other blood tests. Imaging may include CT or MRI brain. There are various other experimental imaging studies that are under investigation. Finally, a lumbar puncture might be needed as well to analyze the spinal fluid. Again, the best place to start is with talking with your primary care doctor.
How can you treat this disease?
It all depends on the type of disease. There are a few medications that may help with quality of life and memory. Unfortunately, there are no treatments that can halt the progression of the disease. Clinical trials help us find a cure and current trials are testing medications that block the progression of the disease.
To decrease the risk of developing dementia, follow a healthy dose of physical activity, a healthy diet, and engage in social interaction. As simple as this may sound, these 3 recommendations can be difficult to complete consistently. Genetics may also play a role in developing dementia. Unfortunately, there are no genetic tests that are validated that accurately predict the development of dementia.
Cherish each and every moment. Live with gratitude.
September is PAD awareness month.
What is PAD? Peripheral arterial disease is a chronic, life threatening condition of the the circulatory system. It may also be referred to as claudication, poor circulation or vascular disease and it affects up to 20 million Americans. The cause of PAD is the blockage or narrowing of the blood vessels that transport blood from the heart to the lower extremities or legs. This blockage or narrowing is due to atherosclerosis or the build-up of plaque. Complications of PAD include sores and wounds that if left untreated can result in limb amputation.
So, who is at risk for PAD? There are a number of potential risks factors that all patients should be aware of. Those include:
- High blood pressure
- High cholesterol
- Age > 60
- Family history of vascular disease
PAD can present with a number of different symptoms. Common symptoms that patients experience include:
- Leg pain when walking
- Cramping or pain in the leg muscles brought on with increased physical activity
- Weakness or numbness in the legs
- The legs or feet feeling cold
- A change in color of the legs
- Sores on the legs or feet that do not heal
A healthy lifestyle can help to reduce the likelihood of not developing peripheral arterial disease. Avoiding smoking, increasing exercise and physical activity and eating a diet of nutritious foods can all help to reduce risk.
If you have risk factors for PAD or are experiencing symptoms which could be due to undiagnosed peripheral arterial disease, please reach out to your primary care physician. Patients may also visit the American Heart Association at www.heart.org for additional resources and information.
Dr. Jennifer Teegarden
School is back in session and in addition to hitting the books, many students are back in the gym training for fall sports. Each year, more than 60 million school aged children participate in organized sports! Being a member of a sports team can bring a number of great experiences and life lessons for students, along with fun and great memories. So whether your daughter or son plays volleyball, basketball, football, tennis, baseball, runs track or is a tumbling gymnast, it is important for parents and students to be aware of overuse injuries.
What is an overuse injury? An overuse injury is damage to a bone, muscle, tendon or ligament caused by repetitive stress and without given the time to properly heal. Children and teens are at increased risk for overuse injuries for a multitude of reasons. Their growing bones are more susceptible to injury and they might not always be aware the symptoms that they are experiencing could be an overuse injury. Some common examples include tennis elbow, runner’s knee, pitcher’s elbow and shin splints.
What symptoms should student athletes and their parents be looking for? Well, there are four stages of overuse injuries and how they typically present and progress.
Stage 1: Pain in an affected area after activity
Stage 2: Pain in an affected area with activity, but not limiting performance
Stage 3: Pain during activity and limiting performance
Stage 4: Chronic persistent pain even at rest
What can student athletes and parents do to help prevent overuse injuries . . .
1. Every student athlete should have a PPE or preparticipation physical evaluation. Ideally this evaluation or sports physical should be performed by your child’s primary care physician, who has knowledge of their prior health history and can follow them for any chronic conditions as well as help manage any acute injuries.
2. All student athletes should maintain year-round fitness, during the season and the off season as well.
3. Proper warm ups and cool downs with all practices and games.
4. Limit a particular sport to 5 days per week. This also helps to prevent burnout.
5. It is recommended that athletes participate in only one sport and on only one team each season.
6. Encourage participation in a variety of sports. This gives your child an opportunity to learn new skills, make new friends and even maybe find a new passion.
If your student athlete has pain or symptoms of concern, contact their primary care physician for an evaluation.
We wish all of our student athletes a fun, safe and healthy season!
Dr. Jennifer Teegarden
Thanks so much to Sami Aaron of the Resilient Activist for inviting me to submit a guest post about what drove me to start Health Suite 110. It's been such a long, winding journey and I am thankful for the company I've met along the way.
It's that time of year again. The air is cooler, the leaves are falling, kids are back into the swing of school and...it's time for that annual flu shot. Just as I encourage adhering to the recommended vaccination schedule for both children and adults, I encourage getting your annual flu vaccination.
My Top Reasons for Recommending the Flu Vaccine:
#1 To help protect yourself from the flu.
Seasonal influenza, or "the flu" is caused by influenza viruses that infect the respiratory tract (nose, throat, lungs). Unlike many other viral infections such as the common cold, the flu can cause severe, life-threatening complications in many people.
#2 To help protect others from the flu.
You can transmit the flu to others for about 1 day prior to showing symptoms and for a week after becoming sick. This is particularly important when thinking about those of us in the community who are at greater risk for complications (older, younger, etc) as well as those of us who are unable to get the vaccine ourselves (infants younger than 6-months of age and those with life-threatening allergies to the flu vaccine).
#3 To help protect yourself from having a heart attack. No, really.
A recent meta-analysis, which assessed 6,400 heart disease patients showed that those who received a flu vaccination had SIGNIFICANTLY LOWER risk of heart attack or stroke.
Frequently asked questions:
General reminders about the flu:
And to round out the discussion just a bit, I agree there are many other measures we can take to help protect ourselves from contagious diseases such as: eating well, getting enough sleep, managing our stress, covering our coughs and washing our hands regularly. Still, I believe vaccinations are an important part of disease prevention.
Health Suite 110 carries Flulaval, a quadrivalent (4 strain) flu vaccine and is available to members ages 6 months and over for $25. Contact clinic to schedule your flu vaccine today!
Wishing you a happy and healthy fall season with family and friends,
I've recently discovered something called the Big Life Journal - a growth-mindset tool to help raise happy, resilient kids. This week's topic is how to deal with negative outlooks, or as I like to call, "the Eeyore syndrome" for those Winnie the Pooh fans out there.
Be sure to check out the FREE download to create your own Jar of Awesome (see below).
Got other tips or tricks? Please share!
7 Powerful Ways to Respond When Your Child Complains
by Rebecca Louick June 28, 2018
Complaining and whining are two of the most frustrating things parents face. They are also completely normal. In fact, the average adult complains 30 times a day or 9 minutes total!
Kids complain for lots of good reasons: to blow off steam, to connect with us, and because they feel powerless. Other times, the complaints might mask an underlying emotion that needs to be released.
Whatever the cause, complaining and whining are opportunities to help our kids find better ways to express their feelings, and shift to a more positive mindset.
While it’s normal to vent sometimes, frequent complaining is not a healthy option.
Repeated complaining rewires your brain….Over time, you find it’s easier to be negative than to be positive, regardless of what’s happening around you. - Dr. Travis Bradberry
A study at Stanford University showed that complaining shrinks the hippocampus, an area of the brain necessary for problem-solving and emotion regulation.
Here are some strategies to help kids express their dissatisfaction in healthier, more positive ways.
Here's a fun activity for your home or classroom that will help you turn around the negativity and complaining. Get the free printable (see below), and create the Jar of Awesome by following instructions.
Whenever you need a little motivation or positivity boost, pick a piece of paper from the jar, read it, and celebrate YOUR awesome moments!