Since Marijuana has been legalized in many states, there is a general perception that it is a natural and safe drug unlike other drugs.  This perception is reflected in the number of pregnant women who use marijuana while pregnant.  In 2017, a study showed that 1 in 20 women used marijuana while pregnant.  In 2002, the number of women who used marijuana was 1 in 10.    

Now before we talk about marijuana use in pregnancy and autism, let’s review some stuff we already know about MJ use in pregnancy.  First it does cross the placenta.   THC crosses the placenta and can be found in fetal circulation at 10% of the maternal level.  Second, we also know that marijuana can bind to fetal cannabinoid receptors as early as 14 weeks of pregnancy.  Third, studies have shown that exposure to marijuana in pregnancy can disrupt normal brain development.  Children born to women who used marijuana while pregnant are more likely to have low birth weight at birth, hyperactivity, and attention, cognitive and behavioral issues.

So, a couple weeks ago a study out of Canada published in Nature showed that women who used marijuana while pregnant were 1.5 times more likely to have a child with autism. The researchers reviewed 500,000 births between 2007 and 2012 in Ontario, Canada.  They found an association between maternal cannabis use in pregnancy and the incidence of autism spectrum disorder in these children.  The incidence of autism spectrum disorder diagnosis was 4 per 1000 children who were exposed to marijuana and 2.4 among children who were not exposed to MJ in utero. 

So, while this study does not definitively prove that marijuana use during pregnancy causes autism, there does seem to be a strong association.  Based on these findings, as well as ACOG (American College of Obstetricians and Gynecologists) recommendation, we encourage our patients to avoid using marijuana during pregnancy and breastfeeding.  

​Dr. Pam

Just like hormonal changes that can occur during pregnancy, there are also big changes that go on in a woman after delivery.  These changes generally last at least a few months, and hormone levels can be affected in some women for as long as they choose to breastfeed.  These fluctuations can influence everything from hair loss to libido to irregular bleeding, and for some women, the effects can be quite dramatic.  Here’s a quick overview of what goes up and what comes down:

1. Prolactin – prolactin is the hormone responsible for milk production, so for moms who elect to breastfeed, this hormone remains persistently elevated.  Prolactin generally leads to feelings of relaxation and calm, but it directly counteracts dopamine, which plays a big role in sexual arousal and gratification.  Thus, you can feel pretty serene while you’re breastfeeding, but you might be so content that you don’t care about having sex.
2. Oxytocin – during breastfeeding, this hormone increases and causes milk letdown and release.  It’s also associated with bonding both with breastfeeding and sex.  During intercourse, it’s released during orgasm, so it’s not uncommon for milk leakage to happen during sex.  Depending on the amount of leakage that happens, some women can become a bit self-conscious, and in turn, this can decrease desire for intercourse.
3. Estrogen – estrogen will be low for at least the first several months after delivery, and it may continue to be low throughout breastfeeding.  Low estrogen can cause menopausal-type changes within the vagina, leading to decreased lubrication and elasticity with increased tightness, which, in turn, can cause painful intercourse.  That drop in estrogen after delivery also plays a big role in postpartum hair loss.  While this should resolve in few months to year and typically only involves catching up with the normal loss that doesn’t happen during pregnancy, for some women the sudden large amounts of hair loss can be pretty traumatic.  Be sure to continue prenatal vitamins, use gentle brushing and hair car techniques, and remember that this change should be temporary.
4. Testosterone – this hormone plays a role in libido/desire, and it is suppressed in the postpartum period and with breastfeeding.
5. FSH – this hormone is responsible for menstrual cycle regulation, and while levels don’t change much during the postpartum period and breastfeeding, it’s level of activity can.  Change in FSH activity may contribute to anovulation (not releasing an egg).  While change in FSH activity can be helpful in preventing pregnancy for some women (some women can still get pregnant while breastfeeding), it can also be a culprit for some pretty erratic bleeding.  Both menstrual and nonmenstrual bleeding can be very unpredictable for women while breastfeeding, with cycles ranging from completely absent to dysfunctional bleeding nearly every day.  The same irregularity can be present with fertility while breastfeeding as well, with some women who don’t ovulate and can’t get pregnant to those with resumption of normal cycles and fertility to those who become pregnant even before they have their first menstrual cycle after their baby is born.

In short, hormones in the postpartum period and while breastfeeding can vary dramatically from woman to woman and have a variety of effects on their health.  Lack of sleep, a fussy newborn, stress of being a new (or repeat) parent and adjustment to the amount of time needed by your new baby can wreak havoc on everything from mood to uterine bleeding to libido, and the hormonal changes during the postpartum period can add a bit of fuel to this fire.  Sometimes the fix can be as simple as starting a birth control pill to regulate your cycle; other times medical intervention or counseling may be needed for postpartum depression.  While it may feel like your newborn is sucking the life right out of you, these symptoms are common, so be sure to discuss your concerns with your provider, and remember that all of these changes should be temporary, so there is a light at the end of the tunnel 😊

​Dr. Nick

The most common complaint I’ve been getting lately is this- “I’ve gained a ton of weight since this pandemic started.”  Many of us went from working full time to working in our PJ’s at home.  Everything has been closed including the gym.  Fourth of July celebrations and the Rodeo were cancelled. Weddings, graduations, kids’ sports activities and summer vacations were are cancelled.  After being told not to mingle with family or friends and just stay home to be safe, it’s easy to find yourself 19 pounds heavier.  Here are some simple tips on what you can do to lose some of those pandemic pounds while regaining your mental and physical health. 
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1. Rule #1: No Snacking at all.  Snacking throughout the day causes continuous insulin release.  This tells your muscle and fat cells to store all the fat and sugar you eat.  This is how you gain weight.  Also, more frequent insulin release leads to insulin resistance because your cells stop responding to the insulin produced.  I always tell patients to stick to only 2 to 3 meals a day and no more than that while drinking only water in between.  This is the reason that fasting diets are so successful- they take advantage of decreased insulin release throughout the day, and this is how they contribute to weight loss.
2. Rule #2: Stay Away from Processed Foods.  Anything that can survive in your refrigerator for more than 2 weeks is likely processed.  Again, the emphasis is on refrigerator.  Most things in your pantry other than dried spices are processed.  Most processed foods are high in sugar, salt, and artificial everything.  These foods were made in a laboratory somewhere and have an excessive amount of sugar, salt and flavor enhancers to encourage constant cravings.  They are very calorie dense and nutrient poor.  Start looking at nutrition labels on food and if you see things like MSG, natural flavoring, disodium guanylate, yeast extract, hydrolyzed protein, autolyzed yeast, aspartame, and other long chemical names that you can’t pronounce-don’t buy it or consume it.  This is not real food.  These are mostly chemicals manufactured in a laboratory that are high in calories and artificial flavors and packaged and then sold in a grocery store near you.
3. Rule #3: Try to Cook Your Own Meals.  This will help you stay away from processed foods and allow you to have control over how much sugar and salt you consume.  I know this is time consuming, but this is the only way to have control over your overall nutritional health, and while there are limited social options, now is a good time to learn a new skill that may even become a hobby.  It will also save you lots of money. 
4. Rule #4: Be wary of excessively fatty foods and diet fads.  Diets like the Atkins diet are popular because they allow you to eat fatty foods like bacon and butter.  The idea is that you can eat really yummy fatty foods and as long as you restrict carbs you will trick your body into seeking energy in stored fat.  This sounds awesome in theory- you can eat fatty foods and lose weight.  While patients do lose weight initially, most are unable to maintain such a low carb diet for long.  In addition, eating a lot of fat puts a lot of oxidative stress on your body and is what contributes to metabolic syndrome and other chronic diseases of obesity.  Believe it or not, Dr. Atkins died obese and likely of heart disease.
5. Rule #5: Get outside and get active.  Go for a walk, run, hike, bike ride whatever, but you need to get out of the house.  Studies are beginning to suggest that most contracted the coronavirus at home.  Enjoy the fresh air and get some Vitamin D.  While exercise and activity does not contribute to weight loss as much as dietary changes, it helps maintain weight loss and is overall good for your physical as well as mental health.  Also, especially important right now, is the fact that exercise helps boost your immune system.

Hopefully this helps!  Don’t let the 'Rona get you down.  Eat health and enjoy the outdoors!
 
Dr. Pam

If your family has been isolating together since the early days of the COVID-19 pandemic, tensions may be on the rise in your household. Let’s face it - as much as you love your family, it’s hard not to get on each other’s nerves when you’re cooped up indoors for an indefinite amount of time. As life gradually begins to feel normal again in many areas, you can find new ways to address and alleviate these tensions. If you’re struggling with any of these sources of tension in your household, here’s how to lighten the mood.
 
Avoid Chaos and Confusion
 
Since the COVID-19 outbreak began, your family’s usual routines may have been thrown out of whack. Suddenly, your kids were home from school, you were working remotely, and you had to say goodbye to the old schedule that your family had followed for years. This may have caused confusion and chaos in your household, but establishing new routines can help you feel like you’re in control again. Create morning, afternoon, and evening schedules that everyone can follow so your family can regain a sense of stability throughout the next phase of this pandemic.
 
Address Lack of Exercise
 
Chances are, your family has been spending most of their time indoors for the past few months as a precaution. But according to MetalBladeCycles, a lack of physical exercise can contribute to stress and anxiety, and you’ll likely end up taking these negative emotions out on each other.
 
If you’ve all been feeling a bit moody and sluggish lately, it’s time to exercise outdoors! Try engaging activities like running, hiking, biking, and even rock climbing - all of these sports will boost your family’s overall health.
 
Gaining Quality Time
 
Perhaps your family has been neglecting opportunities for memorable quality time, and because of this, you’re feeling distant from each other. In addition to outdoor sports, your family can also take advantage of time in nature to simply relax together. Try spending a sunny afternoon in your backyard, having a picnic at a nearby park, taking a road trip to a local beach for the day, or even going on a weekend camping trip. Afterward, your family will feel refreshed and rejuvenated!


Make Space for “Me Time”
 
Getting enough “me time” is especially important for people in your household who happen to be introverted, but that can be tough to achieve when everyone is in isolation. According to VeryWellFamily, kids need time alone to develop their imaginations and feel more independent. They might enjoy solo activities like drawing and painting, playing with blocks, or telling stories with their dolls and stuffed animals, which will give you a break! If you want to encourage your children to spend more time reading, consider purchasing a few entertaining graphic novels for them. Before buying a particular book, research the storyline, make sure it’s age-appropriate, and check out a few Amazon reviews to ensure your kids will enjoy it.
 
Self-isolating is the simplest way to protect your family from contracting COVID-19. But there’s no denying that taking these precautions does present new challenges for your household. Many families in isolation feel exhausted and frustrated by the events of this year. However, if you come up with strategies to safely enjoy outdoor activities, find new sources of entertainment for your kids, and give everyone in your family some more time alone, your household will be able to ride out this pandemic with ease!

Guest blog courtesy of Elena Stewart
 
Photo via Pexels

After the long Idaho winter (seriously, snow in June?!) and all of the Covid lockdown, those nice summer rays warming your skin are the last thing you want to block, right?  Unfortunately, while a little Vitamin D from the sun is a good thing, a nice summer tan is a bit less healthy than you might think, and even worse for your skin is that first summer burn.  Even for those diligently applying sunscreen, chances are good that you’re putting it on all wrong.  Here’s what you should know about both the short and longterm effects of all that sunshine and how to enjoy the nice summer weather while protecting your skin.

What happens when you tan or sunburn?  A tan is your first line of defense against the sun.  Skin damage releases melanin, which in turn increases skin pigmentation, i.e. skin gets darker.  While this does provide some protection, this level of protection is only about SPF 3.  Once the level of skin damage begins to cause cell death, an inflammatory process increases bloodflow to the area, resulting in the warm, red appearance of a sunburn.  Tanning is more of a chronic damage whereas sunburn is more of an acute damage.  Even if you aren’t worried about the increased risk of skin cancer associated with this damage, do you really want to look like Magda from there’s something about Mary?  Skin damage from the sun is a BIG contributor to aging.

Don’t I have to get all of my Vitamin D from the sun?  While Vitamin D is important for bone and immune health, not all of it has to come from the sun.  Eggs, milk, and fish are important sources of dietary Vitamin D, and in fact, dietary intake can provide adequate levels of Vitamin D without the need for excessive sun exposure or additional supplements.

How should I put on my sunscreen and what kind should I use?  Sunscreen should generally be applied about an hour before sun exposure, and you should be using a lot more than you probably think.  For the face alone, a nickel-size amount is appropriate, but for the entire body, a shot glass-sized amount (a full ounce) is necessary.  Also, don’t forget to reapply frequently, every 1-2 hours, to prevent sunburn.

As for the type of sunscreen, SPF 15 blocks about 93% of UVB rays, SPF 30 blocks about 97%, and SPF 50 blocks about 98%.  Mineral sunscreen are typically more effective than chemical sunscreens.  Another benefit of mineral sunscreens is that they don’t contain ingredients like oxybenzone or octinoxate that can be harmful to coral and ocean ecosystems.

If you’re absolutely against sunscreen, there are certain clothing lines geared toward SPF protection.  Some long-sleeved shirts, pants and hats can also be effective protection against the sun, but remember that any area of exposed skin will still be vulnerable to UV damage.

So, should you hide in the shade all summer?  Not necessarily.  There’s evidence that some sun exposure may trigger release of nitric oxide and in turn lower blood pressure, but at the same time, there’s no sense in burning until you become a California raisin either.  As with most things, moderation is probably key.  Apply your sunscreen and don’t get sunburned, but go outside and have some fun, too.  It’ll be snowing again before you know it.

Dr. Nick

How does osteoporosis happen?  Our bones are constantly being broken down and replaced.  Whenever the creation of new bone does not keep up with the loss of old bone, they become brittle and weak.  When this happens even minor stresses can cause a fracture.  These fractures most commonly happen in the hip, wrist, or spine.  There are lots of things that contribute to the development of osteoporosis.  Genetics, age, sex, race, nutrition, lifestyle choices and medical conditions can all contribute to osteoporosis.  Unfortunately, White and Asian post-menopausal women are at the highest risk of developing osteoporosis.  However, there are lots of different options to help prevent bone loss or strengthen weakening bones. 
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There are different medical treatment options available.  The most common of these being bisphosphonates.  Bisphosphonates prevent bone from being broken done. However, this may lead to less new bone formation as it prevents old bones from being broken down.  In addition to this, this class of medications has lots of side effects- muscle aches, esophageal ulceration, osteonecrosis of the jaw, seizures and atypical fractures of the femoral shaft and even esophageal cancer.  Other treatment options include estrogen and estrogen agonists like raloxifene.  While it decreases the chance of osteoporosis, there are many individuals that are not good candidates for this type of treatment because of the increased risk of blood clots and even strokes. 

While we always recommend weight bearing exercises to prevent osteoporosis, recent studies have shown that exercise really bolsters bone mass in the hip and femoral neck decreasing the chance of developing hip fractures.  Studies showed that increases in body mass density at the hip and femoral neck were particularly noticeable in women age 65 or older if exercise training lasted more than 200 days.  Basically, exercise has a huge protective effect on bone mineral density and can prevent fractures without all the side effects that traditional medications like bisphosphonates and estrogen agonists can have.  The thought is that as we age, our bodies produce cytokines that are inflammatory and destroy bones.  Exercise prevents the production of these bone destroying inflammatory cytokines and increases growth factors that help produce new bone.  In women particularly, exercise has also been shown to have a positive effect on estrogen concentrations which helps with bone remodeling. 

With all the innovations of modern society- dishwashers, washing machines, Alexa to turn on our lights and delivery of everything from groceries to dinner, we have become very sedentary.  Unfortunately, our bodies were not built for this.  Our bodies were meant to be active.  Movement and exercise promote the resorption of old bone and the formation of new bone.  This is vital to preventing fractures, back pain from fractured or collapsed vertebra, loss of height over time and stooped postures. 

While it’s important talk to your provider about your risk of bone loss and osteoporosis as you get older to see what options are best for you, don’t discount the importance of lifestyle choices like exercise to help prevent bone loss and fractures. 

Dr. Pam

A very common question at appointments lately is “I think my hormones are out of balance-can I get them tested?”  While society may tell you that an imbalance is the cause for everything from weight gain to mood change to almost any other symptom, it’s not likely the culprit for women with normal cycles, and here’s why:  the amount of sex hormones fluctuates markedly over the course of a menstrual cycle, and in fact, if they didn’t, there would be markedly dysfunctional cycles.  Here I’ll review what happens during the menstrual cycle as well as each hormone involved, how it changes over the course of a menstrual cycle, and also what it does.

What is the menstrual cycle?  The menstrual cycle starts on the first day of bleeding during the period and lasts until the first day of bleeding during the next cycle.  The lining of the uterus is shed and then begins to thicken again in case pregnancy occurs.  Ovulation generally occurs around the midpoint of the cycle (about 2 weeks before the start of the next cycle) in response to hormonal changes, and while the ovum (egg) is present, fertilization and pregnancy may occur.  If there is no pregnancy, then the cycle starts over again.  The length of the cycle can be calculated by using day 1 as the first day of bleeding and then counting days until bleeding starts again.  Typical ranges can be from 24-38 days.  Now that the cycle has been explained, we can move on to the important part – the hormones.
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1. FSH and LH – think of FSH as the director of a cycle.  Follicle stimulating hormone (FSH) comes from the pituitary gland in the brain and is responsible for the growth of an egg during the menstrual cycle until ovulation is triggered by luteinizing hormone (LH).  FSH is highest just before ovulation and then decreases following the release of an egg until it’s time for the next menstrual cycle.  In menopausal women, levels are consistently very high because the pituitary gland wants to stimulate release of eggs from ovaries that are no longer responding.
2. Progesterone – this hormone is released from the corpus luteum (a cyst formed on the ovary each month).  It increases in the second half of the cycle in order to support a pregnancy should it occur, but if there’s no pregnancy, the corpus luteum goes away and the decreased progesterone triggers a menstrual cycle.  High progesterone levels in the second half of the menstrual cycle are responsible for many of the PMS symptoms experienced by women including acne, mood change, headache, breast tenderness, and everyone’s favorite-bloating.
3. Estrogen – estrogen is produced by the dominant follicle in the ovary and increases as the size of the follicle increases over the first half of the cycle.  Increased estrogen thickens the lining of the uterus in preparation for possible implantation of the pregnancy.  Once estrogen levels are high enough, then the LH surge triggers ovulation and the second half of the menstrual cycle begins.  The decrease in estrogen in the latter part of the menstrual cycle stops the thickening of the uterine lining and works with the decreased progesterone levels to allow the menstrual cycle to start over if there hasn’t been a pregnancy.  Persistently high estrogen levels, such as those caused by estrogen production in adipose tissue in women with PCOS, cause continued growth of the uterine lining.  Continually elevated estrogen can ultimately result in unpredictable menstrual cycles as triggers for bleeding can be suppressed, and these cycles can often be very painful and heavy as several months worth of endometrial lining can be passed at the same time.  Over a long enough time, this type of bleeding can even result in endometrial (uterine) cancer.
4. Testosterone – testosterone, while generally thought of as a male hormone, is present in women, although in much smaller amounts.  Testosterone is a driver for libido and plays a role in developing/maintaining muscle mass and bone density.  There is a slight increase around the time of ovulation (in order to encourage procreation), but otherwise levels are pretty stable.  If testosterone levels get too high, women can experience acne, facial/body hair growth, deepened voice, male pattern baldness, heart disease and increased clitoral size.  While some of those effects are temporary, many of them may be permanent.

Given the natural course of hormonal change during the menstrual cycle, a single hormone test may be misleading.  For instance, progesterone levels prior to ovulation will be lower, but by adding supplemental progesterone to “correct” this imbalance, a woman might then live in a constant state of PMS.  Unopposed estrogen in a woman with a uterus will likely lead to irregular bleeding and could cause endometrial cancer.  Testosterone supplementation at high enough levels could cause permanent hair loss (from the scalp) or permanent hair growth (on the face and body) among other issues.  Many times the good intentions to supplement a natural fluctuation in sex hormones will likely make symptoms worse rather than better, and in turn, this could result in further unnecessary tests and procedures.  For nearly all premenopausal women, the better bet may be some sort of contraception-based hormone management.  That being said, be sure to review your full health history with your provider before starting any hormonal therapy, contraception-based or otherwise, to ensure it’s a safe and medically-appropriate treatment option for your specific symptoms. 

Dr. Nick  

There are lots of people out there that are worried about not taking enough Vitamin D supplements.  Its more popular than most supplements out there including fish oil, probiotics, and antioxidants. 

​What is all the hype all about and is it real?  Originally, we were told that Vitamin D helps prevent thinning of the bones.  More recently is has been touted to be a panacea for just about everything.  It helps boost the immune system and mood, helps with muscle weakness, fatigue, prevents cancer/heart disease/diabetes and even helps slow down the aging process.  So whenever one supplement does all this, I think we should be a little skeptical. 

What does Vitamin D do?   It helps your intestines absorb calcium.  Without Vitamin d, your intestines can only absorb 10% of calcium from the diet; with it your body can absorb about 40%.  Your body needs calcium to make your bones strong.  Without enough calcium, your bones will start to thin, soften and can bow outward (known as Rickets in children) and can increase fractures in older adults. 

Many vitamins must be consumed from different types of foods because your body can’t make it.  Not Vitamin D.  Vitamin D is made in our skin when exposed to sunlight and then converted in the liver and kidneys to usable forms.  Vitamin D is found in certain specific foods as well.  Since certain states have long winters and less exposure to sunlight, the federal government has required that Vitamin D be fortified in certain foods like milk, yogurt and orange juice to prevent diseases like Rickets.  This disease is pretty much nonexistent in modern times because of fortified foods. 

So why did experts think Vitamin D was so useful for so many things.  Researchers did observational studies where they looked at people who took supplemental Vitamin D and found that they were less likely to have certain cancers, hypercholesterolemia, hypertension, heart disease, fractures and a myriad of other chronic illnesses that are common in our modern world. 

I thought Vitamin D was just supposed to help with bone health, so how did it help with everything else?  In these observational studies, the individuals decided whether they took additional Vitamin D or not.  The people that were more likely to take theses supplements were more likely to be healthy, i.e. exercise regularly, eat healthily, and thus less prone to chronic diseases like heart disease and diabetes.  When randomized controlled trials with Vitamin D were done (the researchers picked who got Vitamin D and who got a sugar pill), the results were quite different. Most of those studies did not show any benefit in the group that received Vitamin D supplementation.  Some even found that Vitamin D supplementation may cause more harm: high levels of Vitamin D could cause weakness (and increase falls causing fractures), vomiting, and kidney stones. 

So, what does all this mean?  First, Vitamin D is not a cure all despite what celebrities may tell you.  Second, the most important way to stay healthy is to get your vitamins and minerals from actual food and not from supplements.  Third, get some sunshine (just not too much!*) and stay active outside.  This will boost your levels of Vitamin D and provide way more benefit than you realize.  Talk to your provider and decide whether you need Vitamin D blood level testing.  Remember 97% of people in the US have adequate levels of Vitamin D (from the sun and fortified foods) when the Institute of Medicine and US Preventative Services Task Force determined that blood levels above 20 nanograms are adequate.  However, more than 50% of individuals were noted to have inadequate levels when certain commercial labs changed the necessary level to >30 nanograms to have an adequate amount of Vitamin D.  Hope this helps to clear up the craze surrounding Vitamin D.  It would be awesome if a single supplement in pill form helped cure everything, but for better or worse, the old adage still holds-if you want to be healthy, balanced diet and regular exercise trump supplements**.  Have a good summer and get your vitamin D the old-fashioned way, by enjoying that Idaho sunshine while it lasts!

 Dr. Pam

*Too much sunshine, particularly without the use of sunscreen, could increase your risk of skin cancer.
**Be sure to talk to your provider before discontinuing any recommended treatments.

As screen time increases, we’ve begun to see a number of health concerns ranging from headache and eye strain to posture issues and obesity to increased anxiety and loss of interpersonal social skills.  Some of the correlation can be more self-explanatory, i.e. hours a day craning your neck to look at your phone can hurt your neck, but some potentially negative health effects, such as those caused by blue light, may be more subtle.  Here we take a look at blue light and how it can affect your health.
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What is blue light?  Taking you back to grade school, a rainbow shows the different colors that make up white light, ranging from red at one end all the way to violet at the other.  Red has a longer wavelength and is less easily scattered whereas blue has a shorter one and is more easily scattered.  That’s why the sky generally appears blue.
Ok, but what does it do?  Blue light is awesome during the daytime because it can boost attention, mood and reaction times.  It’s not so great at bedtime.  Prior to electronic screens, humans essentially evolved to be dependent on the sun for this type of stimulation, and it’s why for however long humans have been around, people tend to be more focused during the day and sleep at night.  Now, with the advent of tablets and cell phones, some people can’t even get out of bed until they get their electronic fix and the blue light that wakes them up.

Um, is that a problem?  It may not be the end of the world to play on your phone a minute or two before getting up, but not being able to sleep at night due to screen time definitely isn’t a good thing.  Blue light decreases melatonin levels, which are responsible for your circadian rhythm, meaning that falling asleep can be harder.  In some cases much harder.  Given that just over 2/3 of the U.S. has trouble sleeping at least one night a week, it’s not unreasonable to think that there may be a correlation, especially as this is nearly an identical number to those in the U.S. with a smart phone.  Those sleep struggles can lead to obesity, heart disease, decreased libido, inhibited immune system, and even contribute to some types of cancer.

Yeah, but I’m not getting rid of my smart phone, so what can I do?  In an ideal world, stopping screen time for at least a few hours before bed is a good idea.  In a practical world, screen settings with warm light or blue light-filtering glasses/screen protectors may provide some benefit.  While some studies suggest these measures can help prevent some of the melatonin decrease associated with sleep disturbances, the data is mixed, so it’s unclear if these measures really make things better or just make us feel better about trying to do something.  The bottom line is that light is good during the day, and sleep is good at night 😊

Dr. Nick

Antibiotics are one of the great advances in medicine.  They have allowed us to treat infections and do surgeries like cesarean sections that would most likely have resulted in death from infection in the past. That being said, there are definitely times when antibiotics can be helpful, but there are also situations in which they aren’t.  To help explain the difference, here’s a quick overview.

First, what do Antibiotics treat?  Germs consist of bacteria and viruses.  Bacteria are living organisms that exist as single cells.  Bacteria are everywhere.  Some cause disease, some do not, and some are even beneficial like the ones that line your intestines and help with breakdown of food.  Viruses are not alive and invade our cells and use them to replicate.  Viruses are generally harmful.  Antibiotics only work against bacteria because they are living organisms.  They do not work against viruses. 

Antibiotics are great at treating bacterial infections that can cause pneumonia, ear infections, or sinus infections, and they can prevent infections during surgery.  However, if these infections are caused by viruses like the common cold or the flu, antibiotics will not help and are only likely to stir up all sorts of issues:

1. First, antibiotics can have lots of side effects!  The most common side effects of antibiotics include vomiting, nausea, diarrhea, bloating, and abdominal pain.  Notice how the most common symptoms are GI related.  The reason for this is there are lots of bacteria in your intestines- some are good and help with the breakdown of food and some are bad.  In the process of killing bad bacteria, antibiotics may inadvertently kill some good bacteria in the stomach as well, and this is what causes these side effects.  Other symptoms include hives (a scaly itchy rash), coughing, and wheezing.  In fact, some individuals even have trouble breathing (this is an emergency that requires an urgent visit to the ER). 
2. The overuse of antibiotics to treat things like the common cold have led to antibiotic resistance.  As bacteria get exposed to antibiotics, they find a way to thwart the effects of the antibiotics on their cells.  This is how they become superbugs.  They find ways to combat the effect of antibiotics and survive despite being bombarded by different types of antibiotics.  What many physicians are worried about is as more bacteria become resistant, we will run out of antibiotics to treat common bacterial infections because they will be resistant to all the antibiotics currently available. 
3. Another side effect of antibiotics is a common complaint from patients to their gynecologist- vaginal yeast infections.  Antibiotics cause yeast infections in the vagina for the same reason they cause GI side effects.  There are many good bacteria in the vagina. Antibiotics can kill off these beneficial bacteria and cause an overgrowth of yeast in the vagina causing a cottage cheese like discharge and severe itching.  Alternatively, they may also contribute to bacterial vaginosis. 
4. Using antibiotics can cause other infections like clostridium difficile (c. diff).  C. Diff is a bacterium that can cause symptoms that range from diarrhea to a life-threatening inflammation of the colon.  When you take antibiotics to treat an infection, it can destroy some of the normal, beneficial bacteria in the intestines and cause an overgrowth of c. diff. 

There are lots of other theories out there as well that frequent antibiotic use in childhood may be a precursor to chronic diseases like asthma and obesity.  While the evidence for this is limited, we should be very wary of taking antibiotics when not necessary.  The best way to prevent these issues is by being a good steward of our current available antibiotics. 

In closing, here are a few quick tips for making the most of your antibiotics.

1. Please take antibiotics if your doctor encourages you to take antibiotics for illnesses or procedures.  Only take antibiotics that were prescribed by your doctor for you, take them as directed and do not skip doses in an effort to save them for later.   This often kills only the weak bacterial cells while leaving the stronger ones, which can cause your symptoms to return with a vengeance AND be harder to treat.
2. Trust your doctor if they feel your symptoms are more consistent with a viral illness and that antibiotics are not necessary. 
3. Consider probiotics foods while on antibiotics to help regenerate the beneficial bacteria of the gut.  This may help decrease the GI side effects, vaginal yeast infections and other issues caused by antibiotics. 

Dr. Pam