In my practice, I have a fair number of young men who are feeling stressed because of hair loss.  Some have a family history of baldness, while a few are setting new trends on their own.  Many have been taking finasteride for a few years, to help them retain the hair on their heads, and ask my advice when it is time to renew their old prescriptions. 

Widely advertised as "Propecia", this drug for baldness is identical to the prostate drug "Proscar", made by the same company.  The former is in 1 mg tablets, the latter in 5 mg size tablets.  Just to make things annoying to the customer, both are priced the same.  So you can save five times the money by simply cutting each triangular Proscar tablet across the equator.  The smaller (top) half can be cut in two, while the larger bottom half can be cut into three.  If done on a kitchen cutting board with a chef's knife, the savings can be truly substantial.

However, that's assuming you even want the drug.  While some dermatologists still follow the old-school program of using the drug as a first line of defense against hair loss for men (and to a lesser extent in women), more specialists are now suggesting caution. 

For one thing, baldness is not a disease, it is an (obvious) cosmetic issue.  However the side effects of the "cure" can be cause for concern.  For one thing, researchers are now finding some cases of Erectile Dysfunction while men are on the drug, and, even more alarmingly, for years after they stop it.  Other studies are showing an increased incedence of the rare male version of breast cancer.  Still other studies are showing an increase of anxiety and depression for propecia users. For more details: http://www.businessweek.com/ap/2012-04/D9U3HR3G0.htm

Hair transplant specialists are now telling more of their patients to discontinue the finesteride, and focus mainly on the topical treatment of Rogaine, or minoxidyl , in either spray or foam versions.  While it may seem the transplant doctors are biased against the pills for baldness, they actually are concerned about retention of hair follicles in the donor areas.  In addition, they naturally want any transplanted follicles to continue to thrive.  So if anything, they would espiecially want a pill to help their patients retain hair. 

In balance, I remind my patients that hair loss is not a disease, but the side effects of finesteride can indeed be a big health concern.  If my patients weigh the choices and still want to continue the drug, I give it to them with the above caveats. 

For those who elect not to take it, I remind them to take Minoxidil in the 5% format, not the popularly available 2%.  Many will find the spray version less messy, but it can cause scalp dryness and flaking.  The foam is a little easier to deal with; just follow directions and apply twice daily to your scalp.  To purchase, go online to http://www.minoxidildirect.com/Minoxidil.htm . Even in the group that elect to take the oral drug, these topical options can add to the retention. 

Another product that dermatologists suggest is Chronostim, which can also help retain and treat thinning hair.  It is not a prescription, but can be found at  http://well.ca/products/ducray-chronostim-lotion-for_3462.html. These topical treatments are not magic, but they at least offer some retention of existing hair. 

If you prefer, many patients get benefits from using simple oils, like coconut or aloe, applied directly after application of the topical treatments.  (These elements are also found in shampoos and conditioners).  An even more important tip is to not overwash one's scalp, twice a week is usually enough.  Daily rinses are fine, just don't overdo the shampoo, or the hair dries out.  Also, for men and women, be carefull of damage done by hot hair driers, or by excessive tugging with brushes (or rollers).  In general, finger-drying with a cool blast of air is the easiest on the scalp.

 If you are wishing for more definitive results, your doctor can recommend a good hair transplant specialist (an MD) who will examine your donor scalp areas, and let you know the realistic expectations you could gain from transplants of existing follicles.  This surgery can now be done in a way that does not leave obvious circles of new hair clumps; they use just one or two follicles at a time along the front hairline, so the results are virtually undetectable.  The costs are considerable, but at least the results are dramatic and lasting. 

In any event, don't forget that many of the most admired leading role models are thin on top.  From Sean Connery in his seventies to Jason Statham in his forties, to Prince William in his thirties, bald can still be beautiful! 

So keep your eyes open when you are considering baldness pills, as the side effects could be hair-raising.  For more specific advice, please consult your own physician.

We already know that the cell phone has changed the world. 

 At our finger tips, it can bring us countless new apps to monitor our blood pressure or calorie intake,  and, in a crisis, it can help you find the nearest medical clinic, or get the fastest taxicab to a hospital.  If you are lost in the wilderness, your cell phone can be traced by rescue teams, and it could save your life. 

But there are a couple of other ways you can use the basic features of your cell phone for medical purposes.  These are free, and don't even involve apps.

1. The Back of the Phone: label your name, and a work number or email to get hold of you.  If you leave your phone on the bus, and the batteries are dead, how else will a good Samaritan be able to get hold of you?  However, as with the labels on your suitcases, do not list your home address, as it could invite crooks to rob you while you are gone.  While you are at it, you might also put down any drug allergies or other important medical alerts; if you are unable to communicate your issues in an emergency, the medical staff will be able to see it on the back of your phone, even if the phone doesn't work.  Just to be sure, also use a sharpie to put medical alert info on the back of your driver's license or health insurance card, both of which are usually reached for by emergency staff. 

2. The Camera: Today's cell phones have great resolution with their cameras, and almost infinite storeage. 

 You can can archive them in any way you wish.  Use your cell-cam to record the following:

• Your doctors' names and contact info, so followup info like test results or prescriptions used can be sent after the fact.  In an extreme emergency, it could also help attending doctors get direct advise from your own team.
• Any rash or other visible injury should be captured on your camera, to help your doctor make a diagnosis.  This is especially true if the signs have changed or gone by the time you see your doctor.  This can also help document damage to your car or bike if you are in an accident; it might be important for both your medical and your insurance claims.
• Any prescription drug you EVER get! 

This one can save your life.  If you have just returned from holiday, and are finishing the last of your pills for a local illness, take a picture of the prescription.  If you break into a severe rash the day you get home, and have tossed the bottle before you climbed on the plane, please don't tell your doctor that it was a "little oval pill", or that it was "kind of pink or orange", or that it "began with the letter "C".  I have worked in emergency departments, and can promise you NONE of us will be able to guess which drug you are talking about.  EVER!.  Each country has its own drug colors, many use different brand names, and some have blends with different ingredients. But all of them list the generic chemical names, which are, thankfully, universal.  With a simple click of your phone-cam, you can let us know what that drug was.  It could be the one GOOD drug that works better than the rest in your body, or it could be one BAD drug that might kill you with the next dose.  Don't leave us guessing, and don't assume that your doctor's computer can somehow capture the input from another doctor's computer.  We are not like the banks with their ATM trackers; medicine is still in its computer infancy.  So please back up any important medical info with a click of your camera. 

Same point with an X-ray, to show us the exact fracture you got skiing.

  Or with an abnormal EKG, so your doctor at home can see what happened.

  For the same reasons, if you have any known disease, take a picture of any relevant tests before you leave for a trip.  If you have any prior abnormalities, your baseline EKG or blood tests could prove very important to a new doctor that has to come to your aid in a distant city.  And don't forget to take a picture of your list of medications before you leave home!

3. The Alarm:

For remembering ergonomics: Set it to vibrate every 15 minutes during your work day, and you will have the perfect reminder to correct your posture and add in some movement.  Straighten your spine, roll  your shoulders and neck, and pull your shoulder-blades together.  (see our blogs on neck pain, and back pain, the postural challenge).  Also straighten and bend your knees and ankles.  No longer do you need a kitchen alarm or a "cuckoo" clock on your desk or in a meeting, now you can silently remind yourself without disturbing others. 

• For remembering pills: I have one patient who reminds herself to take her birth control pills every day at ten minutes before noon, for twenty one days in a row.  Then, the alarm goes silent for a week, before starting the next cycle of 21 pills.  No more mishaps!  This feature is also good to ping people who are on more complicated medications, to remind them to take their eye drops, pills, or insulin shots.
• To help with Jet Lag: use your phone alarm to wake you at the proper local time, so you don't sleep until afternoon in your new time zone.  Don't always assume your hotel will be perfect in its wake-up calls. If you do sleep in, you will mess up your body's clock for days, and have a miserable week of travel adaptation.

4. The Calendar:

To remind yourself to call for your next Pap smear, or general check up, use your phone's calendar to keep your appointments past and future.  If you need to go back for repeat tests in six months, don't trust your memory, just enter it into the phone.  If you can't be sure of the exact date that far in advance, just remind yourself to call in to fine-tune the details a week or two ahead.

Some of these tips may save your life.  If you think of more ways your phone can be a life-saver, let us know at www.stressipedia.com. 

If you are fond of cranberries and/or blueberries, you're in luck. It turns out that this dynamic duo is good for your bladder.  

Chronic urinary tract infections, while more common in women than in men, can be more than just a nuisance.  If not properly treated, such infections can ascend from the bladder to the kidney, and ultimately cause renal damage.  That is why antibiotics, often taken for months or even years in chronic cases, are so important in our defense.  But one non-medical treatment has been the humble cranberry.  Way back in the black and white days of television, in 1959, Dr Edward Kass published a report on bacterial suppression by cranberry juice in the Journal of Laboratory and Clinical Medicine.  At the time, Dr. Kass attributed the antibiotic effects of the cranberry to its hippuronic acid content.  But now a new study, headed by Dr. Itzhak Ofek of the Sackler School of Medicine in Tel Aviv, reports that blueberries have also gained bladder buster status as well.  It seems that two adhesion molecules by which E. coli bacteria, the most likely offender in bladder infections, attach themselves to bladder cells are incapacitated by a high molecular weight constituent of both cranberries and blueberries, but not any other fruit juices.  So it seems Dr. Kass had it wrong when he thought cranberry juice killed bacteria, it seems that it just makes it harder for the bacteria to stick to the cells lining the bladder, meaning they can be harmlessly passed out when the bladder empties. But in the event that you do not like cranberries, it is reassuring to note that there is now another good alternative, which blueberry lovers everywhere will appreciate.

Your bladder is responsible for storing urine and, when full, it eliminates the urine from your body through a tube called the urethra. Sometimes bacteria enter the urethra and get into your bladder where they can cause infections, called urinary tract infections, or UTIs. Some self-care approaches you can use to help you lower your risk of bladder infections include drinking lots of fluids to cleanse bacteria from your bladder, urinating frequently and taking supplements such as blueberry.

Read more: Blueberries and your bladder

Urinary tract infections occur when bacteria (usually E. coli bacteria) attaches itself to the bladder wall. These infections can be painful. Women are ten times more likely to get these infections than men. Blueberries promote urinary tract health in both men and women. Blueberries contain the same compounds found in cranberries that help prevent or eliminate urinary tract infections.

Blueberries are a source of all kinds of nutrients which are derived from their outer skin. Blueberries contain certain substances and compounds that are able to stop bacteria from attaching to the lining of the bladder; this enables the bladder to flush out the bad bacteria when urine is expelled. These substances include tannin-like compounds that are called proanthocyanidins.

In order for bacteria to infect, they must first adhere to the mucosal lining of the urethra and bladder. Components found in blueberry and cranberry juice reduce the ability of the bacteria which is the most common cause of urinary tract infections.. Drinking blueberry or cranberry juice, eating cranberries or blueberries, or taking a blueberry or cranberry supplement will reduce the risk of contracting infections related to urinary tract infections.

Eating blueberries, and/or cranberries, is simple and tasty. Tossing them on your cereal, yogurt or salads are just a few ways to incorporate them into your diet.

Urinary tract infections, especially chronic or recurring ones, should be taken seriously, with a full medical workup and investigation.  But one of the simple things that may support other treatments, or even obviate treatments in mild cases, is to drink lots of fluids, especially including the juices of the cranberry or the blueberry.

Work injuries used to be from highly mobile tasks of hunting and gathering, for which the body was actually well designed.  So the injuries tended to be from pure accident, rather than from enforced ergonomics.  This changed with the industrial age, when we started to see work injuries  to the hands from machines, or to the low back from lifting.  But now that we have entered the digital age, our workplace has once again radically changed.  Robots and machines do the assembly and lifting, while we sit.  We don't get injuries from "hunting and gathering" in the field, we get them from "hunting and pecking" at a keyboard. 

To see what hours of unremitting bad posture does to the neck, take a look at the "x-ray" image below:

In order to see the flickering images on the screen, the head is projected drastically forward, leaving the neck almost parallel to the horizon.  While this is fine for a few moments, it becomes an unremitting strain for the neck muscles after a few hours.  

Much the same as trying to hold two buckets of water at arms length for hours.  Human muscles are built for movement, and need to be supplied with fuel and oxygen between beats.  Permanent contraction becomes painful, as the muscles are literally starved of oxygen and fuel, much like we can visualize in our hands if we are having a "white knuckle" anxiety attack.  We have small mucles that span the gap between each vertebra, and larger muscles along the entire spine and in layers protecting the neck.  If these muscles do not relax between movements, then bad things happen.  First the muscles start to scream with pain, developing knots, and restricting simple movements.  Secondly, over time, the disc spaces between the vertebrae become compressed, and the joint surfaces between the vertebra start to dry out.  This explains most of the disc disease and osteoarthritis that we see causing neck pains as we age. 

However, neck pains are rare among people who move during their work.  We see inspiring examples of octagenarians with perfect posture who spend their lives as ski instructors, yogis, or dancers, or  in people who seek out athletic endeavours when they are able to get away from their desk jobs. 

But the age of the keyboard does not need to bring new pains to our neck, or to our lives.  It simply means we need to develop a strategy to the new workplace.  Take a look at the two images below:

In this one, we can see trouble already starting.  The laptop is either at the right level for your hands (ie on your lap), or it is at the right level for your neck (ie on a tall table).  In the former case, it is terrible for your neck, and in the latter case it is terrible for your hands (see our post on carpal tunnel).   The same could be said of even smaller devices like the tablet or the phone.  Never a problem for a short task, but this compromise of posture bodes badly for years of unremitting change at the work station.

By contrast, take a look at this person's posture.  In particular, the neck is now in its normal position, as part of the spine, not a right-angle side road.  The weight of the head can now be carried by the structure of the vertebrae, instead of relying on the constant pull of the mucles.  Oxygen and food supplies can now be restored to the neck muscles, and knots and pains go a way (or, better yet, never get started!). 

If your work posture is giving you a literal pain in the neck, try these tips:

1. Use a head-set or speaker feature on your phone.

2. Have someone take a picture of you at your desk, near the end of day.  How's your posture?  If it is like the bad example above, then its time to do an ergonomic assessment.  Many employers will have professionals who can do this, sometimes requiring a doctor's note.  Or, you could follow some of the above advice to help prevent your own neck pains.  In my own case, I have found a stand-up screen/keyboard works well when I am in front of my patients.

3. Set a timer.  Every fifteen minutes MOVE YOUR NECK!  You can still keep your eyes on the screen if you must, but pull back your shoulder blades, roll your shoulder tips, and swivel your neck in all directions.  Use something to pop up on your screen, or try a kitchen timer.  Frankly, even a cuckoo clock would work (the original ones all chimed at the quarter hour, not just on the hour).  The movement will restore circulation to tense muscles, and it will bring fluid back into the joint spaces.  Pain and stiffness don't last long, as long as you move!

4. When you walk, look ahead of you.  Swing your arms normally, and hold your head as if you were balancing books on it.  Don't hunch your neck over your cell phone or tablet while you are walking or on public transit.  As a reminder, back into a wall and have a friend measure the distance between the back of your skull and the wall; your head should almost touch the wall behind you, and not be leaning towards the wall in front of you!

5. If you have a stiff neck, see your doctor for assessment.  Sometimes images are needed, like ultrasounds or X-rays.  If the problem is musclular, massage can work wonders.  If the problem is caused by a righid alignment of the vertebrae, then chiro or physical therapy can be of great value.  I have also found great results from doing medical acupuncture, with needles placed into strategic trigger points with almost instant relief.  Also, consider a change of pillow, depending on whether you sleep on your back or side; some do well with the "reverse curve" pillow, others prefer a horse-shoe shaped pillow filled with air or bean husks.  Be prepared to try a few variations to see what works best for you.

6. Consider yoga or pilates, or other athletic endeavours that break away from the desk posture.  Also consider the foam roll, (as seen in our blog on back posture); my patients find this an excellent daily antidote to desk posture.  Lying flat on the floor with a rolled towel across the line of your neck can also restore the normal curve of your neck, and ease the muscles that create the stiff and rigid conditions of modern neck pain.

The modern work station can be a pain in the backside....quite literally.   The human body was evolved and honed for hunting and gathering, not for hunting and pecking.  So the office chair, and the occupant's fixed posture for hours at a time has contrived to give us a new work problem: the piriformis syndrome, also known as a pain in the butt, and often associated with pains down the sciatic nerve from low back to lower leg.  To better understand the nature of this issue, lets take a look at the anatomy.

The piriformis muscle, which means "pear shaped", was named by the University of Padua professor Spigelius in the 16th century.  It originates in the sacrum, including from the SI (sacro-iliac) joint, and spans the back of the hip joint, inserting on the inside of the big knob of the femur.  It is one of the lateral rotators of the hip, and helps to stablize our body during the weight transfer of walking or running.  It also lies just above the sciatic nerve (the size of your thumb at this point).  Effectively, this nerve to the leg is trapped between the piriformis and a hard place: the bone.  When the piriformis is injured or inflammed, it can easily compress the underlying sciatic nerve, and send pains into the buttock, and down into the leg all the way to the toes.  In the process, it also becomes painful to walk, sit, or stand up. 

 While it may become inflamed from direct trauma, for example during contact sports, it can also be aggravated by sitting for prolonged periods, especially on one's wallet.  We see this "credit card" sciatica more commonly in men, because they typically carry any extra weight on their bellies, not on their buttocks, and because men more commonly carry their (thick) wallets in a hip pocket.  While this pocket is fine when standing, it can certainly add a lot of mischief to the sciatic nerve when inflammation sets in.  In almost 1 out of 5 people, the fibers of the muscle are intewoven into the sciatic nerve roots, making it even more likely for troubles to appear, even without any sudden big trauma.

To treat this condition, we use a multiple approach, involving massage, stretches, and physical (or, as one says in Canada, Physio-) therapy.  Medical acupuncture can also be an excellent and powerful way to speed the patient back to full movements. 

For prevention, here is a video of stretching, which can become a part of your daily routine :

http://www.youtube.com/watch?v=lfP0QssgdXs.

If you perfer still images, take a look at these:

Fig. 17

Fig. 18

Fig. 19

Fig. 20

A common symptom of piriformis syndrome is pain along the sciatic nerve, so it is often thought that piriformis syndrome causes sciatica. However, piriformis syndrome does not involve a radiculopathy - a disc extending beyond its usual location in the vertebral column that impinges or irritates the nerve root - so it is technically not sciatica. Instead, with piriformis syndrome, it is the piriformis muscle itself that irritates the sciatic nerve and causes sciatic pain.

The piriformis is a muscle located deep in the hip that runs in close proximity to the sciatic nerve. When the piriformis muscle becomes tight and/or inflamed, it can cause irritation of the sciatic nerve. This irritation leads to sciatica-like pain, tingling and numbness that run from the lower back, to the rear and sometimes down the leg and into the foot.

Piriformis Muscle Stretches

Stretching the piriformis muscle is almost always necessary to relieve the pain along the sciatic nerve and can be done in several different positions. A number of stretching exercises for the piriformis muscle, hamstring muscles and hip extensor muscles may be used to help decrease the painful symptoms along the sciatic nerve and return the patient’s range of motion.

Several of the stretching exercises commonly prescribed to treat sciatica symptoms from piriformis muscle problems include:

Exercises for Sciatica from Piriformis Syndrome Video

Supine piriformis stretches

• Lie on the back with the legs flat. Pull the affected leg up toward the chest, holding the knee with the hand on the same side of the body and grasping the ankle with the other hand. Trying to lead with the ankle, pull the knee towards the opposite ankle (Figure 17) until stretch is felt. Do not force ankle or knee beyond stretch. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.
• Lie on the floor with the legs flat. Raise the affected leg and place that foot on the floor outside the opposite knee.
  Practical point Stretching the piriformis muscle a few times a day, especially when combined with hamstring stretches, will prevent tightening of the lower back and relieve tension from hip to foot.
  Pull the knee of the bent leg directly across the midline of the body using the opposite hand or a towel, if needed (Figure 18), until stretch is felt. Do not force knee beyond stretch or to the floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.
• Lie on the floor with the affected leg crossed over the other leg at the knees and both legs bent. Gently pull the lower knee up towards the shoulder on the same side of the body (Figure 19) until stretch is felt. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

• Sciatica Exercises for Sciatica Pain Relief
• Sciatica Causes and Exercises
• Exercise for Sciatica from a Herniated Disc
• Exercise for Sciatica from Spinal Stenosis
• Exercise for Sciatica from Degenerative Disc Disease
• Exercise for Sciatica from Isthmic Spondylolisthesis
• Stretches and Exercise for Sciatic Pain from Piriformis Syndrome
• Sacroiliac (SI) Joint Exercises for Sciatic Pain

Buttocks stretch for the piriformis muscle

Watch Piriformis Syndrome Video

• Begin on all fours. Place the affected foot across and underneath the trunk of the body so that the affected knee is outside the trunk. Extend the non-affected leg straight back behind the trunk and keep the pelvis straight. Keeping the affected leg in place, scoot the hips backwards towards the floor and lean forward on the forearms (Figure 20) until deep stretch is felt. Do not force body to floor. Hold stretch for 30 seconds, then slowly return to starting position. Aim to complete a set of three stretches.

One of the more common problems I see in my Sports Medicine Clinic is pain in the lateral thigh and knee. 

This is caused by tension, tearing, or scar tissue in the thin leathery belt that runs from the hip bone (Ilium) to the shin bone (Tibia).  Hence the medical name: the Ilio-Tibial Band or ITB. 

 In any event, it occurs on one or both sides, commonly seen in runners and cyclists, but also present in many other forms of leg exercise.   Sometimes the pains only start part way into an exercise, other times the pains are severe right at the outset, making most activities very difficult. 

To begin, one should see a sports professional for accurate assessment.  Points to review include:

1. Diagnosis: Often this is evident from the history and physical examination.  If the pain is on the lateral joint line of the knee, further imaging could be helpful to rule out damage to cartiledge or ligaments, as well as stress fractures.  Sometimes the pains is sharp to direct pressure over the hip itself, or on trigger points found along the lateral thigh.  Again imaging can help rule out other conditions.

2. Causes: Often this condition is noted only after running or other exercises are initiated.  However the root cause could be posture during a day's desk work, with one or both legs habitually folded under one's chair for hours.  Insufficient stretching is another cause, along with a leg length discrepancy (the longer leg usually bears the extra strain when standing for prolonged periods).  An assessment for foot alignment can be useful in case orthotics might correct for any alignment issues.  Another simple root cause could be ill-fitting shoes, especially if they are old and have lost their support.  Also remember that prolonged walking on concrete with dress-shoes can also irritate the ITB, so consider wearing a proper running shoe if you commute much on foot (keeping your dress shoes at the office).

3. Treatment:  There are many good ways to approach Ilio-Tibial Band pains:

• Therapeutic massage
• Muscle Activation Technique (MAT), commonly incorporated in physiotherapy, chiropractic treatments.
• Foam Roller   
  
  
• Home stretching exercises: for a good review see http://www.fix-knee-pain.com/itb-stretches/
• Heat before exercise (including the hot tub, if available, with a jet pointing to the sore points along the ITB)
• Ice pack after exercise, for about 15 minutes over points of maximal tenderness.  Make sure to insulate the skin with at least a layer of fabric to prevent frostbite.
• Medical Acupuncture, which I do in my office.  We use only a few needles, placed for a few minutes into trigger points of tenderness along the ITB.  For more details on how this excellent option works to generate pain relief as well as treat the underlying inflammation, see our post on acupuncture.
• Cross training: sometimes it helps to switch activities.  For example, if running continues to hurt the ITB, then try, yoga, Pilates, or swimming.  A personal trainer can help with toning exercises for the hip muscles, as well as the muscles of the front and back of the thigh.  Once symptoms settle down, one can then try reentry into the original sport.   

If the above does not prove satisfactory, be sure to return to your doctor for further management.

Are you embarking on a new exercise program to redress the flab put on over years of sedentary living? Well, there are a few things you should be aware of right at the start.

The human body was built for motion, and until the computer age changed the workplace during the last generation, we had plenty of motion just staying alive. To find food, ancient hunters had to walk or run for miles. To kill it, they had to exert great muscular strength and reflexes in battle. To carry it home, they had to be weight lifters. Even in the Industrial age, men at work needed brute strength on the assembly line, and women, lacking refrigerators and cars, put in thousands of calories of exercise walking to stores, tending the vegetable gardens, and, for the minority, joining the men on the assembly lines.

Well, now we all have the easy life, at least as far as exercise goes. With no more exercise than pushing a few buttons or keys at work, and with an average of 5 hours of television to watch each evening after work, it is no wonder that we have collectively turned to flab.

To correct this, many have embraced the quick fix exercise remedy. Jogging along with Jane, or bouncing along with Biff on the TV fitness shows, the average person can be setting him or herself up for injuries big-time. First of all, there is no way that these people get their terrific bodies doing just twenty minutes a day. These professionals work out almost as many hours a day as you work at your desk. So the first step to reintroducing motion to your body is to have a realistic goal, such as to have fun and to gradually improve your exercise tolerance. The sports medicine clinics are filled with weekend athletes wearing slings and tensor bandages to treat injuries caused when their mental enthusiasm exceeded their physical shape

If you have been under-exercised for years, don't try to make up for it in minutes.

• Make sure you invest in the right equipment: Wearing appropriate clothing is a crucial part of exercise injury prevention. An exerciser should choose an outfit that allows him to remain comfortable during his workout, but does not pose any safety risks. For instance, a cyclist should not choose to wear loose-fitting pants, as they can become caught in a bicycle’s pedals, causing a fall. If exercising outdoors, it is also important to select clothing that suits the weather. In cold weather, layers can help an exerciser stay warm, while a lightweight long-sleeved top can be useful for preventing sunburn on warm days.
• Seek professional instruction: An overwhelming 250 certification programs exist throughout the United States, yet all have different requirements, ranging in depth from "heavy" to "feather" weight. While some programs require a college degree in a health-related field, along with the passing of written and practical exams to qualify for certification, others can be completed with little preparation by taking a simple test in an afternoon. And just because a personal trainer is "certified" does not necessarily mean that he or she is qualified to work with people in all different areas of fitness. at a minimum a good trainer should have a certification by a reputable organization, such as the American College of Sports Medicine, National Strength and Conditioning Association, and the American Council on Exercise.
• Ask a health professional you trust to refer you to a good trainer. Health professionals who recommend exercise may have a network of personal trainers that they routinely refer people to.
• Arrange to meet with the trainer before making your final decision. Be sure to ask about his/her background and any relevant training.
• Ask to speak to some current and former clients. They can give you a good picture of the trainer's style.
• Make sure you are comfortable talking openly and honestly with the trainer about your needs and goals. Do not choose someone who intimidates you or someone with whom you feel uncomfortable.
• Check your pulse regularly during the exercise. Review Stressipedia's written and video instruction on how to check your pulse here (Read Your Speed)

And remember, one of the best exercises of all is to turn off the TV for a while, and go out for a walk!

Studies show that the more stressed you are the less likely you are to fight back against a visiting flu virus, and, once infected, the course of the disease is likely to be longer and more severe.

In my 25+ years of family practice, it was remarkable how certain individuals seemed to never get sick, while others never missed a flu virus, or should I say the virus never missed them. Well, a recent study confirms that this is not just a fluke and that there are reasons for this.

Dr. Lorne Becker, an assistant professor of family practice at the University of Toronto, organized questionnaires that asked patients about two areas of their family life. First, family cohesion, or support an individual felt from family members, then adaptability, or flexibility. In a scientific way, he was really asking for a measure of happiness. The results indicated that rigid, inflexible families, who were fragmented and non-supportive of each other had fifty per cent more flu infections than those who had balanced, happy family lives. Mind you, even the most convivial of households were not immune, and still had a 22% rate of infection in flu season, but this is significantly better than the 33% rate for their more miserable neighbors.

None of this would have been any surprise to the Late Dr. Hans Selye, Canada's great pioneer in stress research. A half a century ago, Dr. Selye noted that when laboratory animals were stressed by controlled shocks or punishments, their lymph glands shriveled up, and the rest of their immune systems went into steep decline. This means that a stressed person is less likely to be able to fight back against a visiting flu virus, and, once infected, the course of the disease is likely to be longer and more severe.

Stress can also affect your health in a number of other ways and inhibit your ability to cope. Under stressful condition your response may be eating high-fat, high-calorie comfort foods, smoking, drinking too much, not sleeping, and not exercising. The combination of changes in your body from the way you respond to stress, combined with other behavioral and emotional responses may lead to chronic health problems. These include:

• Obesity. In many people, stress can lead to overeating. But that's not all. High levels of stress may increase the risk for visceral fat. This type of fat develops around waist and the organs in the abdomen, causing metabolic changes that can lead to diabetes and heart disease.
• Cardiovascular disease. Stress does not directly cause heart disease. However, stress can put a strain on the heart and blood vessels, thereby contributing to heart disease.
• Diabetes. Stress can make it hard to follow your diabetes treatment plan, which can lead to poor health. Stress also directly increases glucose levels, especially in people with type 2 diabetes.
• Anxiety and depression. It's no surprise that ongoing stress can wear you down mentally, and if severe, lead to anxiety and depression.
• Asthma. Stress does not cause asthma, but it can trigger asthma attacks and worsen symptoms.
• Skin conditions. Stress can trigger or aggravate skin symptoms in people with psoriasis and eczema. Stress management may help control these conditions.
• Stomach problems. No, stress does not cause ulcers. But it can worsen symptoms of ulcers and irritable bowel syndrome.
• Acne. One large study confirmed what many teenagers already know: high levels of stress makes acne worse in teens.

Here's an action tip:

Stress doesn't cause infections, for that you still need a bacteria or a virus. But stress does interfere with your defenses to any disease. So workaholics beware, if you don't invest enough time and energy in building strong support at home, you may be headed for an avoidable illness. 

It’s also impossible to completely avoid stressful situations. But you can learn t manage the stress you do encounter:

• Get enough sleep and eat a healthy diet. Get 7 to 8 hours of sleep a night so you have the energy to cope with stressful situations. Fill up and fuel your body with healthy choices rather than getting bogged down by high-fat comfort foods.
• Nurture close relationships. Often, we don't appreciate how important friends and family can be for good health.
• Learn to let go. Remember, the sky won't fall if you wait another day to do laundry, clean the bathrooms, or write that thank-you note.
• Try new ways to relax. Some studies have found that yoga, meditation, and relaxation exercises may help reduce stress in people. Yoga will also help build strength and flexibility.
• Get help if you need it. If you can't get seem to get relief from under stress and nothing seems to help, talk with your family physician or a counselor.

Updates:

Mar 22, 2013: Flu took a heavy toll on children this season. The flu has claimed the lives of 105 children this season, says a report out today from the Centers for Disease Control and Prevention. Read more...

If you are in hospital, don't expect your memory to do all the work for you. If you have a question, write it down, then, when the doctor does come for a visit, you won't forget to ask.

Under the best of circumstances, going into hospital as a patient is stressful, because it invokes great change in your life. You have changed your environment, your daily routine, and your eating habits. There are the intrusions of strangers poking and prodding, and wheeling you down the hall for tests.

Coordinating the whole scene is your doctor, who usually sees you for just a few minutes each day. If this encounter is not handled well by both parties, it can lead to further anxiety and confusion. That’s why doctors need coaching in bedside manner.

Especially while you are in the hospital, the ability to communicate accurately with your doctor leads to better healing and potentially can even mean the difference between life and death. This has been confirmed in a series of studies performed and published over the past forty years. Good doctor-patient communication makes a difference not only in patient satisfaction but in patient outcomes including resolution of chronic headaches, changes in emotional states, lower blood sugar values in diabetics, improved blood pressure readings in hypertensives, and other important health indicators.

However, in a recent national survey of both doctors and hospitalized patients, effective communication remains elusive.

Only 48% of patients said they were always involved in decisions about their treatment, and 29% of patients didn't know who was in charge of their case while they were in the hospital.

Here's an action tip:

While your doctor's ability to communicate with you will vary by personality and training, you can benefit from a few tips as well. The following suggested questions were compiled by the Mayo Clinic, and serve as a good model for each patient.

• What do my symptoms mean?
• Do the medications have any side effects?
• What is this test for?
• What risks are involved in my treatment?
• Do I have any options other than the treatment you've prescribed?
• How do the benefits of the treatment compare with the risks?
• What emotional reactions can I expect from my illness?
• How long do I have to stay in the Hospital?
• Do I have any limitations on my activity at home?
• What should I call you about once I'm at home?

With these questions in hand, you should be well prepared to take some of the stress out of the hospital stay.

But what about the case where, despite your best attempts, you just can't establish that rapport with your doctor? Here are some resources for helping you decide what to do if you and your doctor don't communicate well.

• Should You Complain to Your Doctor?
• Sharing Internet Information with Your Doctor
• How to Deal with an Arrogant Doctor
• How to Improve a Doctor's Bedside Manner
• Patients, Medicine and Modesty in a Healthcare Setting
• Doctors Complaints About Patients' Behavior
• What to Do If Your Doctor or Another Provider Insults You
• How to Repair Your Relationship With Your Doctor
• Can My Doctor Dismiss Me as a Patient?

If you have a child between the ages of 7-13 that experiences rapid weight gain, the reason may well be stress.

I have always maintained that obesity is never a problem; it is only the result of a problem. Until that underlying problem is addressed, whether it is boredom, poor self image, or too much stress, all the diets in the world are not going to work in the long term.

Now a new multi-center European study, headed by Drs. Melbin and Vuille and reported in the Scandinavian Pediatric Journal, has come to the same conclusion. They examined close to a thousand children, and followed them from birth to age 15 years. All children who gained more than fifteen percent in relative weight were analyzed according to age groups. Their psychosocial stress was evaluated according to scholastic health records and school nurses' information, and rated 0 (for no stress), 1, or 2. Between the ages of 7 to 13, the students with the highest stress scores turned out to be the ones most likely to be obese.

In addition, the high levels of stress were manifested in other ways. For example, among the seventy overweight children in the study, they were almost five times as likely to drop out of school beyond the nine year mandatory period. When the stress levels were low, almost half of these overweight children lost weight between the ages of 13 and 15, but when stress was high, only 15 % achieved normal body weights in later adolescence. So the authors concluded that rapid weight gain during the school years may be an indicator of psychosocial problems and the ramifications are obvious. Just signing such a child up for an expensive diet program, or subscribing to radical liquid diets will only work for a very short period of time, if at all. If the stresses are not addressed and dealt with, the obesity will soon return.

The American Heart Association has taken a position on this subject based on scientific evidence:  physical inactivity is a major risk factor for developing coronary artery disease. Inactivity also increases the risk of stroke and such other major cardiovascular risk factors as obesity, high blood pressure, low HDL ("good") cholesterol and diabetes.

The American Heart Association recommends that children and adolescents participate in at least 60 minutes of moderate to vigorous physical activity every day.

Here's an action tip:

If you have a child that has suddenly gained a lot of weight, make sure you don’t just shut down the food lines, but open up the lines of communication. Resolve these stresses by working together and, where appropriate, involve professional help. You will do a lot more to cure the obesity if you listen to the child.

How do I promote physical activity in my child?

• Reduce the time your child watches TV, talks on the phone, plays computer games or any other activity that does not require vigorous physical activity.
• Make sure that any physical activity is enjoyable and rewarding - it will help reinforce the idea that exercise is fun and something to be looked forward to, not avoided.
• Be a role model! If you are active and encourage your child to also be active there's a good chance they'll make exercise a habit!