New Year Reading Links: Performance Enhancement

Happy New Year Brain Posts readers!

Thank you for following these posts. To begin 2016 I would like to highlight research related to performance enhancement. These posts will look at legal as well as illicit methods.

Here are a few recent research abstracts that caught my attention and will be on my reading list over the next few days.

Memory Neuroenhancement in Autism

This study examined the effects of a Chinese mind-body training technique named Nei Gong training in children with autism.

Perceptual Training in Beach Volleyball

Beach volleyball players were studied in a trial of methods for gaze-path training.

Supplement Use by UK Army Soldiers

This study surveyed UK Army soldiers in training for use of supplements. Protein supplements, carbohydrate-electrolyte sport drinks and creatine were the most commonly endorsed supplements in use in the cohort. 

Monthly Testosterone Use in Older Men

Twenty four elderly men participated in a trial of supplemental testosterone in two formats versus placebo on body composition and muscle strength. 

Time of Day and Performance in a Cycling Trial

Nine male subjects participated in a trial examining cycling performance at various times of the day. Cycling performance and hormonal/metabolic effects were the key outcome variables in this study.

Follow the author on Twitter WRY999

Photo of red-shouldered hawk is from the author's files. 

Top 10 Brain Posts 2015: Exercise and Brain Integrity

A final Top 10 Brain Post in 2015 focussed on a study of the correlation between exercise habits and integrity of brain white matter.

This study found that brain white matter integrity decreased with age.

However, some of this deterioration in integrity was minimized in older adults with higher measures of fitness.

The original post on this research can be found 

HERE

Follow the author on Twitter WRY999

Photo of jogger on beach in Fort Myers, Florida is from the author's files.

New Year, Healthier You

The beginning of the new year is often seen as a time of rebirth, a chance for individuals to start anew.

Each January, millions of Americans resolve to better themselves – many focusing on their health. However, it's been reported that under 10% of individuals will actually achieve their goals.

This doesn’t mean that you shouldn’t try. It means that you need a plan in place and must be realistic about the challenges ahead.

Check out five of the most common New Year’s resolutions and how you can achieve your goals:

Lose Weight

One of the most popular resolutions is also one of the most difficult to achieve. People want results immediately, but losing weight takes time. Each day presents a new opportunity to make a change: improve your diet, be more active or embrace a healthier lifestyle overall.

Keeping track of what you eat will help you realize change is happening even if it’s not yet visible. It is also very helpful to have a support system in place for those days that are a bit more challenging than others.

Take it one step at a time and plan for bumps in the road.

Fit in Fitness

Getting into better shape doesn’t mean you have to spend countless hours at the gym or on the track.

For the average person, a good fitness program consists of exercises that work the entire body and lasts between 30-60 minutes throughout the day. Cardio work improves the health of your heart, lungs and blood vessels. Weight-bearing exercises enhance the function and health of the bones, muscles, joints and connective tissues.

Start slow and if you are unable to commit a full 30-60 minutes at a given time throughout your day, spread it out. Go for a walk on your lunch break, ride your bike after work or do a few reps while dinner is in the oven.

Quit Smoking

According to the Centers for Disease Control and Prevention (CDC), there are more former smokers in the United States - nearly 50 million - than current smokers. That means it’s a popular goal and that many people succeed.

Regardless of how long you’ve been smoking, quitting will be a challenge. Research the various methods available and be prepared to try different ones until you find the one that works best for you.

As with losing weight, let others help you. Tell your friends, family and co-workers about your plan and explain to them that you would like their support throughout your journey. It also may be helpful to talk with your healthcare provider as they will have suggestions on how to lessen the urge.

Get More Sleep

Have you been unsuccessful in past quests to get fit, lose weight or eat healthier? Perhaps your plan to healthier living is missing one of the most important pieces of the puzzle: sleep. A lack of sleep has been linked to a greater risk of obesity and type 2 diabetes, among other things.

Although everyone has different sleep patterns and slightly different needs, it is recommended that you get at least seven hours of sleep per night. If you have trouble doing so, try avoiding electronics an hour before bed. The blue light emitted from your television, laptop or smartphone can trigger alertness, keeping you awake longer. Also, try to stick to a schedule, regardless of the day. If you go out late on Saturday and sleep in on Sunday, you may have trouble being ready for Monday morning.

Cut your stress

We all do it. Work is overwhelming, we have a list of chores we need to take care of or we are trying to stick to these New Year’s resolutions. We put added stress on ourselves, which leads to a lack of sleep, poor eating choices or other unhealthy habits.

Make sure to make time for yourself. If you’re like many, you have vacation time saved up – use it. Don’t make yourself available 24/7. Turn off your smartphone, television and computer for an hour a day.

Removing unnecessary stress will go a long way in helping you achieve your other New Year’s resolutions.

Here’s to a healthier you!

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How to Deal with Controversy over Physician Assisted Death

We in the U.S. are not skilled at resolving controversy. We're vulnerable to demonizing those who hold different views on issues that matter a lot to us. Polarizations like "pro life" vs "pro choice" harden into rigid convictions. Physician assisted death (PAD - sometimes referred to as "physician assisted suicide") could fall into the same intractable trap. The American Association of Hospice and Palliative Medicine (AAHPM) teaches us how to approach the issue in a morally mature manner.

With regard to whether it is ethically acceptable for a physician in a state that allows physician assisted death (currently Oregon, Washington, Montana, Vermont and California) to prescribe a potentially lethal medication for a terminally ill patient that the patient can use if he chooses, the AAHPM believes, as I do, that "sincere, compassionate, morally conscientious individuals stand on either side of [the] debate." That's the opposite of demonization. This crucial recognition leads the Association to take what it calls "a position of 'studied neutrality' on the subject of whether PAD should be legally regulated or prohibited."

Physicians who support PAD will be disappointed that the Association does not endorse it. Physicians who oppose PAD will be disappointed that the Association does not oppose it. What the Association chose to do was to tell its members and society itself how patients can best be cared for if and when PAD is legal. Here's the essence of their view, quoted - with slight modification - from the AAHPM policy statement:

• The permissibility of PAD is dependent upon access to excellent palliative care. No patient should be indirectly coerced to hasten his death because he lacks the best possible medical and palliative care.
• Requests for PAD emanate from a patient with full decision-making capacity.
• All reasonable alternatives to PAD have been considered and implemented if acceptable to the patient.
• The request is voluntary. Safeguards should focus in particular on protection of vulnerable groups including the elderly, frail, poor, or physically and/or mentally handicapped. Coercive influences from family or financial pressure from payors cannot be allowed to play any role.
• The practitioner is willing to participate in  PAD, never being pressured to act against his own conscience if asked to assist a patient in dying.
• The most essential response to the request for PAD...is to attempt to clearly understand the request, to intensify palliative care treatments with the intent to relieve suffering, and to search with the patient for mutually acceptable approaches without violating any party's fundamental values.

The AAHPM has provided admirable ethical and clinical guidance. "Studied neutrality" reflects moral wisdom, not wishy-washy waffling. AAHPM is doing what a professional association does at its best - offering clear guidance to members, the medical profession as a whole, and to wider society.

Top 10 Brain Posts 2015: Bupropion in ADHD

One of the top 10 Brain Posts featured a review of study of the drug bupropion for the treatment of ADHD.

Bupropion was origninally marketed as an antidepressant. The drug was found to also reduce cigarette cravings and has been marketed under the trade name Zyban for smoking cessation.

There is some indication the drug may be effective in some cases of ADHD.

The reviewed study found evidence of superiority of bupropion over placebo for ADHD in a small clinical trial involving 42 adults.

You can access the full Brain Post review of this study

HERE

Follow the author on Twitter WRY999

Photo of Christmas lights at Rhema in Tulsa, OK is an original from the author's files.

Top 10 Brain Posts 2015: Binge Eating and IBS

I have been highlighting the Brain Post blogs with the highest number of pageviews for 2015.

The third highest accessed post involved a review of a study involving binge eating disorder and irritable bowl syndrome or IBS.

You can access the original post 

HERE

Irritable bowel syndrome is a common disorder affecting up to 4% of men and 8% of women.

This study found that individuals with binge eating disorder had higher rates of IBS even controlling for potential confounding effects of obesity.

The authors noted this finding may be due to a common predisposing factor for both disorders. Additionally, they noted consumption of large quantities of food in short periods of time may put stress on the gastrointestional system that produces IBS symptoms (abdominal pain, bowel frequency disturbances).

Follow the author on Twitter WRY999

Photo of eel and reflection at the Oklahoma Aquarium is from the author's files.

Top Ten Brain Posts 2015: Mediterranean Diet and Alzheimer's

The Brain Post with the second highest pageview count for 2015 was my review of a study of the Mediterranean Diet and Alzheimer's Prevention.

You can access the original post by clicking:

HERE

This study found a link between adherence to a Mediterranean diet with thicker brain cortical regions in the left brain hemisphere.

The regions with increased thickness are regions known to be affected in Alzheimer's disease.

We are a long way from finding a definitive way to modify diet to reduce the incidence of Alzheimer's dementia. Look for this topic to be a continued focus of significant research attention.

Follow the author on Twitter @WRY999

Photo of great egret is from the author's files.

Top Ten Brain Posts for 2015: Number 1

This is a good time of the year to kick back a bit and review 2015.

I am always surprised at some the posts that receive the most visits and post some photos from my recent visit to Sanibel, Florida.

The number one post for 2015 in pageviews was:

One Parent, Two Parents and Child Well-Being

This post summarized results of data from the National Health Interview Survey. The key data on how childhood and parenting changed over the last 40 plus years in the U.S.

1. Fewer children are living in a home with two parents
2. Children are more frequently raised by a single mother
3. More children are living and being raised by a grandparent
4. Children living with both parents had lower rates of medical and psychological problems

It seems the changes that are occurring in the child environment are presenting significant challenges.

It seems like a good time to reach out to any single parents you might know to offer a helping hand.

Follow the author on Twitter WRY999

Photo of great egret at sunset is from the author's files.

Informed Consent for Simultaneous Surgeries

Two months ago (here) and again today the Boston Globe Spotlight team wrote about the practice of having one surgeon doing two operations at the same time, moving between two operating rooms and leaving fellows or residents "in charge." Dr. Dennis Burke, a prominent orthopedic surgeon at the Massachusetts General Hospital, brought his concerns about simultaneous surgery to the Spotlight team. Dr. Burke has been dismissed from the hospital for showing redacted records from his own patients to the Globe team. 

Physician leaders at the Massachusetts General Hospital and elsewhere insist that there is no evidence that simultaneous surgery has led to worse outcomes for patients. And advocates defend the practice - which is common at leading hospitals, as (a) efficient use of skilled surgical time and (b) a way to reduce waiting time for patients. 

If simultaneous surgery were recognized as having even a small effect on patient safety, for reasons of prudence (malpractice liability and terrible publicity) as well as ethics, hospitals would not allow it. But let's assume that definitive studies showed there was no increased risk. What then?

Think about it personally. If you were going under the knife, would you want to know that your surgeon would be going in and out of the operating room to do surgery on another patient at the same time? I would. 

If there's no difference in outcomes, physicians might say - "why do I need to tell patients - there's no difference in outcomes?" The answer is that we have an ethical duty to give patients information that's important to them. I've done an informal survey among friends as to whether they regard the question of whether their surgeon would be doing two operations at once as something they would want to know about as part of their decision-making process. 100% said it is.

Revealing the possibility of another surgeon taking charge in the small print of an informed consent "contract" does not do the job. Good ethics requires open discussion. This may well be uncomfortable for surgeons, just as candor about how often they have done a procedure when they are early in the learning curve is. But it's what we owe our patients, and to the reputation of our profession as trustworthy, not devious and evasive.

8 Health Benefits of Eating Water Melon

Water melon is a sweet reddish, fleshy and juicy fruit that is best enjoyed when served cold in the summer or dry season. It is largely made up of water and can help in re-hydration. It also benefits those who want to lose weight. Apart from water, water melon also contains lycopene, potassium, calcium, iron amino acids and some vitamins like vitamin A and C. Here are some of the health benefits of water melon.

1 Good for weight loss

Watermelon is very low in calories and is free of fats. It also has a very high percentage of water which is very effective for those who want to lose weight. It is also an excellent fruit that helps in combating dehydration.

2 Helps in regulating Hypertension and maintains a healthy heart

Water melon helps in preventing our cells from damage and studies have showed that consuming water melon is able to reduce the risk of developing heart diseases. water melon also reduces hypertension because it contains potassium. All fruits and vegetables that contain potassium help in reducing hypertension.

3 Prevention of cancer

Lycopene is a powerful antioxidant that is found in water melon and in tomatoes. The antioxidant properties of water melon are responsible for reducing the risk of occurrence of cancers.

4 Beautiful Hair and skin

When taking care of our hair and skin, we should also focus on the things that are responsible for their health internally. Applying hair and skin products helps but we need to eat foods that naturally promote beautiful skin and hair. Vitamin A helps in keeping our hair and skin moisturized and it also encourages the growth of our hair and skin.

5 Helps in digestion

Water melon contains enough water and fiber that help in digestion

6 Hydration

We need to drink enough water every day or else we will become dehydrated. Drinking water and eating water-based foods, fruits and vegetables are the ideal to combat dehydration. Water melon contains up to 92% of water and can therefore help in keeping us hydrated. Lettuce also contains a high percentage of water as well.

7 Helps in reducing inflammation

The lycopene that is found in water melon helps in reducing inflammation. This is beneficial to people who suffer from inflammatory conditions such as arthritis. Lycopene also neutralizes free radicals because it is an antioxidant.

8 watermelon helps in reducing muscle soreness

Anyone who does physical exercise or workout sessions has probably experienced muscle soreness. Eating water melon or drinking natural water melon juice before workout can help in reducing muscle soreness that occurs after physical exercise. The amino acids (arginine and citrulline) found in water melon are responsible for reducing muscle soreness.

Health risks

Everything that is taken in excess causes some health problems and water melon is not an exception. Those who have too much potassium in their system should not consume too much water melon or foods that are high in potassium. This condition is known as hyperkalemia. Hyperkalemia can cause heart problems.

Sources:

http://www.livescience.com/46019-watermelon-nutrition.html

http://livelovefruit.com/8-amazing-health-benefits-of-watermelon/

http://www.whfoods.com/genpage.php?tname=foodspice&dbid=31

http://articles.mercola.com/sites/articles/archive/2014/07/21/watermelon-nutrition.aspx

6 Health benefits of orange

Orange is one of the most popular fruits in the world. it has a sweet taste and is very juicy. It is a good source of vitamin C and contains some amounts of potassium, magnesium, calcium and iron. Here are some of the health benefits gotten from eating orange

1 Orange helps in boosting our immune system

Oranges contain vitamin C which helps in boosting our immune system. It also helps in fighting infections like cough and colds. Vitamin C also acts as an antioxidant and prevents our body from getting damaged by free radicals and other toxins.

2 Helps in preventing cancers

Oranges contain Vit C which is an antioxidant. Antioxidants are known to fight cancer causing agents like free radicals.

3 It helps in fighting against premature aging

The antioxidant properties of orange help in premature aging. Apart from preventing damage of cells by free radicals, orange is also able to help in the production of collagen which enhances the health and beauty of our skin.

4 Prevents heart disease and helps in regulating blood pressure

The potassium found in orange is able to bring down high blood pressure and this can greatly reduce the occurrence of stroke as a result of high blood pressure. This is because potassium has vasodilatory properties. An increase in the consumption of foods that are rich in potassium will decrease blood pressure. 

5 Helps in weight loss

Oranges are high in fiber and water which makes it very suitable for those who want to lose weight.

6 Good vision

Any fruit that contains vitamin A promotes and enhances our vision. Vitamin A also helps in enhancing night vision and in the prevention of age related macular degeneration which causes blurred vision.

Side effects and risk

Oranges should not be taken in excess. Consuming too much oranges can cause conditions like diarrhea, nausea, vomiting and abdominal cramps

Sources:

http://www.livescience.com/45057-oranges-nutrition-facts.html

http://www.medicalnewstoday.com/articles/272782.php

http://www.thehealthsite.com/fitness/health-benefits-of-oranges/

Avoiding Holiday Hazards

Robyn S. Medina, DO, a family medicine physician at Penn Family Medicine Valley Forge, offers tips on how to avoid the added risks that accompany the holiday season.

The holiday season is a time for relaxing and celebrating with friends and family. Sitting in front of the fireplace, admiring the decorations and, possibly, sipping on some seasonal cocktails are likely some of the items on your to-do list.

Sorry to be the coal in your stocking, but the most wonderful time of the year can be the most hazardous. Dr. Medina is here to help you prepare for the holidays without the added risks sometimes associated with them.

Enjoy the glow without going up in flames.

Although candles and fireplaces can create a cozy ambiance, increased use combined with other seasonal decorations means more risk for fire. Make sure you:

1. Never leave burning candles unattended or sleep in a room with a lit candle.
2. Keep candles out of reach of children and pets.
3. Don't burn candles near trees, curtains or other flammable items.
4. Don't burn trees, wreaths or wrapping paper in the fireplace.
5. Check and clean the chimney and fireplace area at least once a year.

Get into the festive décor while leaving out the danger.

From tinsel to mistletoe, and Poinsettias to spray snow, holiday decorations are all around. Creating festive displays is one of the best ways to get in the holiday spirit; however, you should make sure you pay attention to any small children or pets that may be around.

1. When trimming the tree, place breakable ornaments and those that have metal hooks toward the top, away from the smaller creatures in your house.
2. Keep poisonous plants (including some Poinsettias) out of reach of curious children or pets.
3. Keep indoor paths clear of wrapping paper, decorations, light wires, toys, etc.
4. Remember not to spray chemicals when others are around. Adding a frosty look to a surface is easy with spray paint; the problem is it can irritate lungs if inhaled, especially those of little tikes. 

Keep holiday drinking under control.

If there is ever an opportunity to overindulge, the holiday season is it. Between the eggnog, mulled wine, champagne and other alcoholic beverages, the options just seem to be a bit more enticing this time of the year.

If the concern of becoming the topic of water-cooler chatter or making those family gatherings a bit uncomfortable isn’t enough, keep this in mind: The time between Christmas and New Year’s is one of the most dangerous times of the year to be on the road. This is because of the number of people on the road significantly increases, which also means those driving under the influence increases. On New Year’s Day, nearly half of all traffic fatalities involve alcohol, the most of any U.S. holiday.

So, make sure you:

1. Know who’s the true man (or woman) of the hour (AKA who’s your designated driver?).
2. Buckle up, no matter how long or short the distance being traveled.
3. Don’t text and drive. Distracted driving causes one-quarter of all crashes.
4. Are prepared for more traffic than usual and possibly bad weather.

Ensure this month is a time of joy and cheer. Just a bit of preparation can go a long way in helping you and your friends and family safely enjoy the season.

Happy Holidays!

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Reddish Egret Pair on Bunche Beach, FL

I am spending a few days in Florida and so I will not be able to post to the blog from my review of neuroscience research.

 I will share a few of my favorite wildlife and sunset photos from my trip to Florida. Here's a picture of two reddish Egret at sunrise on Bunche Beach Florida.

7 health benefits of using Apple Cider Vinegar (ACV)

                                               

Vinegar has so many health benefits. The most widely used vinegar when it concerns people’s health is apple cider vinegar.  Despite its popular use by health and fitness lovers, more scientific research is still needed to confirm some of the many benefits of apple cider vinegar

1 weight loss

Apple cider vinegar can aid in weight loss.  It is able to decrease our appetite and hence less food will be consumed leading to weight loss. Some studies have shown that the main compound in apple cider vinegar (acetic acid) is able to reduce our weight and burn abdominal fats in our body.

2 lowers bad cholesterol

The acetic acid in ACV can reduce triglyceride levels in our body. Triglycerides helps in increasing the bad cholesterol levels in our body.

3 helps in fighting diabetes

Taking about 2 teaspoons of ACV in a glass of water everyday may be able to lower blood glucose levels in people with type 2 Diabetes.

4 sunburn

Mix ACV in your bath water to get some relieve from the discomforts associated with sunburn.

5 Sore throat

The antibacterial properties of ACV can help in relieving Sore throat. Put about 2 teaspoons of ACV in a glass of warm water and gargle it.

6 Deodorant

ACV helps with odours especially those comming from our armpits. Apply ACV on the skin of your arm pit and this will help in eliminating the odour.

7 Oral hygiene

ACV is helpful in eliminating bad breath. It can also help in whitening the teeth. Dilute the apple cider vinegar in water before rinsing your mouth with it. ACV is very acidic and if taken in pure form or in excess, it can damage the enamel of the teeth.

Sources:

http://www.bodyandsoul.com.au/health/health+advice/10+reasons+to+try+apple+cider+vinegar,31365

http://www.mindbodygreen.com/0-5875/15-Reasons-to-Use-Apple-Cider-Vinegar-Every-Day.html

http://articles.mercola.com/sites/articles/archive/2015/03/21/apple-cider-vinegar-uses.aspx

7 health uses of baking soda

                                                                         

Baking soda is also known as sodium bicarbonate. While most women use it to bake, there are so many health benefits of baking soda that are yet to be exploited. Baking soda is usually white,is in powdered form and it taste like salt. Below are some of the health benefits of baking soda:

1 Deodorant

Baking soda can be used as a deodorant. Mix some baking soda until it is in the form of paste and smear it under your armpit. Allow it there for a few minutes and rinse it off with clean water.

2 Facial beauty

Baking soda can be used to exfoliate dead cells on the surface of the skin on our face.  Mix one teaspoon of baking soda with 3 teaspoons of water and apply it on your face in a circular motion. Rinse it off with clean water and allow your face to air dry.

3 Skin relief from sun burn and itches

Applying baking soda paste on the area of skin affected by sunburn can provide relief. Baking soda can also relief our skin from itches.

4 Baking soda can brighten your teeth, remove mouth odour and plaques

Apply baking soda paste on your teeth  and rinse off the paste after some minutes to brighten your teeth. Do this about once every week. Baking soda also helps in eliminating mouth odour. It can remove plaques from the teeth. Do not use baking soda often because it can wear off the enamel of the teeth.

5 Baking soda can relieve heartburn and indigestion

Baking soda is cost effective when it comes to relieving heartburn and indigestion. Mix a teaspoon of baking soda in a glass of water when you feel you have indigestion and drink it to get relieved. 

6 Cancer

Studies conducted on animals showed that baking powder could shrink some acidic tumours. This is because cancer cells can’t survive in an acidic environment and baking soda is able to increase the pH of acidic tumours without disturbing the pH of our body. Some health coaches have incorporated sodium bicarbonate therapy when planning diet for cancer patients but more research is still needed to establish this. 

7 Relieve from insect bites

Apply baking soda paste on the insect bite or sting and allow it for a few minutes before rinsing it with clean water. This should provide some relieve. 

Side effects of baking soda

too much baking soda can upset the stomach and instead cause nausea or diarrhea

Sources:

http://draxe.com/baking-soda-uses/

http://www.drwhitaker.com/7-baking-soda-health-benefits/

https://www.organicfacts.net/health-benefits/other/baking-soda.html

http://articles.mercola.com/sites/articles/archive/2015/02/02/11-health-benefits-baking-soda.aspx

The Four "As" of Ethics

Here's a mnemonic I've found useful for thinking about the actions health organizations need to take to walk the talk of their values:

1. Analysis ("what is the right thing to do?") This is the activity most familiar to ethics committees and classes in ethics. When is it right to pull the plug? At what age should children make their own health care decisions? When the term "ethicist" is used it's generally associated with the analytic activity.
2. Advocacy ("let's do the right thing!") This is the charismatic leadership function. When  leaders are seen as admirable exemplars of the organization's values, bureaucratic position and natural authority coincide. This is a uniquely powerful configuration. But every group has members who others respect and want to emulate. Wise leaders look to these widely admired member of the group as strong influences on the organization's ethical culture.
3. Administration ("we need to create structures that make it easier to do the right thing.") Ethical behavior is strongly influenced by internal ego ideals, but it's also shaped by external factors like prompts in an electronic record that help us conduct and record advance care planning and nudge us when it hasn't been done.
4. Accountability ("how well are we living our ideals? how can we improve?") Many years ago, a primary care colleague had his assistant ask every patient after their appointment - "did Dr. X do what you needed him to do today?" If the answer was "no," the assistant was trained to intervene, either directly or by calling in to the office. Now we have well developed systems like Press Ganey to assist with accountability at the population level, but the basic function is the one Dr. X implemented on his own.

Ethically admirable health organizations need to cultivate all four of the "As". 

14 signs to show that you are not drinking enough water

There are so many people who hate drinking water. They only drink water when they are thirsty. In this generation, there are a lot of people who don’t drink enough water and they are not aware of the consequences of not drinking enough water. A lot of people also make the mistake of substituting water for other manufactured fluids like soda and sweet beverages, not knowing that they are causing more harm than good.

Our body is made up of about 65-70% water and this water is needed for very vital functions like 

• metabolism
• Regulating body temperature
• Eliminating waste products
• Circulation and 
• Detoxification.

It is important to note that when you are thirsty, it is already a sign of dehydration.

When you don’t drink enough water, you will notice the following signs.T

1. Thirst
2. Craving for sweet things
3. Headache
4. Poor concentration on what you are doing
5. Very dark urine
6. Little or no urination
7. Dizziness or fatigue
8. Pain around the joints
9. Muscle cramps
10. Dry skin which always looks white and may have increased wrinkles
11. Smelling or bad breath
12. Constipation
13. Indigestion
14. An increase in the occurrence of gastritis and heartburn

It is very important for us to cut down on the sweet drinks and caffeine we drink as a substitute for water because they are actually causing more harm than good. Sweet drinks and caffeinated drinks have been associated with diabetes, Hypertension and cancer.

Taking Action on Sexual Abuse by Physicians

"Why Didn't Anyone Stop Dr. Hardy?" is the featured headline on the front page of today's Boston Globe. It's accompanied by the photo of the back of the head of a woman who complained about Dr. Hardy to the Massachusetts medical board in 2004. She has her hand against her cheek with a watch showing prominently, suggesting the passage of time over which numerous complaints were made about Hardy, with no action being taken. What follows is a summary of the article and my analysis of the key issues:

The story went back to his undergraduate days at Princeton. Both male and female classmates believed he had committed sexual assaults. But this was the 1970s, before the kind of focus on sexual misconduct that universities now apply. Hardy was president of the premedical society and even, for a time, a counselor in a sexual education program. A male classmate was concerned enough to send anonymous letters to medical schools warning that Hardy was "a person of poor character." Hardy trained at Cincinnati, Stanford and Harvard, becoming a gynecologist and fertility specialist.

In 1999 a woman reported to the gynecologist who had referred her to Hardy that Hardy has massaged her clitoris, saying he needed to get her "uterus to contract." She asked the gynecologist - was this a normal medical procedure? Her gynecologist said it was not, but apparently did not report Hardy to the medical board. In 2004 the patient featured in the article reported Hardy to the medical board, complaining that her clitoral area was raw and swollen after a surgical procedure. Hardy wrote a three page defense. The board took no action against him, but it did make a record of the complaint.

In 2011 Hardy told  a South Asian patient that women from her country were "clueless about sex," and that being brought to orgasm by his massaging her clitoris would help her get pregnant. When this woman ultimately went to the Massachusetts medical board the board conducted an extensive examination - including interviewing classmates from Princeton -  leading to Dr. Hardy's surrendering his medical license, and promising never to seek to be licensed in any other state. Dr. Hardy now lives in Thailand with his second wife and their young children.

In medical ethics classes we typically work with examples of "good v good" conflicts, as when respecting the patient's choices ("respecting autonomy") conflicts with the patient's health ("practicing beneficence"). I interpret the history of Dr. Hardy's case as the opposite - a "bad v bad" conflict.

If the patients' complaints are true, Dr. Hardy has malpracticed, disgraced his profession, and possibly committed felonious assault. Sadly, we know that some physicians betray their patients' trust and professional responsibilities in the way Hardy apparently did. In the past, however, it was not uncommon for an offending physician's denial to be believed, especially when the physician was a "respectable" Caucasian with top drawer credentials like Hardy. When colleagues and medical boards acted this way they were adding "system level injury" to the "direct injury" done by the abusive physician.

But in addition to bad things being done to patients by individual physicians, unresponsive colleagues and inactive medical boards, there are symmetrical risks of harm being done to "innocent" physicians. 40 years ago a young patient of mine with mild developmental disability was angry when I cancelled an appointment. She complained to the medical board that I had molested her. I had hurt her feelings, but that's not what she said to the board. By the time the board contacted me my patient and I had rescheduled the appointment and we were once again on good terms. I was too naive at the time to recognize how serious a complaint to the board could be. My patient had had a brief adolescent snit, but just as a malicious physician may lie about his offenses, a malicious patient may fabricate an accusation. When a board or the court of public opinion finds an "innocent" physician "guilty," a severe harm is done to the physician.

I don't see any way of ensuring the right answer to these "bad vs bad" conflicts. I know that patients have been harmed by having their reports of abuse disbelieved. But I'm sure that exemplary physicians have, on occasion, been harmed by complaints based on misunderstanding or malicious intent. Years ago, when I was in charge of a medical facility, a female patient complained that her male physician had been masturbating during an appointment. I met with the physician to take up the complaint. He said that perhaps his underwear had twisted around his testicles and that he readjusted his clothing and his anatomy via his pocket. (Male  readers have probably experienced the underwear problem.) I believed him, and explained what I thought had happened to the patient. She seemed to accept my interpretation, and that was the sole complaint ever received about the physician. But stranger things have happened than what the patient initially alleged. While I believe I got the situation right, a crystal ball might tell us that the physician lied and I unwittingly exonerated him and did an injury to the patient.

The excellent reporting done by the Boston Globe gives some guidance about how the health system and medical profession can handle these "bad v bad" conflicts better. Colleagues need to follow up on stories they hear from patients or rumors. At the very least this means talking directly with the physician in question. This isn't easy, but it's clearly the right thing to do. It didn't happen early enough with Dr. Hardy. If the physician is "guilty" it puts him or her on notice that the medical community is vigilant. At best the physician will say "I made a terrible mistake and I need to get help..." But even if the physician lies in a plausible manner, knowing that others are concerned will diminish the likelihood of repeat offenses.And if the accused physician is "innocent" he or she will be embarrassed or appalled, but it's better not to have unchallenged rumors circulating.

It's a privilege to be allowed to become part of patients' lives in the intimate way that medical care involves. But that very intimacy creates risks - primarily for patients but also for physicians. We need our health system to protect patients from exploitation and injury without making physicians so wary about accusations that they overly constrain their human warmth and caring.

Not an easy task!

2015-16 CDC U.S. Influenza Trends: Bad Year or Not?

The U.S. Centers for Disease Control provides valuable data on tracking trends for influenza in the U.S.

The most recent trend using outpatient visit percentages is reproduced here. 

The trend for 2015-16 is below 2% of all outpatient visits through the most recent data.

However, the trends graph shows the typical epidemic period is still approaching. It will be a few more weeks before the 2015-2016 influenza trajectory can be assessed.

I have previously posted two items on the relevance of influenza to neuroscience medicine:

Prenatal influenza as a risk for pre-term birth (pre-term birth contributes to a variety of childhood brain disorders)

Prenatal influenza as a risk for adolescent and adult psychotic disorders

For more information on influenza trends in the U.S. from the CDC go here.

Figure is from CDC. Original is here.

Follow the author on Twitter @WRY999

7 reasons to drink more water

Water is very important for our health and body functioning. There are so many people who don’t drink water. There are others who drink water only when they are very thirsty. There are still others who don’t like drinking water so they replace water with one soft drink or the other. But these are all wrong. We ignorantly starve ourselves from water without knowing it.  Below are some of the reasons why you should drink more water.

1 Detoxification

 Drinking enough water helps in eliminating waste products from our system through excretion.

2 Relieving joint pain and arthritis

 Our joints are made up of water. Therefore, water is needed to maintain the health of our joints. Some Doctors have been able to reduce and eliminate arthritis from their patients by simply making them increase their intake of water.

3 Beautiful hair and skin

 Drinking enough water makes our body to be more hydrated. This enhances the appearance of our skin and hair.

4 Relieving headaches

 Drinking enough water is able to relieve some headaches and migraines. 

5 Weight loss

Drinking enough water during the day and before meals helps in weight loss because it suppresses our appetites and makes us feel full.

6 water helps us to age gracefully

When our skin is not hydrated, it will become dry and begin to crack or peel off. This can also cause our skin to wrinkle out and make us age a lot faster. But if we drink water, we will maintain a healthy and beautiful skin.

7 water helps improve our memory

Our brain cells is made up of about 85% of water. In order for it to properly function, it needs enough water. Some health experts have been able to improve memory in some patients by making them increase their intake of water.

Eight Ways to Avoid Holiday Weight Gain

Indulging during the holidays is expected, but keep these tips in mind so the holidays don’t mark the start of a downward spiral into poor eating habits.

1. Weigh yourself

The holidays are not the time to avoid your scale. If you see the pounds creeping on, stop more weight gain as soon as you see it. Be proactive in avoiding holiday weight gain.

2. Write it down

Food journaling works best if you record your food and beverage intake as you go. Write down what, when, where and the quantity that you eat. Make sure to include all snacks and beverages even if you grab just one cracker on your way out the door.

3. Make time to exercise

Exercise helps you de-stress and clear your mind of all that you need to do this holiday season.

Walk the mall before you start shopping, take a new exercise class or practice some yoga or stretching to relax. If it’s too cold to exercise outside, treat yourself to some special cold weather workout gear. Working out in cooler weather can be invigorating, as long as you have the right clothes to stay comfortable.

4. Breathe

If you are a stress eater, consider an alternative to eating when you need a break. Just sitting silently with your eyes closed at any point during your day, or when you feel stressed, is very helpful for keeping yourself in balance. Remember, it doesn’t have to be for a long period of time: even just one minute of relaxing breaths in the midst of a busy holiday season goes a long way!

5. Don’t skip meals

Skipping meals often backfires. If you skip meals, you may overeat at the next meal, or let your hunger make bad food choices for you.

6. Learn How to Say “No, Thank You”

It’s hard to pass up goodies when they are offered. Not only are you turning down delicious foods, you may be worried that you are offending the host or hostess.

It’s okay to say no, but if you need a more creative way to say no, consider these:

1. Thank you, but I already ate.
2. That looks too good to eat!
3. Thanks, but I'm getting a jump start on my New Year's resolutions!
4. I worked out earlier, and I am trying to stay on track tonight.
5. I'm trying to pace myself, but thank you!

7. Get enough rest

When you skimp on sleep, your body works harder to stay awake, and may lead you to make poor food choices. You might reach for another cup of coffee or a sugary snack to give you some energy. Or you might skip a stop at the gym because you are too tired. A lack of sleep can sabotage your efforts.

8. Watch the liquid calories

Holiday cocktails and wine with friends all add up to a lot of empty calories.
For example:

•  One cup of eggnog – without liquor – has about 350 calories and 19 grams of fat.
•  One cup of champagne has about 182 calories.
•  One, 4-ounce serving of red wine has about 100 calories.

Of course, you can swap out healthier versions of classic favorites (light eggnog, for example), but alcohol can also loosen inhibitions, and lead to poor health choices. After a few drinks, you might be more likely to eat more, derailing your diet plans.

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Treatment Guidelines for Problem Gambling

Basal ganglia may be involving in gambling disorder

Problem gambling effects a number of individuals who engage in gambling behavior.

Gambling behavior that meets criteria as a Gambling Disorder according to the criteria of DSM-5 includes four or more of the following over a consecutive 12 month period of time:

1. Increased quantity of money gambled to achieve excitement
2. Restlessness/irritability when attempting to cut down gambling behavior
3. Repeated unsuccessful attempts to cut down or stop gambling
4. Preoccupation with gambling
5. Gambling common in response to feelings of distress
6. Chases losses by returning to gambling in attempt to get even
7. Lies about the amount of gambling behavior
8. Loss of relationships, jobs or other significant life opportunities
9. Uses money from other people to attempt to solve gambling-induced financial problems

DSM-5 notes clinicians should be sure to rule out mania as a primary cause for gambling as this is a common feature of bipolar disorder.

There are few published guidelines for the treatment of gambling disorder. One helpful guideline is the Management of Gambling Disorders published by the Singapore Ministry of Health in 2011.

Here is a summary of some of the recommendations that meet the higher grades of evidence in support of the action:

• Gambling screening is appropriate in high-risk populations including chronic psychological or physical problems, alcohol or substance abuse or mental disorders
• A comprehensive treatment plan that is multidisciplinary and multi-modal
• No specific drugs have been approved to treat gambling disorder-patients should be told pharmacological treatments are off-label and may have side effects
• Opioid antagonists such as naltrexone may reduce gambling urges and thoughts
• SSRI drugs such as fluvoxamine or paroxetine may also reduce gambling urges and thoughts
• Psychological treatments are important and can include motivational enhancement therapy, self-help books, cognitive behavioral therapy (CBT) and mindfulness therapy
• Family members should be engaged in treatment to reduce facilitating behaviors

Additionally, any alcoholism or drug use must be addressed in gambling disorders as they can block effects of treatment and contribute to relapse risk.

Individuals seeking treatment for gambling problems should make sure elements of treatment outlined above are available as part of a comprehensive treatment program.

Figure is a screen shot from the iPad 3D Brain app of basal ganglia thought to be involved in reward and impulsive behaviors like gambling.

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Readers with more interest in this topic can find the free full-text manuscript by clicking on the PMID link below.

Lee KM, Chan HN, Cheah B, Gentica GF, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P, & Yeo HN (2011). Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore medical journal, 52 (6) PMID: 21732000