I’m Back Again, with My Personal Blueprint for Health!

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claudia-mdHi there. It’s Dr. Louella… Yes! I’m still alive!!! It’s been over a year since I’ve posted. I’ve been through many transitions since then. For example, I now see ‘dead people.’ I do medico-legal duty which involves pronouncing people dead from homicides and accidental deaths and referring bodies for autopsy if needed. I am not a CSI (crime scene investigator) but I work with them.

On the lighter side, I have been trying to practice what I preach, a healthy lifestyle. Over my 20 something years in medicine, I’ve heard all kinds of formulas. But for my life, I just want to keep it SIMPLE. My formula for health is to lead a balanced life.

I now emphasize the basics as a lifelong approach to health. It contains nothing new, but as a natural mathematician, I need my own formula. The first four are for your physical health. The last 2 are for your emotional well being. Do not underestimate the power of either. We need them both:health-living.jpg

1.  EAT….we agree it must be done to live.

Eat regularly. Starvation is wrong for many reasons.

But eat small portions (this is key).

Eat balanced: your fruits/veggies, starches/fibre, beans/meat.

Eat a variety of foods. Who cares about ‘superfoods’? Each fruit and vegetable has different benefits which man has not yet discovered. Why go off on the latest trend? Eat them all.

Reduce sugar. Reduce fats.

Use specific vitamin/mineral supplements we are still likely to be lacking.

2.   DRINK WATER…. water is in a class by itself. Most people don’t drink enough. Drink it and drink it often. It actually is needed more than food.

3.   SLEEP….. many of us do not understand the importance of sleep. When we sleep insufficiently our brains do not function at their maximum, leaving us with slower thought processes and fatigue. Find out how much sleep you need at nights, according to what makes you function best, and schedule it!

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4.   EXERCISE….. you may or may not lose weight but exercise has a dozen other benefits. You will also live longer with less pain in later life. Exercise (power-walk, run, skip, cycle, dance, swim, kick box, weight train, do aerobics, karate, etc.) for about half hour a day, plus other routine physical activity (house chores, regular walking, gardening). If you lie around all day and then do half hour exercise, it will benefit you little.

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5.  GIVE LOVE AND RECEIVE LOVE…. to your creator, co-workers, friends, family, significant other, pets. Both giving and receiving love release the feel-good hormone, oxytocin, and improves your well being and functioning.

6.  RELAX/DO WHAT YOU ENJOY…. obviously this would make for a healthier you. Life for most of us on planet earth is stressful. When we are stressed our blood pressure and sugar can rise. Relaxation/de-stressing/fun are aspects of the human nature we cannot properly live without. Schedule breaks. Do something different. Switch your mind off work. Do something you really enjoy. This will give your body and mind time to better assimilate the work you have done and prepare you for what lies ahead. Recreate to re-create your being.

Now that there is MY blue print for me to live healthy. I haven’t got it mastered as yet. For example, I started having more fast food as I was ‘transitioning’. Now I have to practice good old home cooking to get what I need. And I am starting back to exercise…again!!!

This is Dr. Louella, over and out! From the beautiful isle of Trinidad.

Doctor, Does This Drug Have Any Side Effects?

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Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

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He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

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I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

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I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

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Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

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But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

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But No One Told me I am Diabetic, Doc!

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Hi. It’s Dr. Louella in a sombre mood today. I keep thinking about this patient I had today in chronic disease clinic; a young guy in his thirties.

No drama here. I started off with my usual verification of what the patient suffers with. I’ve been doing that a while now, since discovering that patients attend our clinics for years with only a vague idea of what they’re being treated for.

I don’t know if it’s a Trinidadian thing with the responses I receive but I’ve asked this question so many times that I’m no longer surprised…

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‘What are you suffering with sir/madame?’

Some patients get offended. They start to stammer that I am the doctor and therefore I should know. So I let them know it’s a big file (we use handwritten patient notes) and we would move a lot faster if they tell me rather than me having to go through all these notes.

Furthermore I remind them that they are the patient. It is their health and their responsibility to know what they are afflicted with.

‘So, would you like to tell me, sir/madame, what are you suffering with?’

There are other patients who begin everything with ‘they say’. For example that, ‘They say I have diabetes’. When I try to confirm that they mean that they have been diagnosed with diabetes, they respond consistently, ‘So they say’. So in my estimation, they are in huge denial!

Sometimes I would make a check in the notes only to find that they have had this said to them for five years or more. I let them know that ‘they’ say it only because it is true and it’s very important they learn to accept it and deal with it.

Then there are those patients who try to respond correctly but leave out diagnoses. When I check the notes there may be an additional diagnosis such as ischaemic heart disease or chronic kidney disease that they are clueless about and which they sometimes deny vehemently.

So then I need to backtrack to find out where that came from, if they were diagnosed at hospital or presumed to have the disorder or what. I need to know if a diagnosis is true or not to convey this to the patient sitting in front of me.

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Finally there are patients who give additional diagnoses to what are documented. Something may have happened since the last visit or more likely they had been suffering with some disorder and didn’t think it necessary to inform us.

Our patients attend several different doctors, clinics and institutions simultaneously. Very little official information is shared between these groups.

It is often up to the patient to let us know what is going on. To some of them it is a secret. Others forget or don’t think it relevant. Me, I grab up this stuff, because I want to know everything.

I use the diagnosis as a starting point to inform and educate the patient. It’s not that you maybe sometimes could probably have hypertension. You HAVE it and you need to deal with it. It’s not about a bunch of numbers but really debilitating complications that you could get but we are trying to prevent.

Getting back to the case at hand… When I had my usual discussion with this young man about his diagnoses today, I was a bit thrown. He knew he was overweight and had elevated cholesterol but knew nothing about having had diabetes.

But it was staring at me in his notes! He was newly diagnosed as a diabetic on the previous visit. Apparently he had not been told. Oops! That was a problem. And he seemed intelligent enough that he would have remembered.

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I proceeded to take the time to double check his blood investigations. Those results pointed to pre-diabetes, which as I explained to him, was in between ‘normal’ and ‘diabetic’. He was becoming diabetic. Steps had to be taken to try to prevent, or at least delay, full blown diabetes.

(The term ‘Impaired Glucose Tolerance’ is an older term that was and is still used for this condition. I much prefer the simpler ‘pre-diabetes’ when dealing with patients as ‘pre-‘ indicates ‘before’.)

While advising the patient about his condition, I needed to reassure him as well. He had been started on the appropriate medication (metformin). I actually increased his meds for now because his glucose level was high.

I advised him strongly about weight loss, that that in itself may reverse his condition and referred him to the dietitian (they make our life so much easier).

I spoke a lot about exercise because I know that if you’re not into it, it could take you a while to get started. I wanted to get him thinking that this thing was doable.

I threw out different ideas of different types of exercise he could attempt and explained how the day-to-day routine he described was physical activity but not intense enough to be classed as exercise. And he had the size to show for it.

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In the end he was really grateful for the information. But of course, other patients were waiting.

I really feel passionate about helping younger patients prevent and manage chronic diseases. That’s why I spend extra time with them.

It is often more difficult for them to come to terms with their illnesses than older adults. They want to enjoy their youth and do not want to be saddled with strict diets and medication.

I let them see that I take their health seriously and they should too. But I also try to inspire hope within them because without it they wouldn’t even try.

I will continue to ask patients the question ‘What are you suffering with’ or seek verification from the patient as to his/her diagnoses because it is important. It is only when people properly understand what is going on with them can they make informed decisions and live healthier lives.

I feel better now that I’ve shared that. I’d like to think I am making a difference in this world, one dot at a time. Dr. Louella is out!!!

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Doctor advise us! This man’s blood pressure is very low!!!

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Hi. It’s Dr Louella. I had an awesome time dancing in church today. I promised to tell you about a sweet elderly gentleman in “Caring for others more than they care for themselves part II.” Well this is it, but with a different title.

The new title reflects how they bombarded me that day, as soon as I dropped my bags in my office. When I walked into the screening room last Wednesday, I was accosted by nurses.

They were sorry to disturb me so early but they wanted advice on an elderly man with a very low pressure. Now we hardly ever get patients with low blood pressure as a problem; unless they are in heart failure or it is from blood or fluid loss or a severe allergy.

This old timer was a regular, they said. He had been seen for low blood pressure before and had already been  referred to hospital. I looked at the BP. It was for real, 59/35. That’s quite low. I looked at the man. He looked terrible, really sunken in temples and cheeks. He looked like a homeless person.

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He was not out cold so he could speak. He complained of dizziness and some weakness. Said he was 72 years old. First thing that came to mind is if he had had breakfast. Yes he did, was the reply, after I had identified myself. He had had a coconut water. (Ok, so now I knew he did not have breakfast).The nurses had started giving him water to drink. I said, “Let’s get this man something to eat”. All we had were his crackers and my slice of chocolate cake (my lovely cake that I had baked from scratch and brought to have as a snack).

We moved him to the treatment room and gave him these things to eat. I proceeded to find out what his normal diet was like. Turns out he was married, his wife died and he lived with three subsequent women after that, all of whom had died. He has eleven children, who visit him from time to time but he lives alone. He drives his own vehicle.

He often neglected his meals now that there was no one to care for him and did not go through the trouble of preparing anything. He drank about quarter of a 1.5 litre water bottle a day. He sometimes felt weak when going to his garden.

So I was wrong about one thing. Here was no homeless person but a gentleman with the means to take care of himself but not the will to do so. I stressed the importance of regular meals and lots of water and asked if he wouldn’t mind a visit with our dietitian to advise him on meal planning.

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Water is needed for blood. It makes up about 50% of it. When we are dehydrated the blood volume decreases and there is less blood for the heart to pump so blood pressure drops. Eating helps the water to remain in the circulation by providing salt.

I explained that he found difficulty going to the garden because his muscles were weakened by old age and without eating and drinking he would feel much weaker. He was interested in avoiding that.

As soon as he had eaten the snacks he wanted to leave. I had to say “Slow down pappy. That food is not digested so it cannot benefit you as yet”. He himself admitted to still feeling somewhat ill.

I realised that with all this talk I did not do a physical exam on this man. When I did, I found him to have a bradycardia, an unusually slow heart rate. His was 48 while the normal heart beats between 60 and 100 beats per min.

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Here was another cause of a low blood pressure. I ordered an electrocardiogram (ECG or EKG), or heart tracing. It was normal except for a heart rate of 54. He was not on any medication.

I was now able to explain to him that his slow heart rate was most likely responsible for his low blood pressure. But this becomes exacerbated when he is dehydrated. Also when he does not eat, there is less salt to keep liquid in the circulation.

I explained that if his heart rate decreased further to the point where he could not support a decent blood pressure he would need a pacemaker inserted in his heart. He reacted strongly to that because in no way did he wish to go to hospital.

After a couple hours I felt pleased to see our elderly gentleman walking out of the centre, looking and feeling much improved, and with a blood pressure of 105/65. I’m sure that he would now be more empowered to manage such episodes. I’m also sure we’ll be seeing him again, if even for an update.

My next case will be what the doctor does when threatened by someone else’s body fluids. Does she save herself or play the brave doctor? My next post will tell. Bye for now! Dr Louella.

 

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Caring for Others More Than They Care for Themselves Part 1

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Hi folks. Dr Louella is back after a long break!!! I was busy getting married and settling into this new phase of my life (at this age).

I’ve always been looking for a new approach to this blog and I finally hit upon it. I plan to use my numerous unique patient experiences to teach about medicine, and by extension, life.

I have two interesting, touching cases to bring to you to demonstrate the title of this post and the medicine that goes along with it. The second case will be in the following post.

Now the part of medicine that I really enjoy is relating with the patients. I am different in this regard from many doctors I know. I take the time to find out about my patients and work with their situation. That’s one of the reasons why I am such a good family doctor.

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Just yesterday (Oct 6, 2015) we had a chronic disease clinic on work. Clinic was practically over when a nurse came to ask me to re-write an insulin prescription for a diabetic patient. She was an amputee. He husband had broken her insulin vial. He had also put her out of the house and she was staying with a cousin.

I was about to re-write it when she also revealed that the patient had missed her appointment and had come to get a new one. She was in the car.

Well, I thought that the only humane thing to me was for me to attend to her one time. But it was not that easy because this patient believed herself to be inappropriately dressed and refused to get out of the car.

To speed things up I said I would go outside and have a look at what she was wearing. I thought it was fine, a dress with a tube top, and reassured her.

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My Name is ANXIETY!!!

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Hi, Dr. Louella again. I want to chat with you about anxiety today. This comes off our talk on insomnia, where I realized that anxiety was the cause of my recent bout of insomnia.

Now, this is not a treatise on anxiety. It is just want to make you more aware of it and how to deal with it. I am in the advantageous position of both having studied and treated people with anxiety disorders and having suffered anxiety myself. Advantageous? Yes, I know both ends of the stick and it is a good feeling when what you’ve been through can benefit someone else.

Now, I’m not going to pretend that I am cured of anxiety because it is usually not that easy. But I am managing it so that it does not interfere with my life. That’s the key, how functional you are. And I do function!

Well, what is anxiety to begin with? The very essence of it is fear. It may be disguised as concern or worry. It is a negative respond to stress. We allow ourselves to ruminate or obsess over a situation because we are afraid of something going wrong in the future or are unable to let go of the hurts of the past.

Anxiety is basically a human emotion which we all feel. It can be useful in small doses. Say you are crossing a road. Next thing you see a truck come speeding out of nowhere. The anxiety you feel can catapult you to the other side of the road. That’s our “fight or fight” response due to adrenaline (‘epinephrine’, to the Americans), and we surely need it.

But there are other times when that response is misplaced. Your daughter goes out with a friend, and as the night draws later you start to worry more and more about her safety in these times of high crime. You think you have a right to worry about her as a parent. But do you? Examine it with me for a while.

You will be evoking in your body a similar but milder ‘fight or flight’ response with your worry. Hormones are going to be released. Your heart beats faster, blood pressure will elevate, digestive system is suppressed, muscles tense up, but unlike in the previous example, there is no action. You can’t run across the road and save her! You can do nothing.

You get your body in this hyped up state and the excess fuel is not used for any physical activity. Normal bodily functions are suppressed when we are ‘stressed’, including the ability to fight off diseases. You are like this, yet you can do nothing to help your daughter. I let my patients know they’re not helping her, and they’re certainly not helping themselves with their worry.

So now, imagine if you do this repeatedly. Everyday there is something new to worry about: the state of the economy, the package delivered late, the traffic conditions, murder, the failed dinner, the sick child, the list is exhaustive. What happens in our minds? What happens to our bodies?

You may be surprised by what a negative response to stress does to our bodies. Remember, everyone is faced with stressful situations on a daily basis. But we don’t all respond the same. Something one person throws over the shoulder, another person laughs at and yet another rants and raves about. So, it is not the actual stressor but our response to it that affects our bodies.

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When we respond with frequent expressions of fear such as concern, worry, fretting and anxiety, it affects us physically. We are constantly putting our bodies on alert to act but never do. Chronic anxiety affects us through: dizziness, fast heartbeat, fatigue, headaches, inability to concentrate, irritability, nausea, rapid breathing, trembling, digestive disorders, memory loss and premature heart attack.

Look again at those symptoms. Don’t you get some of those from time to time? I have sooo many otherwise healthy patients who come in with the symptoms above. I automatically think ‘stress’ when I see a young woman with mild dizziness. More often than not, there is a huge stressor in her life that she is not coping well with.

And isn’t everyone ‘tired’ or has lack of energy these days? What about stomach problems and memory loss? Hey! I’m not saying we simply dismiss these symptoms as stress-related but it is important to be aware, especially in general practice, that you may not be able to find an actual physical cause of a problem. The possibility that there are psychological factors triggering symptoms is real.

But, being a doctor and knowing my body, if I ever feel dizziness I say to myself, “Girl, you are stressing over something. You didn’t realize, huh?” And when I am forgetting a whole lot, I know I need a rest. When my acid reflux resurfaces, I don’t take meds. I just make a note to myself that I’m stressed.

I must re-direct you to the symptoms one final time. Do you see why you need a good night’s sleep before exams? For memory and concentration. And how could a healthy corporate executive just keel over with a heart attack? Extreme stress. Ever notice you’re just sitting there but you’re breathing hard?

So the long and short of it is that anxiety and excessive stress are not good for our bodies, especially as cortisol suppresses our immune system making us more susceptible to diseases. When I’m stressing myself out a lot I think, “You’re killing yourself girl; shortening your life. Stop it!”

But really, I would like to take you more inside the mind of an anxious person (you may well find that mind is your own) because it’s no big taboo. All of us get anxious, some more so than others. I want to teach you to be able to recognize the state and be able to get out of it quickly.

Ok, so I gotta go now. Will chat more later in the week. I have got an hour and 30 min to get to church, and for me, that ain’t enough. I’m not like my sis who needs an hour. Ciao!!!

 

Insomnia!!!

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teddy-is-sleeping-vector-583552Hi, it’s Dr. Louella again. Would you imagine that after that talk about the basics of health I haven’t yet gotten enough sleep? While people looked forward to this, another long weekend in Trinidad, I didn’t. I knew that preparing for the Indian dance on Friday would take all day. Today I’m opening my office and then am part of a community-based clinic. I must attend a wake tonight then church tomorrow and event planning after. Breathe doc!

But there was a time, not so very long ago, that I wanted this very sleep but could not get it. I experienced insomnia for the first time in my life the end of 2013 into 2014. Now I know this is common among patients, but when you yourself suffer with something you sit up.

And my doc tried everything. He was a psychiatrist so I trusted his judgment and tried very much not to practice self-medicating. But I knew the medical options were limited.

First he thought the air-conditioning in my bedroom was too cold. If you research it you will see that environmental factors have a lot to do with sleep. You need a dark room. They advise you turn off your TV, computer, cell phone, anything with a lighted screen, about an hour before going to bed.

They repeatedly say the bed is only for sleep and sex. But we are all guilty of lazing around, reading, talking, using the computer, watching TV etc. on our beds.

Then what about the noise factor? Our bedrooms should be quiet except for some soothing or isochronic music (did not work for me though; isochronic tones got me tense).

Now these things never mattered to me before. I used my computer, watched TV and chat on my bed. Then next moment I was asleep. It is when you begin to have problems that you need to start examining your environment.

Is your partner’s snoring affecting you. Let him visit an ENT doctor or research solutions on the net. Maybe it’s frequent awakenings from a crying child. Can no one babysit for a couple of nights for you to get back your rhythm? At the other extreme we have the elderly who may need mild sedation at night to prevent them from disturbing the household.

I turned off my air condition and used the fan and still couldn’t sleep on my own. Then I admitted to my doctor my frequent trips to the bathroom. That obviously disturbed my sleep. He wanted me to do less water guzzling (or as they say abstain from fluids for an hour or two before bedtime). When I said it was small amounts of urine he said I needed to learn to hold it, to retrain my bladder.

Good advice. But it didn’t work. I still awoke frequently and couldn’t get back to sleep. This is when I started doing my own research as to what else was out there. I had been using melatonin, which is supposed to be a natural sleep aid, but it just wasn’t kicking in.

I focused on trying to get myself to relax prior to bed. Against my will I had a warm cup of milk, I did not exercise too close to bedtime, I tried mild meditation, and progressive relaxation. As I said, the isochronic tones were not for me but my radio chimed love music throughout the night.

I tried to have a routine time to go to bed and to wake up. I saw where it was said that you ought to limit daytime naps to 30 min and then not after 3 pm. Now, mind you, I have no qualms in telling this to my patients. Because that’s what ‘they say’. But to me it was a bunch of hogwash since I have been taking afternoon naps for years and sleeping perfectly.

In this present scenario, when I missed a nap I slept no better at night. At least if I could get an hour or two under my belt during the day I would feel better.

Of course I know someone who sleeps a lot during the day may having difficulty sleeping at night. I didn’t sleep all day. And the elderly with little physical activity or who sleep all day, may be also unable to sleep at night.

Another rule that I broke is where they say if you haven’t fallen asleep after half hour, get out the bed. Go do something. When you’re sleepy again come back. Sounds good. But when I’m battling with my bed to sleep I’m down for the long-haul. (Maybe that’s why I usually lost the battle).

I feel for my patients a lot more in this area of insomnia after having been through this myself. It was terrible!!! You “awake” on mornings totally unrested, eyes heavy and burning, head groggy. And of course you have to go to work that day.

I only got a good night’s rest when I used the benzodiazepines (e.g. Valium, Ativan) my doctor prescribed. He kept trying to reset my clock with them and started and stopped them. He was particularly concerned about not aggravating another condition I have, that is triggered by lack of sleep.

But we all know benzodiazepines are addictive. You simply cannot take them for long. By now I thought I had figured out what caused my insomnia…anxiety. I never realized anxiety could cause such horrible insomnia. I was getting insights for my patients all the time. But I couldn’t shake the anxiety.

I had always thought that patients often had trouble sleeping because of their thoughts at night. But I had no self-defeating thoughts at night (except “I can’t sleep; I’m gonna die”). I learnt that it was also the daytime thoughts, fears, worries, ruminations that play on our subconscious and prevent us from sleeping at night.

My doctor next prescribed antipsychotics. I went along with it because things were not improving. Within three days I had horrible side effects so I stopped. I realized I had reached the end of the line. This anxiety thing had to stop. I willed my mind to be calm and trust in the Lord I believe in.

In two days, I was sleeping naturally again. It had to happen. I came from a history of beautiful sleep and I was not now going to be condemned to a life of insomnia.

I’ve been sleeping well since, making it two and a half months. I’m still working on the anxiety and have insights to share on this.

I know that a lot, a lot of people have problems to sleep. Please try some of these methods I mentioned above, I can always clarify, and above all, be anxious for nothing (KJV).

Dr. Louella. Over and out!

The Very Basic Rules of Health

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474657739Hi folks. Dr. Louella here. Did you miss me? I wasn’t feeling too well these past couple days. Took two days off work. When I was younger, people, usually the younger ones, would say, “You’re a doctor and you’re sick!” and look in amazement. I would simply explain to them that we are human beings like everyone else and the same imperfect medicine we apply to them applies to us too.

But it’s worse when you’re a doctor. I recently read an article from the UK which expressed the same things I experience. You’re both doctor and patient, there’s no one to turn to, you’re not objective when it comes to yourself, you shun any unpleasant treatment.

So why was I not well? It comes from breaking the basic rules of health, as I am going to discuss with you, and indeed I have discussed with many of my patients. Let’s put aside all the fancy medicine for a moment, all the gadgets and the tests, the antibiotics, the vitamins and the painkillers.

The basic rules of health are to eat well, drink plenty water, sleep well, be active, exercise and don’t be stressed.

So which one did I break? … not enough rest. I am frequently guilty of that. Caused me to faint at a bank. Also think I strained my abdominal muscles lifting some very heavy books. I’m still in pain.

Now, do not take these basic rules lightly. Many people come to me run down saying they think they need some vitamins. Now, vitamins are still controversial but there’s no harm in taking them because we do have deficiencies in our diet that we are not aware about. But vitamins ain’t food! We can last a lifetime on food alone but certainly not on vitamins alone.

Are you having three square meals a day? Basic. No, you miss breakfast because you can’t eat that early in the morning or more likely because there is no time. Well have a juice or a fruit or a cup of milk, something. Pack up breakfast and take it with you to the office. You miss lunch because you’re too busy or dinner because you’re trying to lose weight or it isn’t convenient. No wonder so many of us have stomach problems or experience lack of energy.

I’m sure I explained already that to lose weight you eat small amounts more frequently. You don’t miss meals. Our meals also need to be balanced with sufficient veges, peas and beans and fibre and less of the rice, flour, meat and sweets.

Do you drink sufficient water? Many people don’t. 6-8 glasses a day is a rough estimate. You may require more but not much less. Many people do not like to or do not make the time to drink enough water but our bodies are made up mainly of water and all systems need it to function efficiently.

What about sleep? That’s my Achilles’ heel. I literally started to feel that there weren’t enough hours in the day to get a proper rest, 7-9 hours, and do everything I wanted to do.

But that’s the quickest way for your body to be run down, for you to be less alert, less focused. You make more mistakes without a good night’s sleep, have more memory lapses and are more irritable. It also feeds both anxiety and depression. We need to plan our days so that we get the essential sleep.

You don’t need a doctor to tell you to eat right and sleep right. You need to know the importance for yourself. There is no medication that can replace these things. As I say, basic.

Being active. Many of us lead sedentary lifestyles. A family doctor may sit at a desk for hours with little breaks in between. The office worker, the computer geek, often does the same. The little old lady will sit on the comfy chair all day. The housewife may whip up her chores early in the morning then relax all day. These are common but unfortunately unhealthy scenarios. We must keep moving throughout the day. Obesity is so rampant because we do not do this.

Exercise is something you need to add to that active lifestyle. It increases your heart rate, breathing and the energy you expend. But we don’t like to exercise!!! It takes up our time, and certainly takes effort. It even hurts sometimes. The exercise buff is the exception rather than the rule. But we all know we need to exercise. It’s no secret. Exercise has a long lists of benefits. You lack energy? …Well exercise.

Lastly, let’s talk about stress baby. It is a relatively new buzz term isn’t it? But it’s so real. It incorporates worry, anxieties, fears, depression, all sorts of negative emotions we allow to play on our minds and disturb our psyche. Stress is not the situation or person that is affecting you, but your response to them. Two persons can have completely different responses in identical situations. If we are stressed we cannot function properly.

We often blame others for our problems. But if we do that, we can never solve them because we cannot change the other person. We need to change our attitude to acceptance and move on.

We cannot be dwelling on our past. Those monsters can only hurt us if we bring them into the present. And worrying about the future does not help either. I tell that to clients who insist on worrying about their children and grandchildren as a duty.

We often find inadequacies in ourselves. But we should not dwell on these. Sure, we all have faults, but there are so many wonderful things in each of us that we can be grateful for and focus on instead.

I ask my patients, when last did you have a vacation, or a break? Do you have any me time, especially those wives and mothers. I’ve come across miserable housewives caring for husbands, children, parents and/or in-laws with no time for themselves and feeling unappreciated by those they care for.

For me, I know, I need a time everyday to feel like I am me. Not a doctor, daughter, sister, friend, just me. Just to exist for a few moments. Nothing to rush and do next.

So, please people. These tips I am giving here are worth thousands. Take care of yourself. Do what is necessary. Avoid unnecessary doctor visits. He cannot do for you what you ought to do for yourself. Eat right, sleep well, a little exercise wouldn’t kill, in fact it prolongs lives. And deal with the stressors.

And if you do break these rules know that you will suffer and who will put humpty dumpty back together again? …  Take care. Dr. Louella.

Hypertension 10 – Summary

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Hi folks! It’s Dr. Louella and we’ve reached the grand finale of our discussions on hypertension. Yeeaaah!!!!

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This one you should definitely keep for your records because I’ll be reiterating and reminding you of all the important points, having already explained the mechanics of this disorder in detail.

Firstly blood pressure is derived from the pumping action of the heart as it forces blood into large blood vessels. This causes the blood to circulate around our bodies. The force with which  the blood flows is called the blood pressure.

Just as we are unable to feel the blood circulating around our bodies, we are unable to feel our blood pressure. It is a common myth in Trinidad and Tobago that high blood pressure causes neck pain.

95% of high blood pressure cases are caused by the kidneys by an unknown mechanism. The other 5% have an identifiable cause, usually in younger individuals.

Certain emotional states, such as anger, pain and anxiety, as well as increased physical activity, can cause a temporary rise in blood pressure. This is not hypertension, which is a chronic condition. For this reason, not just one, but a few blood pressure readings need to be taken before a person is diagnosed as hypertensive.

Factors which predispose to the disease include a family history of hypertension, increasing age and certain ethnicities such as Afro-American or Afro-Caribbean.

Dietary associations of hypertension include a high sodium intake (salt, not fresh seasonings), low potassium intake, heavy consumption of alcohol and obesity. Increased oats and fruits in the diet help to reduce blood pressure. Physical inactivity is also associated with a higher blood pressure.

General guidelines for hypertension are that a reading of 120/80 or less is normal and ideal; a target of less than 140/90 is used for those on treatment; less than 150/90 is now used for those over 60 and 130/80 or less for those with certain diseases such as diabetes and heart disease.

Complications of hypertension are the dreaded stroke, heart failure, heart attack, kidney failure, aortic aneurysm and eye disease. Hypertension damages the inner lining of blood vessels allowing cholesterol to enter the wall and form a plaque that partially blocks blood flow.

If it a blood clot forms at the site it seals up the blockage long enough for no blood to flow and permanently damage brain or heart cells. The person then gets a stroke or heart attack.

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The DASH diet has been shown to help lower blood pressure. It includes less salt, alcohol, red meat, fat and sweets including sweetened drinks.

But it also includes more fruits, vegetables and high fibre foods (whole grain products such as whole wheat/meal bread, bran, oats, as well as more peas, beans and nuts).

Weight loss for the overweight and obese is important in controlling hypertension. This can be achieved by a combination of dietary control and exercise. To lose weight you need to eat less and have a lower calorie intake but frequent little meals, and not starvation, is the key.

Exercise is beneficial in lowering blood pressure on its own, even in those of normal weight. Aerobic exercise can take many forms including running, skipping and dancing.

Some people can have their hypertension controlled through diet and exercise alone but most will still need the assistance of medication. Medication is varied but it must be stressed that it needs to be taken everyday, as prescribed by the doctor, unless the person is experiencing ill effects, which he must inform his doctor about.

So there! We’re done. That’s the end of hypertension. I’ve taught you almost everything I know. Feel free if you have questions or comments. See you next week. Dr. Louella is out!!!

Hypertension 9 – Treatment and Compliance

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Hi everyone! I’m on time today. This is Dr. Louella checking in from the office. This ought to be our final post on hypertension but I feel the need to give a summary afterwards to draw all the essential points together. Let us finish up on treatment.

So, let’s say diet and exercise (as we discussed previously), fail. You ask what I mean by fail… well you just don’t do them or you make a half-hearted attempt to do so. Then they will fail. Or, better yet, say you do try, and get some results but not sufficient for your blood pressure to be called normal, what do we do?

It is obvious we turn to medication at this point. Antihypertensive medication is used to control but not to cure hypertension or high blood pressure. Some people’s blood pressures are so high that we have to put them on medication from the start, but this should be done in conjunction with diet and exercise.

Now I don’t need to go too much into the actual medications. There are many classes of antihypertensive drugs and several drugs in each class. One may work a bit better in an individual than another but none is clearly superior.

I do have a lot to say on “The Patient and the Taking of Antihypertensives” though. Oh my goodness! I have only dealt with patients from Trinidad but I am sure there are patients all over who behave similarly.

Many patients aren’t convinced of the diagnosis of hypertension. They say “so they say” but don’t own it for themselves. They are in denial. Others treat it like a minor irritation or joke. But I am usually quickly able to convince them of the diagnosis by giving them the normal range and showing where a number of their blood pressures, as recorded in the patient notes, are beyond that. Remember, if they were diagnosed based on one reading, they have a right to be skeptical.

I show them that antihypertensives work on everyone. If they do not have hypertension their blood pressures would run low if they took medication. Are their blood pressures running low? Or are they being maintained just normal, high normal or even too high? If your blood pressure is normal whilst on an antihypertensive, you need to continue on that treatment, or else it will go high.

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It is difficult to get hypertensive patients to take their medication because they don’t feel sick. This often leads them to rush to take a pill when they do feel something like a headache or neck pain. Recall that hypertension has no symptoms. I tell them if you are waiting to feel something, that’s when complications have already set in, and it will be too late.

A lot of our patient population think a water pill is to help them pass water and improve functioning of their kidneys, so they don’t take it because they pass water just fine. They are oblivious to the fact that it is a pill for treating hypertension, so I make this clear to them.

Many of them have their own regimen for taking medicines: once a day instead of twice, every other day, twice or three times a week, whenever they remember or whenever the blood pressure is high. No wonder the pills don’t work!!! I always ask why? What is your reasoning for this?

I will admit, years ago when I first discovered this deviant behavior I was shocked. I found out that we doctors increased the dosages of patient medication when needed but the patients themselves didn’t. So the notes may be saying as many as four tablets a day when the patient still routinely took one. My most gruesome discovery was bags and bags half-filled with medication at the homes of the elderly we visited in Cedros. I was upset and thought I was fighting a losing battle.

But I’m older and wiser now. I understand many of the reasons they don’t take their medicines as prescribed. I ask them point blank about it and spend some time on the topic. But even after explaining there is no guarantee they will follow comply. Most of our patients are unaware of the names of their medication and this makes it more difficult.

I explain to those that take their meds only when blood pressure is high is that they are doing more damage by allowing their pressures to go high and then taking a pill, as opposed to having it controlled at all times. If your blood pressure is good today it may be the pill you took yesterday. If you miss the pill today it will be high tomorrow or the next day. To decrease risk of complications blood pressure needs to be controlled at all times

Many patients are afraid of side effects. I try to explain that these side effects are only potential and nothing happens to most people. There is no automatic damage by the medication. And furthermore, the damage they will get from hypertension is more sure and worse than what the tabs will do.

For those who have decreased the dosages due to convenience, I explain to them that the drug only is effective in their system for a certain length of time and they need to take it as prescribed for it to work properly. It comes as though you’re wasting your time because the drug can’t work like that.

A few of them cannot read so I emphasise to them that I am changing the dose and ask them to refer to a relative or neighbor to read it for them. Sometimes for the elderly or mentally challenged I ask for them to bring a relative. I explain to that person and charge them with the responsibility.

That’s it folks!!! We just completed the series on hypertension. Only the summary is left. Thereafter I’ll be starting a new topic. Now if I left out anything or you don’t understand something, feel free to comment before we move on. I enjoyed this because it was like a refresher for me and as you can tell, I love to share my patient experiences. Enjoy the rest of the weekend and the incoming week!