Billings or Bust! Final Farewell Mocktail Party


BILLINGS OR BUST!

Join us for a final farewell Mocktail Party

At the clinic on Saturday, January 13
5pm—9pm

Yummy winter snacks and libations for all ages!
Lots of hugs and kisses and reminisces!

I am proud to have accepted a position
as full time faculty at the Montana
Family Practice Residency located at
the RiverStone Health Clinic in Billings
Montana. I start February 1st!

Your gorgeous faces are all the gifts we need!

The car will be packed to its limit ready for takeoff January 15!
 

FAAABULOUS FAREWELL FACEBOOK FITNESS FIFTEEN BY FEBRUARY CHALLENGE!

To my dearest Patients, Friends and Family....

I am excited to present a FAAABULOUS FAREWELL FACEBOOK FITNESS FIFTEEN BY FEBRUARY CHALLENGE!

Many of you may recall our "loose 10 lbs for the holidays" challenges we've held over the years where you weigh in in October and again the first week of the following January and if you have lost at least 10 lbs you got a great Amy Solomon schwag prize.

Well, this challenge will top them all but will have to be on the honor system and I'm gonna play too cuz I will need to be in my best shape for my next adventure, right?

Here's the deal:

We are going to start on MY birthday Friday October 27... that's the first weigh in just before Halloween. and finish on Valentine's day February 14th 2018 just over 15 weeks later

Goals:
loose 15lbs---that's only 1 lb/week
build up your exercise so you are exercising a minimum 30 min/day by the 15th week

some of you might recall my teaching of the "2 minute stair challenge" a great family doctor developed in the 1980s:
  
Basically you set a timer for 2 minutes and walk up and down the stairs
Week 1 you do it 1x 2 minute block/day
Week 2 you do it 2x 2 minute blocks/day. They do not have to be consecutively.  that could be while you are boiling water for tea or brushing your teeth or during a potty break at work
Week 3...3 times, week 4... you got it 4 times and so on
You can do them consecutively of course
Now he had his patients do it for 8 weeks.  At the end of 8 weeks his patients were doing a whopping 16 minutes of exercise; most of it not consecutively. He found on average they lost: 5kg (10lbs) lowered blood pressure, improved sleep (both falling and staying asleep) improved depression and anxiety and more

Some folks have trouble with stairs and simply march in place.

Of course there will be prizes!

I'm up for the challenge... How about you?

I'm excited!

Sincerely,

Dr. Amy
Amy Solomon, MD

Goodbye Cali! — A Letter from Amy

To My Cherished Patients, Colleagues, Community Members and Friends,

It is with bittersweet tears that I announce the closure of my practice, Balance Health of Ben Lomond.

It is a time of great transition and I am pleased to announce that I am in the process of interviewing for positions as core faculty at large Family Practice Residencies across the US.

I will have the opportunity to educate the future doctors of America.  In addition, I will join a strong family practice faculty that models all the traditions, skills, and joy of Family Medicine that I have embraced these last 21 years as a rural-ish physician here.  The teams I have met with so far are sharp, strong, enthusiastic, supportive and collaborative and I really feel like I will fit right in.  I have narrowed my search and opportunities to UCSF Fresno, Spartanburg SC, Lynchburg VA, Billings MT and Des Moines IA.

Further, I am hoping to start an Addiction Medicine fellowship wherever I land.  In many states it will be the first in that state.  I plan to work intimately with the American Society of Addiction Medicine and the Society of Teachers of Family Medicine to educate our new doctors so they grow as compassionate, capable healers to partner with their patients as they are challenged with the chronic struggles that substance use disorders present. 

Whew…

I’ve worked hard to get here.

I feel I have lived the dream of every family doctor.

I have resided and worked alongside the beautiful people of the San Lorenzo Valley.  I’m so grateful to have raised our children here.

I am honored to the very pit of my soul that my patients have trusted me with their health and have respected my direction for their welfare. 

I know they will be able to go on and work with new physicians to continue to take good care of themselves as they are their own team captains.

I will be winding things down over the next 90 days. Fortunately, our office is on the great EMR Elation…as such we will make sure our patients have a summary of their chart and important notes, labs etc to present to their new PCP.

I will not be available for any appointments, refill prescriptions nor do referrals etc. after November 30, 2017.

I will keep my website updated as things change.

With deepest gratitude and blessings,

Dr. Amy Solomon

THE GREAT AMERICAN SMOKEOUT

Every year, on the third Thursday of November (November 17), smokers across the nation take part in the American Cancer Society Great American Smokeout event. Encourage someone you know to use the date to make a plan to quit, or plan in advance and then quit smoking that day. By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk.

About 40 million Americans still smoke cigarettes, and tobacco use remains the single largest preventable cause of disease and premature death in the world. While cigarette smoking rates have dropped (from 42% in 1965 to 17% in 2014), cigar, pipe, and hookah – other dangerous and addictive ways to smoke tobacco – are very much on the rise. Smoking kills people – there’s no “safe” way to smoke (OR CHEW OR SNUFF) tobacco.

Quitting smoking has immediate and long-term benefits at any age. Quitting is hard, but you can increase your chances of success with help. Getting help through counseling or medications can double or triple the chances of quitting successfully.

FLU VACCINE IS NOW AVAILABLE

Our Flu vaccines are scheduled every Thursday starting October 13 @ 9:00 AM. Drop-ins welcome, but it helps to call ahead!

What is the flu (influenza)?

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly. People who have the flu often experience fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, and fatigue (tiredness). Some people may have vomiting and diarrhea, though this is more common in children than adults.

Some people, such as senior citizens, young children, and people with certain health conditions, are at high risk for serious flu complications. The best way to prevent the flu is by getting vaccinated each year with a flu shot.

What is the flu shot?

The "flu shot" is an inactivated vaccine (containing killed virus) that's given with a needle, usually in the arm.

This season's vaccine protects against the three influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

The vaccine takes effect approximately two weeks after it has been administered as antibodies (substances in the blood that protect against infection) accumulate and provide protection against influenza. Therefore, you may be susceptible to influenza during the two weeks after your flu shot.

Is there a Flu Vaccine for 65+?

Seniors ages 65 and older have a higher risk for developing complications from the flu and account for more than 60% of the flu-related hospitalizations each year. Recent studies show that people ages 65+ may not respond as well to standard-dose flu shots because they do not produce as high of an antibody response following vaccination as do younger people. People with low antibody levels may be at higher risk of catching the flu.

There are vaccines, Fluzone High-Dose and Flaud, designed specifically for patients ages 65+ and works by improving the production of antibodies in order to provide a stronger immune response to the flu than traditional vaccines. Like the standard flu shot, Fluzone High-Dose and Flaud are given as an injection in the arm and the side effects are similar, though some patients may experience increased redness around the injection site.

Who should get a flu shot?

The CDC recommends everyone ages 6 months and older* get a flu shot this season, including healthy people, and people with chronic conditions. In general, it is recommended that anyone who wants to reduce his or her chances of getting the flu should be vaccinated. It's especially important for some people to get vaccinated, including:

  • People who are at high risk of developing serious complications like pneumonia if they get sick with the flu. This includes:
    • People who have certain medical conditions including asthma, diabetes, and chronic lung disease
    • Pregnant women
    • People 65 years and older
  • People who live with or care for others who are at high risk for developing serious complications. This includes household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease.

     

Who should not get a flu shot?

Certain individuals should not be vaccinated without first consulting a healthcare professional. These patients include:

  • Those with a severe allergy to chicken eggs
  • Those with allergies to certain medications and preservatives, including certain antibiotics and Thimerosal (preservative)
  • Those who have had a severe reaction to an influenza vaccination in the past
  • Those who have had Guillain-Barré Syndrome (GBS) within six weeks of getting the flu vaccine previously
  • Those who have a moderate or severe illness with a fever should wait until they recover before getting a flu shot

What are the common side effects of the flu shot?

The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:

  • Soreness, redness, or swelling where the shot was given
  • Fever (low grade)
  • Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it.

CDC Vaccine Information Statements

 

Influenza (Live, Intranasal)

Influenza (Inactivated) 

REFERENCES

Hamborsky J, Kroger A, Wolfe S, eds. Centers for Disease Control and Prevention (CDC).Epidemiology and Prevention of Vaccine-Preventable Diseases. 13th ed. Washington, DC: Public Health Foundation, 2015.

Vaccine Information Statement: Influenza Vaccine (Inactivated). Centers for Disease Control and Prevention (CDC). August 7, 2015. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf. Accessed June 2016.

Vaccine Information Statement: Influenza Vaccine (Live, Intranasal). Centers for Disease Control and Prevention (CDC). August 7, 2015. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flulive.pdf. Accessed June 2016.

BREAKFAST ANYONE? I HOPE SO!

Well, school is back in session and for many of us that means getting into routines.  A big part of that includes getting up and eating breakfast.  


I often tell my patients who honestly report skipping breakfast to consider the word “BREAK the FAST”.  I urge them to think about it.  Their bodies have been without fuel for hours while doing the restoration work while they sleep.  To expect our bodies to perform well on no energy is ridiculous.  It’s like driving a car without gas.  


According to a Food Insight survey, 93% of Americans agree that Breakfast is the most important meal of the day, yet less than half of them actually eat breakfast regularly.  It seems intuitive, yet there is an enormous body of research that demonstrates the benefits of eating breakfast and the risks of not.


Here’s what we know about skipping breakfast:  People who skip breakfast tend to have higher cholesterol and larger waists; adults who skip breakfast are less mentally and physically efficient,  have increased risk of heavy machinery and factory accidents and athletes  will train less effectively. Further it is almost impossible to get all your daily nutrients in if you don’t eat breakfast. 


Here’s the good news: most importantly,  children who regularly eat breakfast have better exam scores.  This has been shown many times.  I tell all my pediatric patients that they will do better in school if they simply eat breakfast.  


Additionally, eating breakfast can raise metabolism by as much as 10%.  This has been shown as breakfast eaters being less obese, chosing less sugary foods as snacks later in the day, being  more productive during morning work; less enticed by fatty foods, feeling fuller and more satisfied on less calories at lunch; burning more calories in a morning workout, etc. etc.


So, hopefully you are convinced that eating breakfast is an important thing…but what should you eat?  There are a lot of studies looking at this subject as well.  In summary it doesn’t really matter what you eat as long as you eat something.  Those who choose the sugary/fatty choices had less benefit than those eating healthier choices, but still fared better than the non-breakfast eaters.
Most stick to the common breakfast foods: cereal and milk, eggs and toast, yogurt, fruit and granola.  My daughter often has cold leftover chicken or other seemingly “heavy” foods…she is a straight A student.  The healthier choices seem to have a balance of protein and carbs.


Often people skip out on breakfast because they feel they don’t have time or they don’t like breakfast or they don’t know what to eat at all or they are just too lazy.  

Here are some ideas:

  • Yogurt, fruit and granola (most fast food places and coffee shops offer this already assembled)
  • Ditto oatmeal, nuts and dried fruit
  • Peanut butter on toast
  •  Eggs:  a recent article in the Valley Press by Julia Blanton delineates how eggs really are a great source of protein.  You can even buy them hardboiled and ready to go at many supermarkets
  • Melted cheese on bread (big fave in my house)
  • A smoothie with fruit, yogurt or protein powder, milk, nuts whatever or again buy it premade by Odwalla or Naked juice or similar
  • Cereal and milk-obviously


All this said, I can’t stress enough the importance of breakfast.  My mother tells the story of how my grandmother used to chase her down the stairs of their New York apartment building with a glass of orange juice begging her to drink it….Parents chase your kids, feed them in the car, demonstrate good habits and eat a good breakfast yourself.  Kids, why not raise your grades and have something to eat before school?


Bon apetit!

Free Addiction Lecture Series - Now Running!

LECTURE 1: Addiction 101 An Overview 

LECTURE 2 : Neurobiology for Everybody 

LECTURE 3: What Drugs of Abuse and Alcohol really do to your body 

LECTURE 4: Managing chronic pain and substance abuse 

LECTURE 5: Other co-morbidities (like depression, anxiety, ADHD) and addiction 

LECTURE 6: Sleep and substance abuse

LECTURE 7: The science of Stress and Chillax 

LECTURE 8: Integrative strategies to treat addiction 

Lectures will be about 60 minutes with plenty of time for questions and will continue on a  rotating schedule. Detailed handouts will be available.

SUPPLEMENTS FOR WELLNESS

In this day and age we have ever increasing information about the physiology of our bodies coupled with a deteriorating supply of nutrients in our foods.  Historically, I have never really pushed supplements beyond fluoride for kids, prenatal vitamins and calcium for healthy bones.

Newer research and approaching health from the functional medicine point of view of what does our body need to have added and removed to take care of itself has expanded my recommendations.  This list has been formulated from many sources.  Most of the items appear on nearly everyone’s list.  


OMEGA-3-FATTY ACIDS: 


These are essential poly-unsaturated fatty acids.  Our bodies do not make them so we need to ingest them.  They are critical for brain and mood function.  They also have tremendous anti-inflammatory properties which is why they are helpful for arthritic conditions and the prevention of heart disease.  They lower triglycerides and make low density cholesterol molecules into higher density molecules which is heart protective as well.  Our bodies perform best at a higher ratio of omega 3 fatty acids to omega 6 fatty acids.  The fatty acids are found in protein sources.  Animals fed a “normal diet” of free range grass have a higher content of omega 3’s.  Corn fed, commercial raised animals are very high in omega 6’s.  To obtain enough omega 3 fatty acids it is best to eat cold water fish like salmon and halibut at least 2 times per week.  Many experts take that even farther and suggest 2 grams twice/day of a fish based omega 3 fatty acid supplement. To minimize burping up fish you can put your supplements in the freezer and they dissolve further down the digestive tract and are well f absorbed from there. 


B COMPLEX:  


This is a group of 12 substances lumped together because they are found in similar foods.  They are water soluble, thus your body can’t store them in fat tissue and need to be replenished daily. Your body can synthesize 4 of them, but the other 8 are “essential” and need to be taken in via food or from a supplement daily.  The B vitamins serve many roles in the body; most notably maintaining nerve function, forming blood cells, controlling substances associated with heart disease like cholesterol and homocystiene; keeping hair, skin and nails healthy and more.  B vitamins can be found in meats and dairy products and some in leafy greens.  Over cooking and exposure to sunlight diminishes their presence in those foods.  Some people may get enough in their diet, but are unable to absorb them from their stomachs. Our stomachs produce “Intrinsic factor” which is needed for B12  to be absorbed.  Conditions that cause increased acidity to the stomach (like stress, caffeine or too much alcohol) disturb the production of intrinsic factor and thus the ability to absorb Vitamin B12.  It is best to take a supplement that has the full content of B's as over supplying one may make you deficient in another.   I reccomend a sublingual product that can dissolve under the tongue.  Read the label and make sure it contains at least B12 and folic acid (folate) as well as the other B's sometimes manufacturerers separate them and that is super confusing

MAGNESIUM:  


Every cell in our body uses magnesium as a regulator element to control other minerals and jump start enzyme activity.  Magnesium deficiency can present like many other syndromes with fatigue, depression, leg cramps, anxiety, headaches, insomnia, body aches, heart palpitations, weakness and joint pain.  Magnesium is very prevalent in nuts, grains, legumes, green leafy vegetables and of course prunes.  But today’s soil has been depleted and as a result many people do not get enough magnesium despite eating the above foods.  Most resources recommend 400mg/day total (check your multi and calcium supplement they often contain 150mg or so but that's not enough).  When you go to purchase your supplement you will notice there are many forms of magnesium.  Mag citrate, mag oxide, mag gluconate etc.  It is recommended to take Mag citrate or mag aspartame as they are the most absorbable.  Ideally this supplement should be taken with food and in combination with Vitamin D and calcium for best absorption.  Ingesting magnesium oxide may cause diarrhea.  Alternatively, soaking in Epsom salts (magnesium oxide) is another great form of absorption.  Topical gels are also available.  It can take up to 6 weeks to notice benefit from replacing magnesium

VITAMIN D:


Vitamin D is found in many dietary sources, such as fish, eggs, fortified milk, and cod liver oil. The sun also contributes significantly to the daily production of vitamin D. The term "vitamin D" refers to several different forms of this vitamin. Two forms are important in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by plants. Vitamin D3 is synthesized by humans in the skin when it is exposed to ultraviolet B (UVB) rays from sunlight. Foods may be fortified with vitamin D2 or D3.  The major biologic function of vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. It acts like the glue that helps the calcium stick to the bones which is why it is suggested to increase bone mineral density and decrease fractures. Recently, research also suggests that vitamin D may provide protection for mood disorders, muscle weakness and pain, hypertension (high blood pressure), cancer, and several autoimmune diseases. Symptoms of vitamin D deficiency could be described as chronic pain, insomnia, weak bones, frequent infections, depression, etc. However, most people are not aware they are deficient as those symptoms are common to many conditions.
Part of the problem today is that many people do not get enough sun exposure as they work indoors.  Further using sunscreen, which is very important for skin protection, prevents the skin from making vitamin D.  Of note, our latitude on the planet, here in Santa Cruz, is not the best for the angle of light to produce Vitamin D in our skin.  Almost every vitamin D level I have checked in non-supplemented people has been low.
Vitamin D supplementation is easy and affordable.  I suggest everyone take at least 1000 mg daily.  If levels are checked and found to be very low then we often prescribe a mega-dose weekly and recheck levels.  If you are experiencing fatigue, muscle aches or depression, get your level checked.  Please note it takes at least 2 months to notice improvement of symptoms when replacing or increasing. 


ZINC: 


Zinc is an essential trace mineral and micronutrient that is found throughout the human body, mainly in the muscles and bone. More than 100 enzymes require zinc in the metabolization of nutrients such as carbohydrates, fatty acids and proteins. Zinc is necessary for normal growth and development during pregnancy, childhood, and adolescence. A dietary restriction in zinc during these periods increases risk of cardiovascular and renal disease in adult life.  Zinc is also involved in: immunity, wound healing, sense of taste and smell, vision, prostate gland health, inflammation, acne, atherosclerosis, ADHD and myopia (nearsightedness).
Zinc is found in foods, such as red meat, poultry, shellfish, oysters, whole grains, beans, nuts and fortified cereals.  It should be noted that the zinc in the vegetarian sources are bound in such a way that they are poorly absorbed.
Current formal recommendations for Zinc supplementation are about 10mg/day; however most experts feel this is insufficient, again due to the diminishing supply in our food.  You can get zinc supplements in 25mg and even 50mg doses.  I suggest 25mg every other day.   Most multivitamins contain zinc. check the amount of zinc before supplementing. More modern formulations do contain more than 10mg.  Caution should be noted that rarely, too much zinc can prevent your body from absorbing other trace minerals like copper and even more rarely be toxic so we do need some, more than most of us get but not lots.


CALCIUM: 


Calcium is the most abundant mineral in the body. Calcium is required for vascular contraction and vasodilation, muscle function, nerve transmission, intracellular signaling and hormonal secretion, though less than 1% of total body calcium is needed to support these critical metabolic functions. Serum calcium is very tightly regulated and does not fluctuate with changes in dietary intakes; the body uses bone as a reservoir and source of calcium, to maintain constant concentrations of calcium in blood, muscle, and cells. This is why we tell you that calcium on your blood test is not reflective of your bones and rather we order a bone density test.
The remaining 99% of the body's calcium supply is stored in the bones and teeth where it supports their structure and function. Bone itself undergoes continuous remodeling, with constant resorption and deposition of calcium into new bone. The balance between bone resorption and deposition changes with age. Bone formation exceeds resorption in periods of growth in children and adolescents, where as in early and middle adulthood both processes are relatively equal. In aging adults, particularly among postmenopausal women, bone breakdown exceeds formation, resulting in bone loss that increases the risk of osteoporosis over time.
 
Calcium is found in some foods, added to others, available as a dietary supplement, and present in some medicines (such as antacids). Adults should have about 1,000 mg of calcium/day (1200mg if you are a post-menopausal woman or adolescent)  It is very easy to get enough calcium through diet.  Foods rich in calcium include dairy (especially yogurt, hard cheeses and milk), bone-in fish like sardines, and fortified products like bread, tofu and orange juice.  Many leafy greens have a decent amount of calcium but usually on the order of 100mg or less per serving.  Kale has the most!  One caveat also is that cottage cheese, ice cream and cream cheese have less than the leafy greens/serving!
 
If your diet is not rich in these foods then many supplements are available. The two main forms of calcium in supplements are carbonate and citrate. Calcium carbonate is more commonly available and is both inexpensive and convenient. Due to its dependence on stomach acid for absorption, calcium carbonate is absorbed most efficiently when taken with food, whereas calcium citrate is absorbed equally well when taken with or without food.  Many supplements come combined with Vit D, magnesium and zinc.  Keep in mind your body can only absorb 500mg of calcium at a time so spread out supplements with breakfast and dinner.  And, if you are able to get a serving of a calcium rich food, like yogurt, don’t take a supplement with that meal, it will be wasted.  
Finally, a recent study showed that there may be a risk of heart disease if we get too much calcium in supplement form.  So stick to the guidelines and try to get it mostly through food.

All that said FOOD is still the best source for for nutrition.  Eating freash non processed real food in a vraiety of colors will get you most of what you need.  Read labels.  Ask questions.  Be smart!!!!
 

Yours,

Amy Solomon