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The Twilight Series & Sleep Deprivation: Be Warned!

One of the hottest new books is Stephenie Meyer’s series called The Twilight Saga. My sister-in-law gave my wife a copy of the first book in the series and for three straight days, she couldn’t put it down. She was going to bed about 1-2 hours later than her usual time, and when my wife is sleep-deprived, even a little bit, we all pay the price. Furthermore, she’s now 8 months pregnant! 

 

Going to bed at a regular time, along with practicing good sleep hygiene (such as not watching TV or eating in bed) should be practiced by everyone. Of course things happen and you can’t always go to bed at a regular time, but choosing a particular book to read is one thing you have control over. Especially now that I’ve waned you. 

 

Consecutive nights of even mild sleep deprivation have been shown to diminish memory, mental acuity, and reaction times, not to mention mood changes and irritability. Imagine if you went through all three of Ms. Meyer’s books. Depending on how quickly you can read, most women (since mostly women are reading these books) will probably lose anywhere from 1-2 hours of sleep on average for about 1-2 weeks. In our already sleep-deprived, stressed-out society, additional sleep deprivation is the last thing we need.

 

I rarely put my foot down on any issue with my wife, but on this issue, I insisted that she stop reading further books in the series.

 

Are you currently reading one of Stephenie Meyer’s books, and if so, how much sleep are you losing?

10 Tips For Healthy Holiday Eating

Many patients find that the holidays are often incompatible with their diet and exercise regiments. But before you sabotage in two short weeks what you’ve worked so hard to maintain the previous 11 months, take heed of the following advice from expert holistic nutritional counselor, Peter Lappin.  These tips not only can help you avoid your penchant for overindulging this season (and regretting it later), they’ll help you enjoy many more holidays to come in the future.

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1. Don’t go to a holiday meal starving.  A lot of people under-eat in anticipation of a big meal, and then fill up on fat-laden crackers, cheese, nuts, and dip before the turkey gets carved.  Eat sensibly and don’t skip meals on feast day.

2. If you’re going elsewhere to eat, resist the invitation to take home leftovers. It isn’t just the sweets that are a potential problem, it’s anything associated with holiday eating — turkey, side dishes, etc. — that are not part of your regular diet.  Politely decline the offer and you won’t have the food around to tempt you. 

Solutions For Your Biggest Holiday Health Risk

According to a study that looked at 53 million U.S. death certificates issued from 1973 to 2001, researchers found a significant overall increase (5%) in heart related deaths during the winter holiday season, with the highest number of cardiac deaths occurring on December 25, the second highest on December 26, and the third highest on January 1st.

In the medical journal Circulation, where this study was published, researchers cited cold temperatures, along with emotional stress and holiday overindulgence as possible triggers for this sudden peak in heart attacks. This may be true, but there’s still one other major factor that this and other studies like this overlook. And that is that anyone who suffers from a sleep-breathing problem like obstructive sleep apnea, may be more at risk during this time of the year especially if they’re not aware.

The Deadly Link Between Sleep Apnea and Heart Problems 

If you look at all the medical studies out there linking sleep apnea and high blood pressure, heart disease, and heart attacks, it seems almost implausible that anyone who’s at risk for heart problems, wouldn’t also know that they may also be suffering from a sleep-breathing problem.

However, 80-90% of people with obstructive sleep apnea or OSA in this country remain undiagnosed and therefore untreated. As I often reiterate to my patients, and expound in my recently released book, Sleep, Interrupted, OSA is a massive trigger for heart problems but many, including some physicians, may miss its severe implications–especially when so many other factors come in to play during the winter holiday season. 

According to one other research done on this subject, respiratory disease, which tends to rise and therefore weaken patients with heart problems, was thought to play a role in increasing cardiac arrests.

Some doctors also cite that frigid temperatures can aggravate heart problems since cold weather constricts blood vessels which in turn raises blood pressure and makes you more susceptible to blood clots. Add to this the sudden physical exertion of shoveling snow and it seems more than plausible that deaths by heart attacks would certainly peak during during these icy, snowy, blistery months. 

Yet studies show that even in Los Angeles, where the temperature is much more temperate, deaths by cardiac arrest peak during the holiday season. Therefore, factors like over-eating and heightened stress during the holiday season were also cited as possible causes along with people putting off seeking medical treatment as to not disrupt their holiday plans. The study also pointed out that the shortage of staffs at local hospitals during major holidays may contribute to this rise in heart related deaths as well.

Even though all these seasonal triggers are problematic for those with preexisting heart problems and should be addressed appropriately (like staying warm and avoiding strenuous activities), they nonetheless mislead patients and physicians alike to attend to the symptoms rather than the cause. 

Specifically if a patient has OSA and this is what’s aggravating or even causing his heart problem, taking care of their high blood pressure, or their respiratory problems with medications is like treating a bullet wound with a band aid. Sooner or later, undiagnosed and untreated sleep breathing problems can wreak more havoc on your health than any of these other factors combined. It may just be that the holiday season with all its manifold health risks are providing the right place at the right time for heart patients to feel the full effects of OSA.

But before I can explain how you can avoid being part of this grim statistic, an explanation of what obstructive sleep apnea is is in order.  

What is Obstructive Sleep Apnea? 

Obstructive sleep apnea (OSA) is a condition where a person, due to an obstruction in the airway, stops breathing anywhere from 50-200 times a night while sleeping. These obstructions occur as a cause of several factors, one of which is that the muscular structures surrounding airway can slacken and close off the airway resulting in a cessation of breath or "apneas."

Ceasing to breathe multiple times throughout the night leads to a number of different physiologic consequences. Periods of low oxygen levels (along with elevated carbon dioxide levels) triggers a stress response by activating blood gas level sensors in the body, which constricts blood vessels. During an apnea episode, tremendous vacuum pressures are created (up to -80 cm of water pressure), which prevents proper blood flow to the heart, which ultimately results in less blood being pumped out of the heart.

After the apnea ends, chest pressure returns to normal, and a sudden increase in blood flow through the heart along with constricted blood vessels can lead to a severe rise in blood pressure.

In effect, frequent arousals like these over many nights, and years can cause injury to the lining of the blood vessels, which can promote or aggravate heart disease. The elevated blood pressure can also carry over into the daytime where any acute external trigger, like emotional stress can further aggravate. Add to this the excess weight gain, along with more inactive time indoors during these cold winter months, and it’s just a massive coronary waiting to happen.

Some classic symptoms of OSA include daytime fatigue and drowsiness, snoring, frequent nighttime urination, and morning headaches. Unfortunately, most doctors still are taught that you must be an older, heavy-set, snoring man with a big neck to have sleep apnea. Yes, that’s true, but that’s the extreme end of the spectrum. We now know that even young, thin women who don’t snore can have significant sleep apnea.

(To find out if a sleep breathing problem may be making you sick take our free quiz )

Practical Solutions For An Impractical Season

If you suspect that you may have OSA, then the first thing you must do to protect yourself from impending heart problems is to get a formal sleep evaluation by a sleep medicine doctor as well as undergoing a formal overnight sleep study.

However, even if you don’t have sleep apnea, there are many common sense measures you can take to avoid the risk of heart problems or any number of health problems for that matter during this special time of the year. As I explain in my book, Sleep, Interrupted, everyone is susceptible to sleep breathing problems to some degree as a result of our unique airway anatomy. Consequently, any measures taken now to reduce or to allay this problem will allow you to enjoy a much healthier winter season.

Reduce nasal congestion: Any amount of nasal congestion can aggravate airway collapse, thereby causing more breathing cessations, frequent arousals, or overall inefficient sleep. Use lots of nasal saline irrigate your nose to keep your airway clear. Saline acts as a mild nasal decongestant. Allergies can aggravate nasal congestion, so you should take steps to reduce your exposure. Some people with flimsy nostrils that cave in when they breathe in may benefit from nasal dilator strips (Breathe-rite strips). For a detailed explanation on how to breathe better through your nose, read 7 Tips to Breathe Better Through Your Nose).

Maintain your normal sleep routine: As difficult as it may be, try to maintain your typical sleep-wake schedule. Sleeping too long or too little can definitely trigger sleep breathing problems since certain hormones and stress levels can be affected due to rapid changes in our sleep patterns.

Don’t eat late: Although it’s important to avoid overindulging this holiday (for help on how to eat healthy for the holidays read, 10 Tips For Healthy Holiday Eating), it’s also more imperative to eat about 3-4 hours PRIOR to going to bed. Stomach juices have been known to aggravate sinus problems and prevent restful sleep. 

Avoid alcohol before bedtime. Rather than eliminate spirits of any kind this season, avoid drinking 3-4 hours before you go to sleep. Alcohol relaxes your throat muscles and can aggravate obstruction while you breathe at night.

Slow down and take a deep breath. During these hectic and stressful times, many of us forget to pause and take breaks regularly in between our daily routines. Every few hours, when you’re transitioning from one major activity to another, stop everything you’re doing, sit down, and take 5-6 slow, deep breaths. Focus on the air as it moves through your nostrils, down the back of your throat, into your lungs, and back out again. If you do this regularly, what you’ll find is that not only will you feel less stressed, but you’re more productive and focused for the activities that you perform.

In addition to all the above measures, try to maintain your regular exercise routine along with a modest diet. More importantly, rather than take these suggestions as a moratorium on your holiday fun this season, consider it a life long policy to ensure many more future holidays in the years to come.

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Sources:

Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time: The Holidays as a Risk Factor for Death
David P. Phillips, Jason R. Jarvinen, Ian S. Abramson, and Rosalie R. Phillips
Circulation. 2004;110:3781-3788

The "Merry Christmas Coronary" and "Happy New Year Heart Attack" Phenomenon
Robert A. Kloner
Circulation 2004 110: 3744-3745.

 

 

7 Tips to Breathe Better Through Your Nose

Most people take breathing through their nose for granted. But for many chronic mouth breathers, breathing through the nose is a struggle, if not impossible. Not only is their quality of life diminished, but they’ll also have a variety of other health-related conditions such as dry mouth, snoring, fatigue, and poor sleep. In my last article I addressed 5 reasons why it’s important to breathe through your nose. In this article, I’ll talk about 7 ways that you can breathe better through your nose naturally. 

Before I discuss the various ways to breathe better, a short anatomy course in in order. The nasal septum is a thin piece of cartilage and bone that splits your nasal cavity right down the middle. No one has a perfectly straight septum; everyone’s septum is slightly curved. Sometimes, nasal trauma can shift or move the septum away from its’ midline position. The nasal turbinates are wing-like structures that line the sidewalls of your nose. It’s covered with a mucous membrane, and normally it helps to smooth, warm and humidify air. The turbinates and sinuses also produce about 2 pints of mucous every day. The turbinates swell and shrink, alternating from side to side every few hours. This is called the nasal cycle. 

The front side walls make up your nostrils, which are soft cartilages covered on the inside and outside with skin. The back of your nose is one big cavity (called the nasopharynx), and the passageway turns down 90 degrees into the back of your throat. The nasopharynx is also where your ears connect via the Eustachian tubes. 

If any part of the anatomy that I described becomes obstructed partially or completely, you’ll feel stuffy in your nose. Usually it’s not one thing, but usually due to a combination of different reasons. For example, if you have a mildly deviated septum, suffering from mild allergies will swell up your nasal turbinates, narrowing you nasal passageways. This may not be enough to clog up your nose, but if you have flimsy nostrils or had rhinoplasty in the past that weakened the nostrils, then breathing in with a stuffy nose may trigger your nostrils to collapse. 

Starting from the tip of your nose, the first thing you must do is to find out if you have flimsy nostrils. If you have a very narrow nose, or if your nostril openings are very narrow and slit-like, then you may be prone to having flimsy nostrils. Try this experiment: Take both index fingers and press them just besides your nostrils on your cheek. While firmly pressing on your cheeks, lift the cheek skin upwards and sideways, pointing towards the outer corners of your eyes. Take a deep breath in. Can you breathe much better through your nose? Let go and try it again. If this maneuver works for you, you may benefit from using nasal dilator strips at night (one brand is called Breathe-Rite). Sometimes, the adhesives on these devices are not strong enough, or end up irritating the skin. Another way of treating this condition are various internal dilators (such as Nozovent, Breathewitheez, Nasal cones) that you can find over the counter or over the internet. 

Second, try using nasal saline sprays. You can use the simple spray bottles that put out a fine mist, to more sophisticated methods such as aerosol cans or even using a Water-pik machine (there’s a nasal adaptor that you can buy for this). Another popular variation is something called a Nedi-pot, which uses gravity to pour salt water into your nose and sinuses. You can either use prepared saline packages, or mix your own recipe (one cup of lukewarm water and 1/2 teaspoon of sea salt or Kosher salt with a pinch of baking soda). Whatever method you use, you’ll have to do it frequently to get maximum results. Besides cleansing out mucous, pollutants and allergens, saline also acts as a mild decongestant. 

Third, try not to eat anything within three hours of going to bed. If you still have food or juices lingering in your stomach when you go to bed, it can leak up passively into your throat and not only prevent a good night’s sleep, but these same juices can also leak up into your nose, causing swelling and inflammation. In addition, many people will also stop breathing once in a while, which creates a vacuum effect in the throat which actively suctions up your stomach juices into your throat and nose. 

Fourth, try to avoid drinking alcohol close to bedtime. Not only does alcohol irritate the stomach, it also relaxes your throat muscles as you sleep, which aggravates the process described in the previous paragraph. 

Fifth, if you have any known allergies, especially if it’s something in your bedroom, try to either remove it or or lessen your exposure to it. For example, many people are allergic to dust or molds, and if you have carpeting, or an area rug, it can harbor these allergens. Frequently washing your bed sheets in very hot water also helps. Investing in a quality HEPA filter should help even more. If you have any pets, consider keeping them out of your bedroom. If conservative measure to control allergies is not good enough, consider seeing an allergist for a more formal evaluation. 

Sixth, get regular exercise, especially outdoors. Not only are you exercising your heart and your muscles, you’re also exercising the nervous system in your nose. Vigorous physical activity activates your sympathetic nervous system, which constricts the blood vessels that supply your nasal turbinates. This allows you to breathe better through your nose, with all the added benefits described in my previous article. 

Lastly, slow down and relax. Modern society has removed all the natural built-in breaks throughout the day. Along with all the information overload and constant stimulation, going nonstop all day only adds to the increased stress levels that everyone experiences. In between major activities, take a minute or so to stop what you’re doing and stretch, get up and move around, and do some deep-breathing exercises. Stress can tense up the muscles, causing you to breathe shallower, which causes physiologic changes that can ultimately aggravate nasal congestion. 

These simple 7 steps won’t help everyone, but If you can go down the list and apply all the steps, many if not most of you should feel some improvement in your ability to breathe through your nose. If you’ve tried all these steps and still can’t breathe through your nose, then seek medial help. An otolaryngologist (an ear, nose and throat doctor) is the best doctor to take care of this condition. 

If you are a chronic mouth breather, in addition to what I described above, your jaw is probably more narrow than normal, with some degree of dental crowding. Chronic mouth breathers also tend not to sleep well at night due to various degrees of breathing difficulty. I discuss these issues in my other articles (sleep apnea and upper airway resistance syndrome). 

 

Why Your Lack Of Sleep Can Make You More Creative

 

It’s a known fact that sleep is essential for proper cognitive functioning, retention, concentration and mental acuity. Now, according to recent research, sleep may even enhance your creativity. According to the article in The New York Times which cites the study, those who slept more showed improved mental agility including the ability to make novel connections between disparate ideas by as much as 33%. As a result of findings like this, corporations that hinge on innovation such as Cisco Systems and Google have installed ergonomic sleep stations called EnergyPods in their corporate facilities.

 

But what about those people who sleep more than 9 to 10 hours and still feel exhausted and groggy? Why aren’t these sleep mongers waking up wide eyed and bushy tailed, bursting with creative energy? The answer to this seeming disparity depends on where these people lie on the sleep-breathing continuum. 

 

Why Some Need More Sleep While Others Can Do Without

 

If you are one of those people who wake up refreshed and recharged after a good night’s rest, then your sleep quality is probably the kind that the researchers are pointing to when they say that sleeping more can make you more creative.  

 

However, there are many more people who sleep longer than the usual number of hours (like 9 to 10 hours) and still wake up feeling groggy and exhausted. For them it’s a major chore to get through their day, let alone have the energy to innovate and come up with new ideas. For those of you who find yourself in this situation, it’s probably not the amount of sleep but the kind of sleep you’re getting that’s impinging on your creativity. Here’s what I mean:

 

Sleep is composed of six stages: awake, stage 1, stage 2, stage 3, stage 4, and REM (rapid eye movement). Stage 1 and 2 are known as the "light" stages of sleep, REM as the "dreaming" stage and stages 3 and 4 as the "deep" or delta stages. We need a good distribution of all the sleep stages to get the proper restorative sleep we need to be creative.

 

As I point out in my book, Sleep, Interrupted, many people who suffer from sleep breathing problems like obstructive sleep apnea (OSA), or upper airway resistance syndrome (UARS), are often unable to get past stage 1 and 2 let alone stay long enough in REM or stage 3 and 4 sleep stages to get the kind of quality sleep they need to feel truly rested. The reason why this happens is because their airway is constantly in danger of closing off or obstructing. These people’s airways are smaller than most, which is the result of various factors like having a floppy palate, larger than average tongue to jaw size ratio, or having chronic nasal congestion, just to name a few. (For more information, listen to my podcasts on OSA and UARS)

 

These are usually the people who feel tired even though they may have slept more than 10 hours. For them, the reason why they’re feeling so unproductive is not because they need more sleep but because they lack the necessary amount of deep restorative sleep they need to feel refreshed and rejuvenated.

 

The one exception to this rule are those people who are often categorized as the creative class.  For these type of people, sleep deprivation is not only a requisite component of their lifestyle but a vital by product of their creativity.  Many sculptors or painters will say that a 4 hour session can seem only like one hour. For them, a bout of inspiration can help them forgo all sorts of physical constraints, even sleep. In fact, more than one painter or sculptor have even told me that when they are unproductive, they intentionally sleep deprive themselves mildly to rev up their creativity.

 

So, you may be asking why is there such a wide discrepancy between those whom the sleep experts say need more sleep to be creative, and those who need less sleep to maintain their creativity? Again the answer to this mystery lies in how well you’re breathing at night while you sleep and how well your body can adjust to the constantly fluctuating sleep deficit.

 

Sleep Less, Get More Creative

 

Whenever I see patients who work in traditionally creative occupations, I find, more often than not, that many of them have narrowed upper airways, leading to easier collapse of either the throat or tongue structures while in deep sleep, leading to multiple arousals and inefficient sleep. Many of them also keep erratic sleep schedules, working without sleep one night, and sleeping in all day the next. Yet, many creatives will tell me that they thrive under these kinds of stress and pressure. They say that this is when their senses are most heightened and when they’re the most productive. 

 

This is very similar to what happens when people undergo a mild to moderate form of sleep deprivation. What happens in these situations is that a low-grade physiologic stress response occurs. In fact, the lack of sleep can actually induce hyperactivity of the sympathetic nervous system therefore enhancing not only their sense of smell, hearing or intuition, but also heightening emotions and creativity. It’s not all that surprising then that many creative types tend to either consciously or subconsciously shift back and forth from getting too much sleep to no sleep at all to maintain their creative drive.

 

This may be also why those who tend to be creative are often attracted to work that’s not constrained by the typical  9-5 work schedule. According to Richard Florida, in his fascinating book Rise of the Creative Class, this is the reason why so many creative types congregate in metropolitan areas like New York (the city that never sleeps). He suggests that creatives work independent of traditional work conventions, and why innovations like telecommuting, mobile work stations, and global networking, have become so popular in this modern day economy. Florida further argues that this new "creative class" is any person or group of people that uses their intellect and creativity to enhance their work, which includes both the traditional creative types, like actors, writers, and musicians, and even the non-traditional creatives like doctors, lawyers, accountants, engineers, techies, architects, and interior designers. They are at their best when their time for work, rest and play is shaped by no other standard than their own. Not surprisingly, these creative types won’t or can’t adhere to the good old fashioned 8 hour sleep paradigm. This may be another reason why some people get more creative when they sleep,  and some get less creative when they sleep too much.

 

The Final Word On Sleep

 

Of course, prolonged sleep deprivation, for anyone can have detrimental effects on your health and physical well being. It’s imperative that if you have a sleep breathing problem to have it treated so that you are getting the requisite amount of deep sleep needed to maintain proper cognitive functioning. 

 

Yet, if you consider the way that the human airway anatomy developed, you’ll see that we are the only mammals that are susceptible to the kind of sleep-breathing problems I describe. This makes me wonder if this isn’t the very reason why sleep makes us more productive and at the same time, be more creative than any other mammal alive. Just something to ponder the next time you have to pull an all-nighter. 

 

 

 

 

 

Can Snoring Help You Lose Weight?

A recent study published in the Journal Archives of Otolaryngology – Head & Neck Surgery showed that snorers burn more calories while sleeping than nonsnorers. For obvious reasons, the press and the internet is buzzing with this new finding. For those of you who think that you can lose more weight by continuing to snore, the study authors did note, however, that this does not mean that you can continue snoring away without any sort of treatment. 

 

Most people who snore will have some degree of sleep apnea, and this is a serious medical condition. Untreated sleep apnea can lead to high blood pressure, depression, diabetes, heart disease, heart attack or stroke. 

 

If you snore (or have simultaneous apneas) your body is in a stress state, more commonly known as the fight-or-flight response. This increases your metabolism, as well as keeping you from staying in the lowest metabolic state, which is the deeper stages of sleep. We know from numerous studies that inefficient sleep, due to whatever reasons, will promote weight gain.

 

There are even studies that suggest that the vibrational trauma can cause carotid artery plaque formation. 

 

Do you snore, and if so, are you overweight?

On Health And Healing

The other day, my 5 year-old son Devin accidentally bumped his leg on a table corner. After a brief pause, I could see the grimace on his face and tears starting to well up in his eyes. I went over to him, asked him where it hurt, and after rubbing my hand over the area that he pointed to, I gave him a kiss on the forehead, and told him that everything will be OK. Within 5 seconds, he was smiling and running around again. This incident reminded me about the importance of relationships in any form of healing, as well as how we even define what health or healing is.

One of my most memorable courses in college was called “Paradigms of Health & Disease.” It was a fascinating course which explored how various cultures perceived and defined heath. Some cultures (such as ours) defines health as an absence of disease. Other cultures define health as a state of balance, in harmony with your natural environment, world or universe. I’m sure I’m missing dozens of other definitions, but what I want to convey here is that even within our Western, modernized culture, all of us have different perceptions and ideas on what it is to be “healthy.”

The famous 16th century French barber-surgeon Ambroise Paré said (paraphrased), “I place the dressing, and God heals the wound.” Whether or not you’re religious, Paré’s quote emphasizes the human body’s innate ability to heal, given the right conditions. If you have a cut, what we do as physicians is to facilitate the wound to heal, by cleaning the wound and placing a dressing. The body does the rest. Doctors get into trouble (especially surgeons) when they take credit for the almost miraculous recoveries after treatment with an antibiotic or after major surgery.

In this context, do doctors actually heal patients? Is the act of administering a medication or performing surgery the act of healing, or is the body actually doing the healing on it’s own, once the proper environment is laid in place? This health science issue is definitely up for debate, but one thing for sure is that the patients’ proper physical, emotional, and mental environment is critical for any kind of healing to take place. This is something that we as physicians tend to forget all too often.

Over the years, I’ve noticed that there are many terms used very loosely in the health-related medical fields, such as words like naturopathic, chiroprathic, osteopathic, and allopathic. Sometimes these words are used interchangeably, and other times they are used inappropriately. Hopefully, I can clear up some of the confusion surrounding these terms, as well as to give you some guidance as to who to go to when you have particular healthcare needs.

As I’ve mentioned in my other articles, I’ve come on a journey over the past 10 years in private practice, where I realized that to truly treat a simple ear infection or a sinus infection, you must address the entire person, including their diets, sleep habits, lifestyle and stress issues. Giving medications is only covering up the problem, a sort of a band-aid, until the problem comes back later on. It’s not surprising that it’s estimated that the vast majority of visits to the doctor’s offices are a direct or indirect result of diet, lifestyle, and stress-related issues.

Traditional Western, or allopathic medicine (supposedly) uses scientific reasoning, logic and methods to find the true cause of illnesses and attempts to leverage the latest technology towards achieving this goal. The term allopathy was originally used to describe a healing practice that used agents that are the opposite of what’s causing an illness (allo – against, pathy – disease). For example, an antibiotic is used for bacteria.

Homeopathy, on the other hand, uses substances that are similar to what’s actually causing the illness to treat the disease. An example of homeopathy is using very dilute concentrations of lead to treat lead poisoning. A basic foundation of homeopathy is that the substance or toxin in question must be diluted numerous times to the point where only a few (or less) molecules exist in the solution. Interestingly, Dr. Hannemann, the founder of homeopathy, originally coined the term allopathy and it was used in a derogatory manner. Modern allopaths like to think of allo- to mean all or inclusive.

Osteopathy is a form of medicine that focuses on proper bony alignment and it’s relations to the rest of the body. Modern osteopaths (Doctor of Osteopathy, or DOs) are the equivalent of MDs, with all the privileges rights, and responsibilities. In medical school, osteopaths take additional courses in spinal and bony manipulation and are more focused on addressing the whole person, rather than a body part or organ.

Chiropractic is similar to osteopathy, but focuses mainly on spinal and vertebral alignment and functioning. The inventor of chiropractic describes coming up with the concepts after a woman’s hearing loss went away after he resolved a bump behind her neck.

Naturopathy is a form of holistic healing that emphasizes the body’s innate ability to heal, using remedies such as light, water, food, herbs, and massage.

Last but not least, I should also mention Chinese medicine (with acupuncture) as well as Ayurvedic medicine. These ancient form of healing are thousands of years old and are still being actively used in many parts of the world.

To overcome all the shortcomings of each of the above mentioned disciplines, physicians have recently introduced terms such as alternative, complementary, integrative or holistic. Some of these words are sometimes used interchangeably, but it’s important to distinguish the true meanings of each of these terms.  Admittedly, there are many definitions and variations for each of these terms, but I’m going to present the more commonly accepted definitions that I have come across.

Alternative medicine is any modality that is not traditional, allopathic medicine. In the US, due to the many problems associated with our current health care system, many people are either rejecting it altogether or looking for alternative ways of dealing with their health. This involves preventive and wellness options as well as treatment for acute or chronic conditions. Examples of alternative medicine (in the US—it may be different in other parts of the world) include Chinese medicine, naturopathic medicine, chiropractic, and Ayurvedic medicine. I’m sure I’m missing many dozens on others.

Integrative medicine is the practice of integrating or combining all the different forms of medicine, drawing from each field the most useful and effective methods of treating certain conditions. It gives equal weight to all the different fields. Some would criticize the fact that integrative practitioners sometimes use untested and unproven ways of therapy to treat certain conditions.

Complementary medicine is similar to integrative medicine, but from what I understand, uses essentially one main modality, but draws on the the beneficial aspects of other “alternative” areas when necessary.

Holistic medicine involves looking at the whole person—the physical, psychological, emotional, and spiritual. In theory, all physicians should be practicing holistic medicine, but very few end up doing so.

All of the above forms of medicine incorporate good nutrition and proper exercise as a basic foundation. Some may argue that Western, allopathic medicine has moved too far away from a “holistic” form of medicine where there used to be a much stronger doctor-patient relationship, to more of a technology-driven, algorithm-based, guided missile type of treatment. Due to obvious limited resources, time constraints, information overload, and medical-legal problems associated with our current medical system, the problems that we currently face are not surprising. Andy Kessler, in his book, The End of Medicine, predicts that with rapid advances in technology, doctors won’t have to rely on clinical judgement and experience. Rather, they can just order a test to make any diagnosis.

Another concept that needs clarification is timing. There is a major difference between treatment after an accident or infection, versus taking active steps to prevent an accident for infection from taking place at all. The former considers health as and absence of a disease (no more sinusitis), and the latter will take active steps to balance the body so that even if exposed to a cold or allergies, they won’t progress into a sinus infection. This is what differentiates someone that takes a reactionary approach to their health care issues, versus someone who takes an active or preventive approach so that illness is less likely to happen.

So ultimately, what is healing? Different modalities will have different definitions. An allopathic doctor will define it as total eradication of a bacterial infection from the body. A Chinese medical doctor will define health as a sense of balance in all the different forces, as well as between opposites. Can healing occur spontaneously, or is a second person needed for more optimal healing to occur?

If the patient feels significantly better, but the infection is not completely gone, has healing taken place? What if the infection is completely gone, but the patient doesn’t feel any better? Different medical paradigms will give different answers.

One interesting common feature amongst all the major healing arts, with the exception of traditional allopathic medicine, is that treatment always involve some sort of hands-on manipulation of skin, muscle or other body parts. Allopathic doctors will use manual techniques only briefly for diagnostic purposes, but rely mainly on tests to make the main diagnosis and resort to pills or surgery for any further treatment. In essence, we’ve abdicated the personal, relationship-driven healing arts in favor of technology and science.

I vaguely remember a study on newborn babies where one group had frequent manual touching, contact and stroking, whereas the other group did not. The group that were constantly touched had much faster rates of development, weight gain and other various measures. If babies need constant touching and reassuring to thrive and survive, why can’t adults benefit from “touch” therapy as well, no matter who lays on the hands?

This also explains why as a child, whenever my mother rubbed her hand on my belly for a tummy ache along with a soothing song, I always felt better. This goes to show that in a sense, whenever tactile relationships are involved, all of us are healers.

A Surgeon’s Adventure With Yoga

Last night, I went to my first ever yoga class. I was invited by Deborah Quilter, a certified yoga teacher, personal trainer, author and consultant, to experience her class. I gladly accepted and I’m so glad that I did. 

 

You may be wondering what a card carrying member of the American Academy of Otolaryngology – Head and Neck Surgery and the American Academy of Sleep Medicine is doing going to a yoga class. You see, it all started with may passion for helping people to breathe better. What I discovered was that not being able to breathe properly at night also affects how you breathe during the day, and vice versa. After having read tomes of book and articles on breathing, I was drawn to the concepts of pranayama in the yoga literature. When I was invited by Ms. Quilter to experience her techniques of breathing in her yoga class, I gladly accepted. 

 

One thing that struck me about her method of teaching is that nothing is forced, not even the breathing. One particular aspect of pranayama breathing that I’ve already learned is what’s called the relaxing breath, where you take longer slowly exhaling compared to the time you take to inhale. In Ms. Quilter’s class, she emphasizes that you should follow and observe your natural breathing rhythms, rather than trying to modify it or alter it in any way. After this "natural" breathing pattern is established, she adds subtle, gentle movements that are in sync with theses natural, spontaneous breathing patterns. I must say that the one hour session seemed more like 15 minutes. It was truly a memorable, and relaxing experience. 

 

Even my wife, who’s 8 months pregnant, is raving about her yoga for pregnancy DVD program that she performs 4-5 times every week. This is the best she’s felt out of her 3 pregnancies to date.   Now I know having experienced this first hand, why people seem to love yoga.

 

Have you tried yoga, and if so, how do you feel afterwards?

 

Q: Why do I lose my voice all the time?

A: There are many reasons for losing your voice, but one of the most common reasons for chronic voice problems is due to acid reflux. This is not your typical gastro-esophageal reflux (GRED) in that you don’t have to have any heartburn or indigestion. The only thing you may feel is hoarseness, but more often than not, you’ll also have chronic post-nasal drip, throat clearing, cough, a lump sensation, difficulty swallowing, or pain. This is called laryngo-pharyngeal reflux disease, or LPRD.

Initially, try eating dinner much earlier, and avoid alcohol close to bedtime. There are various over-the-counter medications for acid reflux, but they are not designed for this type of reflux. If your problem persists for more than a few weeks, or keeps coming back, it’s probably prudent to see an ear, nose and throat specialist for a proper evaluation.

 

 

Can Smoking Be Good For You?

Despite all the really bad known consequences of smoking, there’s one aspect of the act of smoking that may actually be beneficial. It’s been shown that it takes about 1-2 minutes for nicotine to go through the bloodstream and reach your brain which gives you that "relaxed" feeling. But what most smokers will tell you is that they feel better after the first 1-2 deep inhalations. Plus, since nicotine is a stimulant, how can it make you feel more relaxed?

 

I sometimes joke with my patients that in the typical workplace, the only people that get regular breaks are the smokers. Modern society has gotten rid of all the natural,  built-in breaks. So smokers, by going out of their stressful environments every few hours, are taking grown-up time-outs. Not only are they taking these "breaks," as they puff in the cigarette smoke, they are actually performing deep breathing exercises. They’ve associated the good feeling that they get with the physical act of smoking, which also happens to make you take some slow deep breaths. This is the concept that George Wissing describes in his fascinating book, Quit Struggle Free. 

 

By no means am I recommending that everyone who’s stressed go out and start smoking. But by using these concepts, you can get the same benefits of smoking without inhaling the toxic chemicals from cigarets. There are various resources for learning deep-breathing exercises, or take a yoga class.

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