Anti-Aging and Longevity Institute

Our Annual Spring Seminar is (almost) here again!

2012-01-16T14:13:00.001-08:00

Whenever I go to Anti-Aging meetings and listen to the presentations and review all the exhibits I can't wait to share all the new information with my patients. This is why I hold seminars twice a year.
Science is always evolving, even a tried and true remedy may have improvements or new uses and when I do the seminar I can bring up-to-date information to people, its nothing short of exciting!
Even though I am bursting to share immediately, I think it is good that I have a little time to try out products and research more information on things I am interested in, so I have first hand experience.

In addition to dynamite information, I find good products and order them so people can try them at a discount. As my husband will attest I try EVERYTHING myself first! Some products are duds and some like my Anti-Aging serum (SAST) are brilliant, I was able to discuss creating that with a holistic biochemist 10 years ago at the Anti-Aging conference and I still swear by it!
Among other things I found some anti-wrinkle gel that is incredibly affordable and works. It is listed as Nature's Alternative to Botox and it will only be $15 at the seminar (usually $45 though some websites have it listed as high as $100!!!). And then there's the portable infrared sauna, I am loving it daily. It makes me sleep like a baby. (That's me in the sauna!).
I have had several people offer to do a testimonial regarding their Hormone Treatment and HCG weight loss programs, so there will be people who have been there and done it, that you can talk to and as usual... Zumba and Nia

All that to say, "it's Time!", the seminar will be on May 12th 2012 at Turf Valley from 9.00 to 3.00
Hope to see you there.

Stage 4 Breast Cancer in a 28 year old

2012-01-09T20:51:00.000-08:00

My second patient of this New Year was a young lady of 28 with breast cancer that has already spread to her lymph nodes. A lump was found by her husband who advised her to get it checked out, for someone so young with a 3 year old son, she seemed incredibly calm. Waiting until the end of the Holidays she and her husband showed up first thing on Monday morning. I thought back to my last blog of 2010 and thought even with the mammogram schedule I follow, she would have been dead long before she 'qualified' for a mammogram. This case shows that self breast exam is still critical, yet the preventive Task Force advises against teaching our patients to do them. I cannot fathom the basis for that recommendation.
When young people get cancer it is somehow even more scary.
At the Anti-Aging conference I went to in December there was a talk given by the surgeon who has done the most robotic surgeries on the prostate in the world. He told us of his frustration with the new recommendations not to do Prostate cancer screening through the blood with the PSA test. He said the youngest case of Prostate cancer he had ever seen was in a 31 year old male whose Primary Care Physician had accidentally checked off a PSA test on his routine lab work. His Insurance company said they would not pay for the test because he shouldn't have had it at his age. "Even though it showed I have Prostate cancer he asked?"
What is the world coming to? Are people getting cancers earlier or are we just picking them up sooner? Not sure but PLEASE pay attention to your health and if anything doesn't feel right, get it checked out, no matter what narrow minded people( even Doctors) may say. Did I mention I'm running for 'Most Popular Doctor this year??

Best Wishes,
Be Well and Be Safe

Dr. Tuakli

Happy New Year! "New" resolutions ........again

2012-01-09T20:08:00.000-08:00

So another year is here and probably another series of resolutions. I think I have gone into defensive mode because I actually don't consciously make New Year's resolutions anymore. We tell ourselves why make them we will just break them anyway and then feel worse!
At the same time, let's think about the 'pros' of making resolutions. Would it not be a wonderful thing if politicians and other big wigs could join us the 'small fry' in reviewing what mistakes we made the year before and vow to rectify them? But then again, maybe politicians are a bad example, they rarely admit that they have made a mistake unless they are caught (literally) with their pants down and then they are more focused on damage control. Sorry, I digress.
New Year's resolutions do have their place however, even if they are soon to be broken. The traditional one is the Diet and then of course to Quit smoking. As many people as I have seen make these resolutions and there have been hundreds, there are always some, no matter how few, who actually stick with them. For these people making a resolution was life altering. Sometimes starting down the path of your resolution with baby steps ends up in major gains in your health and general outlook on life.
Be positive! At least you meant well! Sometimes being positive can be the difference between life and death, literally.
When I start my patients on the HCG diet (Yes, I am an ardent believer in the results) , I ask them to make a 3 point Affirmation (resolution if you will) they say it in the morning before they start their day. The 3 points are: Firstly: today is Day X.... why? because it reminds you of how much you have already achieved and that you are on the path to finishing. 6 weeks after all is not a life sentence. Secondly: enumerate the reasons why YOU want to lose weight (I want to fit into the gown I wore 2 years ago, versus, my co-workers keep bugging me to lose weight) and Third and finally "I am worth it!" The reason I have my patients do this is because if you start the day positive you can put a spring in your step, and actually achieve your goal instead of thinking " Oh Dear! Do I really have to follow that diet again today! As you can imagine, if you start the day on the negative you are less likely to succeed.
There are many examples I can give you such as cutting down red meat and cholesterol, to smile more, take more time off and de-stress etc but the point is, for whatever period of time you follow the new resolution (join the gym!) at least you can say you made the resolution, its better than shunning the idea altogether.
So verbalize some good changes you would like to make a one of these days it will actually happen. As a physician I am hoping there will be some health centered resolutions in there too.
Happy New Year, let's not be afraid to make resolutions! Cheers to your Health and Longevity
Sincerely,
Dr Tuakli

Mammograms and Breast Cancer prevention

2011-10-30T19:47:00.000-07:00

The nice thing about blogging is that I can have an opinion and express it as such. This may be in direct contrast to the official 'recommendations' of the medical establishment.
A case in point are the new mammogram recommendations. Last year someone who was writing an article for 'Good Housekeeping' called me and asked how the new recommendations would change my practice. I told her honestly, they wouldn't.
My response must have been either uninteresting or not politically correct as it wasnt published!

Now that Breast Health awareness month is back (October) I get asked this question again quite a bit.
As far as I'm concerned the new recommendations dont make sense and I believe if my patients see the facts they will agree.
Some of the most egregious recommendations include: discouraging women from doing their own self breast exam and not starting mammograms until the age of 50. Do these jokers know how many of my patients would have been dead by now if I followed these recommendations?

While glancing through a recent edition of Family Practice News I noticed a reference to a study done in Michigan, with more than 5000 women, which agrees with me. The study was reported at the symposium of the American Society of Clinical Oncology. It found that many breast cancer patients would have more advanced disease and face harsher treatment if the recently updated screening guidelines of the US Preventive Services Task Force were widely adopted.
In women under 50, 48.3% of breast cancers were detected by mammography, 46% by palpation.
The speaker concluded that " you are better off if you can have your cancer detected by mammography .....you will have more options and likely need less aggressive treatment......we would support the societies that continue to recommend annual screening mammography starting at age 40"

Do not misunderstand me, mammograms are not perfect and there is some radiation exposure but if you have breast cancer they definitely beat the alternative! I think if you are under 50 you can work it where you can get more thermograms and less mammograms but you still need to get that baseline mammogram to know where you stand. They dont hurt anymore and can be life saving.
Breast cancer treatment has come a long way but we still have a long way to go to eradicate the disease.

Prevention is ALWAYS better than cure.

Stay Well

Dr Tuakli

DOCTORS ABUSING PAIN MEDICATION PRESCRIPTIONS !!

2011-10-30T19:34:00.000-07:00

As a follow up to my last Blog, I had a patient last week who was seen in one of the area hospital ERs complaining of Flu-like symptoms. The doctor she saw confirmed that she did in fact have THE FLU and gave her Ibruprofen 600mg and Percocet to take every 4 to 6 hours! My incredulous medical student asked the patient several times if she was sure she hadnt complained of pain and the patient insisted that she hadnt. Quite frankly whether she had or not it is totally inappropriate for a patient to be given narcotics for THE FLU!
Unfortunately this patient was very compliant and took her narcotic medication as prescribed. She passed out at work the next day and was rushed back to the hospital. In the process of falling she scraped her leg and had some other minor injuries, she could have cracked her skull open.......... because of the flu.
Unbelievably, when the patient came to my office she was still taking the medicine because they told her in the ER that she had passed out because she had not eaten but they forgot to tell her to stop taking the medicine. Such compliance!

I plan to complain to the hospital in writing, its time we did something about this dissemination of drugs in our community. As a popular commercial on the radio says "not a sermon, just a thought".

Prescription Pain Medications

2011-10-02T18:11:00.000-07:00

I recently had a minor procedure done and it was a very illuminating experience for two reasons:

Firstly, being a patient is a very humbling experience, I must confess I was deeply moved by the kindness of the people that took care of me. It is so different when you are the one with the clothes on giving instructions!
In those few hours I learned so much that I would venture to suggest that every doctor and medical student be required to be a patient for a day. Even though I knew all about the procedure, the staff carefully explained to me what I should expect. They were very sensitive about maintaining my privacy and making sure I was comfortable. Being on the receiving end made me realize how priviledged we are as health care providers to be able to help other people. It is amazing how a little kindness can be so affirming.
My promise to myself from now on is to be more compassionate and empathetic with my patients, I believe nothing else in Medicine is as important.

The second thing that I have pondered a lot since my procedure is how we as physicians have to a large extent caused the epidemic of prescription drug abuse. A subject that is featuring prominently in the news media these days because of Michael Jackson's death.
Prior to my procedure the resident (Intern) physician asked me which pain medication I 'preferred' Oxycodone or Tylenol #3. I was very taken aback because number 1, I don't have a preferred pain medication (and I don't believe most people do) and number two I knew that this procedure usually doesn't cause any pain. She reluctantly gave me a prescription for Motrin which I didn't even fill. I had no pain, none and can't imagine why I was expected to have any. If I didn't know better I could have gone home with a prescription for Oxycodone which has pretty good street value.

I have noticed for sometime now that many surgeons just routinely give patients pain medications in case of need, they constantly say "we want to get ahead of the pain".
What pain?! What we need to do is get ahead of the Pain Medication addiction and only give people pills when they need it. Even women who have just had a baby are given scripts "just in case". It really hit home hard with me a veteran physican being offered unnecessary pain medication by a young doctor who is already programmed to dispense it.

One can only imagine how much pain medication Micheal Jackson was given after all his surgeries, and I have no doubt that is probably where his addiction started.

We physicians must first do no harm but if we doctors wont change at least the patients can.
Here are my suggestions:
Decline a script if you don't need it and don't obediently take any for your family members either without questioning.
If an over the counter pill will take care of your pain don't even fill the prescription.
Get only small amounts of pain medication if needed and flush away any remaining pills when you no longer have pain.

This is my personal opinion and I feel very strongly about it.I really think that with all the technology and other advances we have made we should be able to eliminate the scourge of drug addiction.

Help spread the word.
Be well and stay active!

HCG DIET

2011-09-28T19:06:00.000-07:00

For years I have been recommending this diet to a select group of my patients. I have to admit, it has been so successful I have expanded the range of patients I offer it to.

This is the ONLY diet I have seen where people do not gain back the weight, really!!

On average you will lose 20 to 40 pounds depending on what your starting weight is and how diligent you are with it
.
Unfortunately with all the recent publicity a lot of fake products have popped up. All kinds of potions are sold on the internet as "HCG" and even reputable nutrition stores seem to be selling ""HCG alternatives" or substitutes. These products give the diet as a whole a bad name when they don't work or cause side effects like hair loss.

HCG is a hormone, if you pick up a bottle of "HCG" at GNC for $60 and it says "this product contains no hormone" put it down!

HCG is very safe and effective when done with Physician supervision.

I will be be discussing this diet and its pro and cons in my Laurel Office at 11.30 on Saturday October 8th, you will be able to speak to people who have done the diet. Call to reserve a spot...... you will be glad you did.

Video from the Spring Seminar

2011-08-28T19:00:00.000-07:00

What a busy summer! My son videotaped me (from the side) at the last seminar and has put it on youtube. I thought it was worth sharing the link with those of you who might be interested in listening to the kinds of topics I cover at my seminars. The angle is not deliberate but hopefully it is informative.

http://www.youtube.com/watch?v=c1p2bd0UN5w

Telomeres on the Today's Show

2011-07-24T17:39:00.000-07:00

Here is an interesting snippet from the Today's show about Telomeres.
I have discussed these at 2 of my prior seminars, let me know if you have any questions,

http://today.msnbc.msn.com/id/26184891/vp/43737929#43737929

Enjoy!
Dr Tuakli

Anti-Aging Seminar summary

2011-07-20T19:21:00.000-07:00

Here is the link for my son's Youtube video of the seminar in May

http://www.youtube.com/watch?v=qXyY5HF8Mp0 , Let me know what you think!

A Supplement for Whatever Ails You!

2011-07-03T19:27:00.000-07:00

People ask me all the time "what supplements should I take?" Well, the answer to that question depends on the individual but there is one supplement I would recommend to everyone if I had it: The one that prevents Procrastination!
Just imagine if I could invent such a supplement, perhaps I would call it 'Dr T's major motivator'. I could create that and retire young!
Unfortunately, Motivation, which is the antithesis of procrastination, doesn't come in pill form. It has to come from inside.

The good news is that sometimes something external to ourselves can trigger that magic 'M' button and get us going.
Think of all we could achieve if we could eliminate procrastination in our lives.

Are you reading this because you want to live longer with the best quality of life you can? Do you need to lose weight?

Get past the procrastination and take that first step, call us...............TODAY! I will do my darndest to keep you motivated, you are not alone :)

Go for it, be well!

Dr T

Our Spring Seminar: A good time was had by all!

2011-05-26T17:41:00.000-07:00

Hello there! We had such a great time at the seminar on Saturday, they keep getting better, and better. What a wonderful and enthusiastic crowd. They had so many great questions and were so much "into" it!
The next few blogs will be about the seminar and I will try to recap some of the information shared as I get further into it
.
We started the day as usual, with some NIA, led by our expert instructor Ms. Claudia Salomon, she got the blood flowing to everyone's brain.

Next we looked at what Anti-Aging means and what an Anti-Aging program does. After this, we listened to a compounding pharmacist: Sam Georgiou talk about 'how to get your libido back'. He gave out little red cards with his 'turbo charge' formula.
I know Trader Joe's got a run on Brazil nuts and Cod Liver Oil after his talk :)! Both the male and the female participants were feverishly writing down all of Sam's tips.
I then gave a talk on what I call the Untold Truths of Hormone Replacement where we discussed the common misconceptions about what exactly Menopause and Andropause entails. I'll get more into that in another blog.
Dr Scott Buckner, an Interventional Radiologist, talked about Varicose Veins and a non surgical alternative for Fibroid treatment.
After lunch and an additional stretch with the NIA instructor we talked about .........Feet!
Watching the audience, it was clear that most people had never really given much thought to their feet however at the end everyone had a new appreciation of the two things that carry us around all day long! Everyone was planning to get their feet checked at their first opportunity. I really wished I had been a little more pro active with my feet, we really need to embrace every part of our bodies and what they do for us.
Every one loves show and tell, so I showed before and after pictures of Acne Treatment, Wrinkle Therapy with Dysport and Fillers, Obagi and skin tag removal. This was followed by a demonstration of Filler insertion on Cindy Battle and Free Dysport for everyone which was really popular.
We rounded the day off with a Zumba class.
Last but not least, I would like to throw a shout out to our sponsors for being so forward thinking as to support an Anti-Aging Seminar : The Vein Clinic, Professional Arts Pharmacy, Arbonne, Chef Tracey, and Angela Riddick, Obagi and Spectracell. What a great day! Hope to see you all at the next seminar in October. In the meanwhile, please be healthy.

Spring Seminar Agenda

2011-04-24T19:55:00.000-07:00

Spring is here and its time for another seminar!
Our Spring Seminar will take place at Turf Valley Resort and Conference Center in Ellicott City on May 21st 2011. It starts with registration at 9.30 am and ends at 4 pm.

We will be discussing:

Anti-Aging

Hormone Balancing

Restoring the Sex drive in Women and Men

Non surgical treatment of Fibroids and Varicose Veins

Taking care of our Feet as we age

Weight loss; The HCG diet

Dysport as an alternative to Botox, Restylane and Perlane fillers

and of course:

Practice NIA and Zumba

The seminar is open to men and women of all ages, hope you can make it!

Sign up on line at this website or by phone at 410 992 0011. It is $20 in advance, imagine that for an all day program you can't beat it, and $25 at the door. Hurry, its filling up fast!

Thank you!

2011-03-31T17:56:00.000-07:00

Last weekend I was thrilled and amazed to receive an honor from the local chapter of the AKA at their annual International Women's Day luncheon.
Interestingly, some of my patients think that my volunteer and teaching activities are a distraction to my practice so I really thank a patient of mine Ms. Shawn Jackson who nominated me for the award. Shawn realizes that volunteering is not only OK, it is actually necessary for professional women to give what we can to uplift our communities. I also commend the AKA for their acknowledgement that we should all use our gifts to help others and we should think globally. Women the world over look to women in the United States as role models and mentors.
It has indeed been an exciting 2 weeks for me, one weekend I am returning from Haiti where I was doing what I love: Helping people take better care of themselves and teaching and then the next weekend I am receiving an award for for it.
I think there is a need in all of us to help our fellow human and in my case volunteering fills that void. I love it! I receive so much more than I give every time.There have been times when I have been depressed at the scope of the work to be done and the smallness of my contribution but now I realize that even if you only help one person, you have made a difference.
As Livingston said:" Sympathy is not a substitute for action"

Thank you AKA for the wonderful award, I am proud and grateful to have been selected.

How old is your spine? Can it keep up?

2011-02-13T18:30:00.000-08:00

No that's not a typo, how old ARE your bones? And can they keep up with everything that you would like to do?

This may seem like an odd question and probably not one you have asked yourself lately, however you should. In fact you should question the age of all your organs and do what you can to maintain their vitality. Many people spend a lot of time focusing on what age their face may appear to be and with modern medicine they are able to adjust that but what about their other systems?

This is the essence of what Anti-Aging or Age Management medicine is about. Figure out what damage has been done and slow it down or fix it. Figure out if you have enough of what you need nutritionally to get through the day. How do you know what your Glutathionine and Selenium levels are if you don't get them checked? What is your anti-oxidant level and why don't you care?

Time marches on and it will be harder tomorrow than it is today to repair and revive yourself, if you allow yourself to deteriorate completely it may actually become impossible. So don't wait. Lose the weight, do some form of exercise daily, exercise your brain and have a plan.

A study done at the Deaconess Medical Center in Boston showed that by the time a person is 75 they will have three of these six conditions: Frequent falling, urinary incontinence, confusion and memory loss, osteoporosis or arthritis, heart disease and depression. But this should not be looked upon as inevitable and remember with each condition comes more medication!
I read this today: You know you are old if your back goes out more than you do! What a pleasant prospect.

Anyway! Coming back to those bones, if you are over 50 or a post-menopausal women you should have a bone density scan ( along with a colonoscopy and an Anti-Aging evaluation). Remember that your bones are as strong as they will ever be at the age of 18 from then on your goal is to hang on to what you have. Weak bones can lead to misery and death as you get older.

Then again it doesn't hurt to take care of the outside AS well so I'll throw in a little plug for our February special. You can get "Botox" for as little as $50 before the end of February and $50 BACK on fillers, only through the end of the month.

Stay Young, Healthy and Happy!

The Fall Seminar

2010-11-26T19:34:00.000-08:00

Hard to believe it will soon be time for our Spring seminar and I haven't written about the last one yet! The spring seminar will be in May this year and once an agenda is decided on it will be posted. Meanwhile for those of you who missed it, here's the 'wrap' on our Fall conference:

Our Fall Seminar was held on October 24th at Turf valley Golf Club and Resort, it was great!
We had a really good turn out, perfect weather and lots of enthusiasm. From the minute Claudia (Salomon4Nia.com) started us off by putting us through the paces of NIA there was great energy and excitement in the banquet hall.

The inital discussion was about obesity and why many diets seem to fail. We talked about the 'D'spot in the brain which controls the loss and redistribution of fat and how abnormal fat stores are kept in a vault that is difficult to access. We talked about ways to get rid of this fat and other weight control tips.

After this a doctor from the Vein Clinic talked about Fibroid embolization, Varicose viens and Venous congestion. The audience listened with great attention and had plenty of questions for the speaker.
We then got started on the subject of skin care and tips. Always be gentle with your skin even when it itches or you cant resist the urge to pick. Apply your anti-oxidant solution daily. I showed several 'before and after' pictures of skin procedures we do in the office including : removal of moles and other lesions, clearing up severe acne, melasma (dark pigmentation of the face associated with hormonal changes and pregnany)and then pictures of Botox and Fillers to prepare everyone for the afternoon demonstrations.

The morning ended with an in depth discussion of Andropause (Male menopause). Most of the men were nodding in agreement by the end of the presentation with the sudden realization that they do indeed suffer from symptoms of Andropause but had just never known what to call it.
The vendors/sponsors of the program were a great hit. People signed up for Viridian "green" electricity supply, Vitamin testing, NuSkin demonstrations, Vien assessments and Zumba.

Our afternoon program included live demonstrations of Botox and Filler and discussions of Bio-identical hormones. Some lucky participants won Obagi products and free vitamin testing.

We finished with a Zumba class!

Well, more fun is in the offing, Stay tuned! If there is any specific subject you are interested in that you would like discussed at the next seminar please let me know asap.

Meanwhile, Happy New Year and see you soon.

Return to Harvard

2010-11-01T18:13:00.000-07:00

After 27 years I finally returned to Boston and the Harvard Medical area. Of course the area is very built up and now all the Hospitals seem to be one big collective conglomerate. In my day, Beth Israel was very distinct from the Dana Faber Institute and Deaconess but no more, where one ends the next one starts.

The T (the Boston mass transit system)is still fairly decrepid and jammed packed with people who all seem to be under 30, My Lord! I never realised when I was one of them, that 90% of the people on the T are students. I bet Boston has more students per square yard than anywhere else in the country. My husband and I felt like 'seniors'almost everywhere we went. Speaking of the T at least it now comes out to the airport negating the need for the old 2 hour sit in the tunnel.

Well, my purpose of going to Boston was to return to my old stomping ground. I find that people at Schools of Public Health are always so interesting and 'Global'. Full of ideas about how to change the World's health.

On my way in to the Alumnae event I had the distinct pleasure of meeting the chief investigator of the MRFIT trial, himself an alumnus. The MRFIT trial was one of those pivotal trials that proved that a high Cholesterol causes heart disease. That was big news back then! He smiled when I suggested I might need his autograph, I believe he was from the class of 47!
At the registration desk, I asked if anyone else from the class of '84 was there. "What did you say" one of the students asked, "2004 or 1994?" "err... that would be 1984 I responded" now feeling very flattered as they all looked incredulously at me. I was similarly astounded to hear myself, could time possibly pass that fast? I was looking at graduate students in my old school who were not even born when I was there. We were equally fascinated by each other. "Its nice to know your anti-aging program is working" joked my husband.

Later,we went to Harvard yard and bought Harvard sweatshirts, mugs and key rings. Did I feel at home? Not at all, I felt like a tourist and when I discovered that Filene's had been closed my heart sank. All these years, to tell the truth that's what I missed most about Boston, Filene's!

I am officially a Marylander, proud and happy to be back doing what I love practicing medicine! Its nice to be able to go back when you want to but nothing beats the present. I often say reliving the past only wastes the present and diminishes the future. The future is ours to live ! Stay healthy, feel great, do better!!

Aging is no fun! ( However our seminar is will be!)

2010-09-12T19:39:00.000-07:00

Let's be honest: the other title for this blog is "keeping it real".
Why? because aging, at least physically, really is not any fun. Aging is, after all a degenerative process and that is exactly why 'Anti-Aging' is so important.

With Anti-Aging, the process is not so daunting and we retard the rate at which our body degenerates,and slow the rate at which various organ systems become problematic.

On October 23rd 2010, I will once again be giving a seminar on how to feel good and look good as you age. It is about what YOU can do to help yourself maintain and reach new heights as you get older.

The goal is to maximize all our resources both inherent and external to contnue to feel vital, energetic and sexy as the years add up, at least on paper. In short we want to widen the gap between our chronological and biological age as much as possible.

Please mark your calenders:
Date: October 23rd 2010
Place: Turf Valley Golf Resort and Conference Center, Ellicott City, MD
Time: 10 am to 4pm (break for lunch 12 to 1)
Cost: $15 before October 15 $20 after October 16th

Its going to be even more fun than the last one with a Zumba/Nia class and lots of hands on demonstrations, Get all you questions answered. Hope to see you there!

Hi from Costa Rica

2010-07-27T19:45:00.000-07:00

Hi I am in Costa Rica for a week. My husband teaches deaf students at Galluadet and he is here to oversee a summer project at the deaf school. It is the rainy season now, the season that is referred to as winter here and rain it does, everyday!
The terrain is incredibly lush and green and I am sure these rains are partly responsible.
I thought this country would have more of a Carribean flair but it doesn't, most Costa Ricans seem to take themelves very seriously!
Here are a couple of photos, unfortunately the volcano was shrouded in clouds this morning so I dont have good shots of that but plenty of other aspects of nature.

Watch for my 'Men's Blogs' and for our fall seminar which is coming soon.
As they say in Costa Rica "Pura Vida" (pure life)!

Growth Hormone the mystery reparative hormone

2010-07-19T19:40:00.000-07:00

The majority of my Anti-Aging patients are male but the reverse is true when it comes to Hormone Replacement. Its an observation that I find interesting, why the difference? I'm not sure.
This month I am going to focus on issues affecting Anti-Aging specifically and many of them are more male directed intentionally because I think that sometimes women's issues are overrepresented.

What is Growth Hormone exactly and why is it so popular? Growth Hormone is naturally secreted by the pituitary it affects almost every organ in the body, it is a master controller of metabolism and muscle tone.

In my opinion, Growth Hormone is a misnomer,oftened referred to as HGH (Human Growth Hormone) it was originally named because children without it didnt grow. In adults once the growth plates are closed there is no opportunity for getting taller no matter how much growth hormone a person takes.
The name gives the impresion of a substance that can cause strange things to grow like horns and cancer, it actually does not. It is in fact HGH a reparative hormone which helps the body repair damage and heal faster.

I recently had a patient whose company sent him to a leading hospital annually for an 'executive' physical. This, and the fact that he had formerly been a triathlete led him to believe that he was very healthy. After he had some arthroscopic surgery last year he became very frustrated because he could not get back to his prior level of fitness. A friend told him he needed to find an Anti-aging physician and he found me. I ran a series of tests on the patient and started him on therapy. We optimized his vitamin, and supplement levels in addition to short course of HGH.
At his 3 month follow up visit, the patient told me he was 'back to 100%'. It took less than 90 days to get him back in condition, something physical therapy and working out had not been able to achieve.
I had another patient who was 35, also an athlete and when he was offered his 5th knee surgery decided there had to be another way.
The first patient asked me an interesting question, one in fact that I couldnt answer: "Why doesnt every patient who is getting surgery get treated like this from the get go?"
I have no idea, but it seems to make sense. Why should this be 'the medicine of the future' when we have the information to help people now? Why dont more orthopedic doctors refer their patients to get 'tuned up' before undergoing the knife?
I put all the patients who come to me for a 'pre-operative' physical on a healing regimen, afterall, surgery is just self-inflicted trauma. We can anticipate the damage that will be caused and limit it.
(For more information on Growth Hormone please see my website).

Another interesting point that this case brings up is: Do you really want your preventive medical care managed in a place that is totally focused on disease? It is fine to go to the country's best hospital for 'Treatment' but the goal of Preventive Maintenance is different. Be clear about exactly what you want from your 'routine' physical exams and what your doctor's focus is. Primary prevention is the art of preventing something before it occurs, secondary prevention (for example a mammogram) is detecting a disease early enough to do something about it and then there is the third option: fixing a problem that is already entrenched.
You choose what works best for you.

The benefits of having your hormones balanced

2010-06-26T15:31:00.000-07:00

For those of you who followed my blog from Haiti, thank you for reading it! It is amazing how stimulating an environment like that can be. With all the hardships the Haitians are AMAZINGLY strong people and I feel priviledged to have been able to go there and help in any small way. They say the first person to benefit from any service is the giver and it is so true! I will go back when I can.

In the meantime I shall refocus on what I specialize in and try to help more people here at home to feel better in a different way.
Everytime I meet with both new and old HRT patients I am inspired by how much good natural hormone balancing does for them. Professional people who are able to carry on with their busy lives without missing a beat, mothers who had babies in their forties but can still keep up with them as teenagers,and relationships that refind their zest. I see people who can come off anti-depressant and anxiety medications once their hormones are in better balance and young people throwing off PMS and bad periond cramps that used to keep them at home every month.

So this too, is a very gratifying field of medicine for me something that I enjoy practicing everyday.

My next blog will be about Telomeres,a fascinatng field of research in Anti-Aging.

Its good to be back .....do come and visit!

Devastated!

2010-06-19T17:37:00.000-07:00

After two weeks of taking more pictures than I have ever taken in my life I lost my camera with the memory stick of 600 photos! I am truly devastated. I couldnt wait to get home and share them with you. Now I am really glad that I wrote a daily blog, that is how I will have to remember the small details of my trip. There will be others and as my insightful daughter (age 14) said, at least I am home safe and sound.
Thank you for reading my blog.
Now I will go back to Hormone replacement and Anti-aging and hope that in some small way I did some good.
Wishing you Good Health!

A new birth!

2010-06-17T03:23:00.000-07:00

Day 10
Well here I am packed and ready to go! I was really starting to get into a groove at the clinic. It helps to have cooperation, I believe there are many staff members who actually enjoy what they do. Unfortunately they have little or no direction and no personal experience or education to fall back on.
I asked about the staff member who had fainted on Monday and was told she was fine however she had not returned to the clinic. After consulting Denise the clinic manager we decided to do a home visit (“visite domicile”), I needed an interpreter and another staff member decided she would like to tag along as well. So the 4 of us set off among the tents, boy it was hot! A few minutes later we were at the lady’s tent. “She’s in there!” I was told, so I pulled back the curtain and there was a new born baby on the floor barely a foot from the doorway! I guess it’s the coolest place to be.
The rest of the team was unfazed, “where is Madame F ? they asked loudly. They were advised that she was in the opposite tent and everyone turned in pursuit . Whoa! wait a minute. Ummh about the baby, I said not wanting to appear overly dramatic. I had several questions like who, what, why and when. We started to question the mother. No ,she hasn’t seen a doctor since she delivered. Yes, the baby was born in the tent. Amazingly everyone was so matter of fact, I was still stunned at this sleeping miniature person and the surreal surrounding!
I gave Mom prenatal vitamins and a lecture on the virtues of breast feeding and visiting the clinic for a check up, photos taken and onward!

Our next visit was almost at the top of the camp wow! Up and up and up! Great views of Terrain Acra. We went into a tent and a man was fixing some kind of wheel barrow-like contraption , I talked to him. He said he paints pictures he had some on display, my impression was so-so talent. I asked him about the tent : how many people in this tent , 7 he said. There is an open area in the middle of the tent where cooking is done. The latrines in this camp have no doors because people have stolen them to add to their tent space. I asked how people maintained some dignity and was told that when they go to the latrine they concoct some kind of cover.

As I followed the clinic director further into the tent I got my second shock of the day. A 57 year old paraplegic man who looked like an AIDS or TB patient. He was really cachexic (thin) and his legs went in two different directions and clearly had not moved in a long time. The skin on his legs was like something I’ve never seen before! You could count every rib! He gave me permission to post his pictures. Apparently he was paralyzed by a car accident before the earthquake but he says things got worse after that. I gave him the only thing I had, a bottle of prenatal vitamins,and advised his family members to try to do a little physical therapy. I told him he would sleep better if he was adjusted to a 45 degree angle. He seemed to appreciate that piece of advice.

I later had a discussion with the clinic manager. I suggested they have a meeting with him and his family and discuss amputation. This may be the only way for him to get on with his life, he cant use his legs and they are just going to be a major source of infection and ultimately kill him. It is not easy to suggest cutting off someone’s legs.

NEWS hot off the press:
Someone knocked on my door this evening and told me there is an outbreak of typhoid. Apparently the Ministry of Health randomly screened 15 stool samples and all tested positive. They might need even more help if this keeps up.

And finally the Corail latrine update :
The Corail camp manager met with Oxfam today and they have agreed to back pay the latrine cleaners however they are still philosophically against paying people to clean up their own waste. The compromise is to back pay but none going forward, they are going to build more latrines now so that only 5 families share a latrine. They believe this will help the people take ownership of the cleaning process. That could turn out to be a pile of S…tuff no pun intended. At least a riot was averted for now. They also handed out more food rations today but only to pregnant women, so pregnant women came out of everywhere, once again food to last2 weeks and no more.
The only down side of today is dealing with a colleague who is a pediatrician and insists on talking to me as if I am a child! It is starting to get to me but Voila! Its my last day!

As always Desiderata proves inspiration:
Go placidly amid the noise and haste, and remember what peace there may be in silence.
As far as possible, without surrender, be on good terms with all persons. Speak your truth quietly and clearly; and listen to others, even to the dull and the ignorant, they too have their story. Avoid loud and aggressive persons, they are vexations to the spirit.
There is literally a new baby born every minute, even in Terrain Acra one can see the potential for the future that arises from every birth.
With all its sham, drudgery and broken dreams, it is still a beautiful world!

From Home visits to Brazil Haiti Day 9

2010-06-15T19:11:00.000-07:00

On the way in to the camp this morning I discussed strategy with the medical director. He seems to have bought into my idea of offering prenatal care at the clinic but after asking for a prenatal flow sheet form for the 10th time and still not getting it, I think the chances of pulling it off before I leave are pretty slim.
Once we get the form the process would be, to teach the triage staff what to do on each pregnant woman and to develop criteria for referrals. The staff at the camp have a very low level of education and it takes several repetitions of the same thing to begin to effect change. Today ,I believe, was the first time every patient I saw had been weighed (that’s another story), I am now attempting to get a last menstrual period date recorded on every female patient (50% yesterday, 0% today). And then there’s the protocol for reading pregnancy tests another challenge which I think would work out with a little more practice.
On the subject of criteria, we need to develop some for ‘home visits’. I like the idea of home visits it gives a warm fuzzy caring kind of feel and who doesn’t like the doctor to come to them? I went to visit a lady whose right arm was broken during the earthquake, her leg was injured also but that has resolved . She is left with chronic pain in her wrist and arm and minimal motion. I demonstrated some exercises for her, she really needs to do physical therapy and I think I convinced her that in spite of the pain she must force herself to start using it. I gave her some pain medication and tomorrow I will give her a wrist splint. I am a little leary of giving her a splint because it may cause her to use her arm even less. She promised to do the exercises 4 times a day, regardless, so we will see.
As I was finishing up with her 3 able bodied women approached and sat down to be ‘seen’. They were all in the early stages of pregnancy the nurse told me and they didn’t feel like coming down to the clinic! I really have a problem with this kind of healthcare, I think it is a mistake to end up having drive-thru clinics and creating a dependency on them purely for convenience. The clinic is less than a five minute walk from their tents but they prefer to tag on to home visits. I think a lot of people think that prenatal care is just a matter of handing out vitamins. It is not. The patient needs to be weighed, the blood pressure checked, the length of the uterus measured and the urine checked for protein among other things. None of them had had tetanus shots and Haiti has the highest incidence of neonatal tetanus in the western hemisphere. I told them to come down to the clinic tomorrow. They weren’t overly enthused but I told them if they care about their babies they need to come to the clinic every month. I hope all this Aid that is pouring into Haiti does not create a ‘fast food’ approach to preventative care, were people feel entitled to door to door service without any need for effort on their part!
Viva Brazil! There is a huge fan base for Brazil in Haiti, tons of people were wearing yellow and green and the Brazilian flag was flying everywhere. There was palpable excitement in the air today and everyone (who wasn’t working) was glued to the radio or TV for the world cup match between Brazil and North Korea. At the camp a gunshot rang out when Brazil scored and you could hear the roar of the crowd. I was doing the home visit at the time, my first opportunity to actually wonder through the camp and see inside a tent that people are living in. Incredibly the average number of occupants per tent is 5. The one i saw had a sheet hung in the middle to divide the sleeping area from the sitting area. I hope to see more homes tomorrow.

Corail, Port au Prince, Haiti a planned tent community

2010-06-14T20:04:00.000-07:00

Today was another interesting day, I have now taken a total of 440 photos!
After arranging supplies we loaded up the truck and headed off with the new doctor to the clinic.
I had volunteered to speak at the morning clinic meeting because I heard that when the second year resident who was volunteering at the clinic, had spoken on Saturday there had been some resentment about ‘Expat’ doctors. I spoke for several minutes aquainting the staff with my qualifications and experience and suggested that not all volunteers had the same experience. I pointed out the fact that although we are here to help the ultimate responsibility for the clinic rests with the Haitian staff and doctors. I then gave some suggestions on how I thought the clinic procedures might be improved, I told them they could take them or leave them. I think my presentation was well received for the most part.
As we were clearing up after the meeting one of the staff people fell flat on her face. This was not the same member who passed out twice last week. I treated her for heat exhaustion. My translator had called in the morning to say he wouldn’t be coming in today because he had diarrhea, I brought him in some Peptobismol. This brings to 6 the number of staff members I have treated in a week! The clinic is about 105 degrees with no air all the time (minimum). The new doctor had a good idea and we lowered the tent wall, this made it noisier but at least the temperature decreased by about 5 degrees.
We talked to the camp manager about the possibility of a generator for the clinic which would allow for a fan and use of the nebulizer. I get the impression that this is not going to happen however because of logistical and budgetary constraints.
In the afternoon I went out to the camp called Corail. This is a very interesting camp. It is what is called a planned camp. It was set up to move some people out of Terrain Acra and it now houses 5,000 people although people are drifting in and around it daily, I am sure it will be double thesize in a year. The difference with this camp is that it is structured, all the tents are in lines, with gravel on the ground. A few seedlings have been planted to create trees. It has problems though and apparently regular riots. The current controversies include the fact that food rations were given out 3 weeks ago and people are really hungry. This camp has no soil to grow food and no industry near by for jobs and none of the usual vendors, I didn’t even see the usual lottery booth. Oxfam refuses to pay people to clean the latrines and says the people should clean them of their own volition so the latrine cleaners stopped. Within 24 hours the latrines could not be used and a riot was brewing. ARC is temporarily paying the people but is unable to sustain it, there was a meeting with World Vision this afternoon and apparently they are saying they will pick up the tab, so we will see.
A stone slab has been set to allow the setting up of a primary school, which will be going up tomorrow, there is already a kindergarten. All the camps have kiddie friendly spaces, showers and a water supply. Oxfam ships in 10,000 gallons of water daily to the camp. The water balloon was deflated when I was there and the camp manager said he was not sure why Oxfam had not yet delivered the water.
While we were walking around the camp manager came and told me about a pregnant woman who was complaining of abdominal pain and crying and there was no one to transport her to the hospital. Everyone was stressing. Right place at the right time I guess! I examined her and fortunately I determined that it was probably a urinary tract infection and I just happened to have some medicine in my bag. Its hard to lecture a pregnant woman about drinking more water when there is none to be had! Anyway all is well that ends well……… I guess. At the end an ex-lover came up to us and started a long story about how she was a ‘bad woman’ and his girlfriend didn’t want her in their tent anymore and….
The best part of going to the camp? the kids, I gave out candy and the kids sang for us. There was a group of boys steadfastly playing soccer the whole time I was there oblivious to our visit. The worst part, people are hungry and thirsty something bad is going to happen.

Sunday in Haiti !

2010-06-14T18:53:00.000-07:00

Today was a little more heart wrenching than I had anticipated. After staying home all day working on clinic inventory and helping the medical director with his mid-term report I thought I would go out and get some air. I asked the driver to take me to 2 camps I hadn’t been to.
He first took me to the ‘golf course’ camp otherwise known as the ‘Sean Penn’ camp. This massive camp is located at the Pentionville Club and houses about 50,000 people. At the gate are guards who allowed us in and waved vaguely in the direction of the camp. There is a huge red mobile clinic at the entrance, really fancy and new looking, Wow ! I thought as I turned to look across the way at two abandoned tennis courts. Then we proceeded down this really complicated stone road that seemed to head straight down a hill. To call it a bumpy ride would be a major understatement! Just when I was ready to stop bouncing there it was! Piece upon piece of plastic as far as the eye could see. Children running around, people selling small goods in front of their tents, hair being braided and just general busy-ness Wow, Wow, OMG Wow!
We made our way around the camp and I could sense the desire for normalcy. It is inconceivable how people are surviving and it is impossible to see an end to this.

Interestingly, along with the people vending on the main drag there are several lottery booths. In any other situation it might even have been funny, squatters investing in lottery tickets! After noticing the lottery booths in the camps I now see them everywhere sometimes 3 within a block of each other. It must be good business!
Also in the camp are churches and other facilities but everything is really cooped up and water is at a premium.

From this camp we went to Delmas 2 otherwise known as the old military airfield which at least had passable roads and thoroughfares, otherwise more of the same.
Each camp has a clinic but each one is run by a different NGO (non governmental organization). It was all very interesting and sad.

In the evening I went to eat at a Creole restaurant. The food was so so, the restaurant was showing the world cup game of Germany thrashing Australia.

I got a little email card from my daughter when I got back saying she was proud of what I am doing……. Nice!

Tomorrow will be busy. Bon Nuit!

Como ye Aayiti (How are you Haiti)?

2010-06-12T19:34:00.000-07:00

Como ye?! That is how Haitians greet each other, it means how are you in creole.

Feeling hot ,hot, hot! This heat index of 106 is killing!

I saw 17 patients in this morning’s Saturday clinic. The heat in the tent (clinic) is oppressive, I may have to suggest ARC consider a generator so we can at least have a fan. The staff member who almost fell on me when she passed out 3 days ago, returned to work today and passed out again! I lectured her on electrolyte balance and enough water and not staying in the tent for more than 2 hours straight, even as my head throbbed like it was going to explode.

It seems someone has set up a big screen TV for the World Cup, somewhere in the camp. As I was seeing patients there was this huge unanimous roar …………Britain scored! World Cup fever or Mondial is everywhere.

Haiti is very enamored of the World Cup and football, cars everywhere are flying flags, with Brazil and Argentina leading the pack. A man was walking down the street with a huge Argentinian flag around his neck and many wear T shirts.

This evening I am staying home but I can hear parties everywhere in this gated community where most of the UN personnel stay. Is it related to World Cup or just weekend stress release, I don’t know , but they sound like they are having a good time. The house I share with 5 others is like a ghost town! I plan on catching up with writing tomorrow.

I finally figured out why my computer will not recognize my scan disc. It is the one I bought for my Blackberry memory. I tried 3 different methods before it struck me. the pictures are perfect on the camera. If anyone can tell me how to download the pictures it would be much appreciated.

I have had the "Desiderata on my mind since the morning I woke up to begin my journey, i finally googled it this evening......
"Go placidly amidst the noise and haste and remember what peace there is in silence"!

Haiti Day 4

2010-06-10T19:02:00.000-07:00

I am feeling very encouraged today, I spoke with the medical director of the clinic on the way in and he was very receptive to my ideas. In fact, he was so excited by some of my proposals that he put them into action as soon as we arrived at the clinic. I think my long email yesterday was very effective.
I personally saw 26 patients today half in the morning at Terrain Acra and the other half at a site where we went in a mobile clinic called Acacia.
One of the interesting cases I saw was a 17 year old with severe anemia, I concluded that it was iron deficiency because her mother said she keeps eating rocks (a condition known as pica). When I asked if she craved ice they both looked at me amazed and said Yes, she eats a lot of ice too. The symptom of craving ice is associated with iron deficiency anemia, did some I research on this earlier in the year hoping to find time to write a paper, which I would still like to.
After all the patients had left a guy came into the clinic complaining of pain in his eye after a piece of metal flew into while he was cutting something metal. Apparently it happened on Monday (3.5 days ago, not a good sign), he had a classic presentation of a corneal abrasion from metal with a very well defined hole right on his cornea. I later saw a guy sawing one of the metal rods that are all over the city from buildings collapsing and I could see exactly how he got the injury!
After the morning clinic I plugged in my IPOD and listened to Andrea Bocelli, I imagined him standing on top of the heap mound singing the song and of how much joy his gift would bring the people listening. Crazy huh? Well that thought lead me to another which made me smile to myself because I am so glad that I too have a gift or talent of a different kind that I can share ………. What a privilege!
In the afternoon, we went to Acadia. We had to get down from the car at some point on our way to Acacia because it was not passable and then we trekked over piles of rubble to arrive at our destination. We had to go under a massive pylon that was only being suspended by an electricity cable. Its pretty amazing what you DON’T notice after awhile!
We went to see people who cannot readily get to the clinic at Terrain Acra, even as we left the bulldozer was scooping up rubble, an amazing task. There are USAID crews everywhere trying to clean up stone by stone.

Terrain Acra Port au Prince

2010-06-09T20:10:00.000-07:00

HAITI
Today is Day 3 of my visit here.
The first thing you notice when you arrive here is how hot it is! I have never sweat so much in my life, not even in Africa.
After a slight wrinkle at the airport on Sunday I made my way to the “group house” that is shared with 5 other people. It is actually a beautiful house in a ‘safe’, gated community. I sleep in a tent on the ‘balcony’ which fortunately is inside. Fortunate because this is the rainy season. It rains every afternoon, sometimes it is a thunderstorm with a deluge and sometimes it is lighter.
On the drive from the airport there were obvious piles of rubble and destruction and a fair amount of traffic.
I met my house mates and forced myself to stay awake until after we went out to dinner, getting to the restaurant took 40 minutes. The traffic in Port au Prince is really bad and I was to discover just how bad the following day. A large part of my time is spent sitting in traffic, after a stop at the main office and a security and camp briefing I finally got to the “Tent city” where I will be practicing for 2 weeks. It is called Terrain Acra.
Terrain Acra has to be seen to be believed, it is a community of 28,000 people displaced by the earthquake all living under pieces of plastic sheets. There is no running water or electricity, the temperature outside is between 97 and 103 degrees, this is magnified by the plastic sheeting and lack of air circulation. Children, goats and pigs rummage freely in trash piles that are everywhere. What is it about pigs that makes them smell so bad?
Terrain is a squatter settlement on the waste dump of a factory owned by 3 brothers with the last name Acra (I understand they are of Lebanese origin). The brothers have agreed to allow these people to stay on the land until January 11 2011 at which time they want their land back. The police have agreed to forcefully remove the people at that time.
The ‘clinic’ is a large tent donated by Unicef, it has been divided up into 5 examination cubicles and a table which represents the pharmacy. I was only there for a few hours on my first day and then I was told to return to the office. Once there no one seemed to know what I was there for so I guess I should have gone in the ‘mobile clinic’. In the office I was given a disc on key by the data entry guy. I tried to open it later on my own computer. There was nothing on it but viruses, my computer went crazy!
DAY TWO
My second day began with a quick breakfast and then the long car ride to the camp, on the way in, I could tell my stomach was starting to rebel. I had the dreaded thought that I might have to use one of the latrines (a hole in the ground which is used as a toilet). Try as I might I couldnt ignore it and the cramps got worse. Just in time to start the daily meeting ! Great, why didn’t it start before I left the house so I could take something? I checked in at the pharmacy table, No, they didn’t have any diarrhea medicines! I decided I had no choice but to bite the bullet and go to the latrine.
The latrines stand proudly with their graffiti covered plastic flapping whenever there is a suspicion of a breeze. I am not too proud and I do need to hurry up before I run out of options, I thought. Let me check them out.
I went back and got some gloves, I didn’t like the idea of toughing the plastic not even for the second it would take me to get into position. OK, now I’m ready! I picked up the plastic and the smell was overwhelming, I reeled back and rethought my strategy, Nah! I can wait!
Unfortunately my stomach had other ideas. The cramping got worse, I was dodging in and out of the meeting trying to look very busy without doubling over. I thought perhaps I could wear a mask and that might make it tolerable (“does anyone have a hazmat suit, I’m going in!”) but I couldn’t find one. Finally on my third attempt I stepped inside the latrine and held my breath. It sounded like everyone in there had similar problems! I tried to hold the plastic ‘cover’ with one gloved hand a failed attempt at some modesty and prayed it would soon be over. Added to this was the fact that the latrine temperature is a good 10 degrees hotter than the outside. Now, you can understand why in 3minutes you lose almost a litre of sweat and exit with near syncope (that means fainting). I recalled one of my colleagues had mentioned he was about to pass out the day before doing the same thing. I returned to the clinic tent sweating buckets and seriously nauseous just in time to hear the medical director announce “I would like to introduce Dr Tuakli, our new visiting doctor!” Showtime!
So why do I tell this graphic tale you wonder? Because it really brings home how these people are living on a day to day basis with zero options, it’s a wonder a massive epidemic of cholera or dysentery hasn’t wiped the whole camp out or that people don’t become despondent in the face of such living conditions. Compared to this the rest of the day was less traumatic. I saw patients in the clinic including an 82 year old resident of the camp and several children. There was some mention of me organizing the women and child care system for the camp , we’ll see how that pans out. I guess every little bit helps and I am glad to make my contribution.
Around 3pm I went with the medical administrator to a ‘cluster meeting’. This is where all the organizations that have health programs helping out in the various camps get together and decide on strategy. There are Aid organizations from all over the world mostly Europe and the US. They decided with the WHO to call on the Haitian government to stop forceful removal of squatters in camps. By the time I spoke to my husband on skype my voice was gone and I was wiped out, I thought it was just dehydration and a stomach virus, but No, this morning I woke up with a full blown cold.
DAY THREE
I have spent the day with a nose dripping like a faucet but in addition to that I worked in the clinic in the morning. I am discovering creative talents I did not know I possessed. Yesterday a lady brought a child in with a fever of 40 degrees centrigrade (normal is 36) and said the baby had begun to have seizures, requests for Tylenol were not working and after insisting I was told there was none in drops. The child had already been stripped and sponged but was still hot (big surprise in that tent!). Brain wave! I asked for a tablet then crushed the end with my otoscope and poured the powder into the child’s mouth. He didn’t like that and started to whine, next I grabbed my water bottle and dripped some water into his mouth, Voila! All washed down.
Today, a lady came in with a child with Hydrocephalus (a big head from too much water on the brain) the child is 15 months old and has a fresh scar on the head where some surgery has been done to relieve the pressure in the brain. A sad case, the child cant walk or talk, legs are paralyzed. Apparently the doctor she saw had given her a prescription for Amoxicillin liquid, which was not available so she was told to go and buy the prescription elsewhere. The child’s caretaker came to me and asked me to help. She said the child’s mother had died and she had no money. I spoke with the doctor, “well she can come back tomorrow and she can see if we have some then” she said. Ahh, I don’t think so! I went to the pharmacy and told them to take an adult pill and have them crush half of it three times a day.
I have treated four staff people so far!
A middle aged lady came in with a 3 day old baby, apparently it had been delivered ‘at home’ in a tent, the mother was not there. Unfortunately, this opportunity to intervene was missed, the clinic staff cleaned the umbilicus and sent the baby ‘home’.
This plus several other issues prompted me to send a long email to the program director. I’m not sure how popular I am going to be after this!
My mind is racing with ideas of things we can do to help the community at Terrain Acra .
I will keep you posted!

Headed for Haiti, Emotions!

2010-06-06T15:57:00.000-07:00

Its 5 AM!

And so begins my self-inflicted adventure to Port au Prince in Haiti. I said goodbye to my worried husband around 7.15 am at BWI and boarded the flight to San Juan. I was very worried that my bags would be too heavy but we were able to include all the prenatal and kiddie vitamin bottles I had brought with me plus a 5 pound bag of candy for the kids.

What are my emotions? I am not sure, after having so many people,including my dear husband, tell me not to go, then the security advisories and disclaimers from the American Refugee Committee (ARC) the group I am going to work with,I feel mre anxious than I usually am when I leave for a volunteer trip. The positives include the possibility of perhaps making a difference to someone in Haiti and also the chance that I may actually get more rest there!

Apart from only getting 3 hours of sleep last night and getting up with a sore back, the past few weeks are starting to take their toll. In addition to organizing a women’s seminar and having to evict a tenant from a rental property, I have had to work through my son’s “senior pranks” and graduation plus get my practice ready to do without me for two weeks and prepare for Haiti, all the while reassuring everyone that I will be coming back alive! In retrospect its been a tough year so far – a sentiment I am sure that is shared by everyone in Haiti! That thought rapidly puts everything in perspective doesn’t it?

I am hopeful that I can maintain my enthusiasm but am a little scared of being overwhelmed by the squalor and misery. My other fears are another earthquake or hurricane making orderly functioning impossible, plus I am claustrophobic so I will not be one of those surviving for days under the rubble- and then there's security.
Clues to the security situation have been provided by ARC: a casual mention that I will be picked up from the airport by an armed guard and their repeated requests that I fill out a “proof of life” form. “What is that?” I finally asked. “Just a form that lists answers to questions only you would know in case you get abducted” Aaah, yes of course!

I am anticipating up to 12 hour work days and I wonder if arriving exhausted is really doing a disservice to my potential Haitian patients.

Enough about you, what’s going on in Haiti you ask. Well I don’t know yet, I’m on a little plane on the way there from Puerto Rico. The captain says it is 33 degrees centigrade at the moment – what is that?

I will write about my initial impression and emotions shortly. Meanwhile where are my tissues……..just in case!

Shout out to sponsors!

2010-06-06T15:55:00.000-07:00

I wanted to acknowledge those who sponsored our seminar:
Northern Pharmacy with a special shout out to April!
Vien clinics of America
Spectracell

Happy 90th birthday Ms. B! News about our great seminar!

2010-05-31T14:40:00.000-07:00

Here is a picture of me with a patient of mine who turned 90 this month. Doesnt she look great!Happy birthday.

Last weekend I held an anti-aging and hormone replacement seminar entitled: looking good and feeling good after 40! It was great and very inspiring for me personally to see women so receptive to receiving new information.
The seminar opened with Claudia Salomon a renowned Nia (and Zumba) teacher helping us claim the space that we were in. What I thought was going to be a mild stretching exercise had me breathless when called upon to speak even though we performed the movements right where we stood. After lunch she gave us another 7 minute workout and for those who wished she did a full class at the end. So invigorating and energizing, after Claudia the excitement was palpable, the room was electrified.
The first discussion was about Bio identical Hormone replacement and evaluating what hormones need to be replaced. Over 40, the most important hormones to get in harmony are: Estrogen, Progesterone, Cortisol, Thyroid and Insulin. Many people were surprised to discover that all steroid hormones are derived from cholesterol and there is such a thing as a too low cholesterol.
We also talked a lot about women's sexual dysfunction, how to manage it, how hormone replacement can help and what Herbs maybe useful. Its interesting that "erectile dysfunction" is all over the airwaves now and is considered a socially acceptable topic of conversation but more women than men suffer from sexual dysfunction yet no one feels comfortable talking about it.
Wow! No one knows unless they ask. "Is this normal?"
Dr Kanter followed with a very concise presentation on body contouring with plastic surgery. He got rave reviews from all the participants. He covered the body from head to toe and kept the audience spell bound with his before and after photos.
After lunch Claudia's routine helped with digestion and then we were back to talk about Anti-aging and Telomeres.
Three scientists were given the Nobel Prize for medicine last year for their work in this amazing field. Its implications are profound for understanding the aging process.
(Call our office if you would like to get your telomere length measured).
I was able to discuss a full and comprehensive Anti-aging workup such as the one we perform, in great detail. A very important component being neurological testing.
Dr Comeau a local physician talked about Botox and Fillers and then did a demonstration on my office manager Cindy. Once again everyone was riveted with attention.
There wasnt a dull moment!
It helps to be a woman over 40 and with the number of women I see in my practice I know what subjects are of interest to Baby Boomers. It is my goal to keep bringing you seminars
that are relevant, interesting and exciting with the end result of bringing life to your years!
We shall be holding another seminar in early fall, if you would like to be notified of our events please call our office at 410 992 0011 and give us your email address or send it through the contact page of the website.

Next week I will be blogging from Haiti !

Vitamin D the under represented vitamin

2010-02-09T19:03:00.000-08:00

I first got interested in Vitamin D a few years ago when a professor of Dermatology at a high profile institution in the North East got kicked out of his job for recommending that people get more sunlight. I was a little curious as to what sparked such controversy as clearly, an Ivy League dermatologist would be unlikely to put his job on the line over a vitamin!

After that I started receiving emails from the 'Vitamin D Research Council' an organization apparently funded by a doctor who believed so much in the importance of vitamin D that he put his career and a fair amount of his own money into proving the point.

Initially I was a little skeptical of the apparently far reaching consequences of Vitamin D deficiency: from possible association with Autism and ADHD to an increase in Cancer and infections. Then my skepticism turned to concern, the more I read and the more I checked my patients' vitamin D levels. Almost 90% of my patients were vitamin D deficient and at least 50% severely so. As a result, I have been checking Vitamin D levels routinely in all patients presenting for an annual physical exam for at least 2 years.

Most patients are not aware that they are deficient and have no symptoms but sometimes people are markedly symptomatic. Fairly often I find that Vitamin B12 deficiency and Vitamin D deficiency go hand in hand.
Such was the case with a patient of mine who came in to my office complaining that she thought she was developing Alzheimer's. She was very distressed and told me a story of constantly forgetting things and her anxiety about this. She became emotional when she explained how she did not want her children to find out. I suggested she see a neurologist and get some labwork done while she was waiting for that appointment.
Apparently she was so demotivated and forgetful she didn't get the labs done, continued with the neurologist who told her she didn't have Alzheimer's but she could try some medicine if she wanted, in case it helped. She declined.
She came back to see me 3 months later more tearful and agitated than before, she could hardly get out of bed in the morning because she was so tired. Her legs hurt and everything was a struggle. This time she got her labwork done and both her Vitamin B12 and Vitamin D level were extremely low.
With replacement she is fine, two weeks later she was back working the garden she loves and now she laughs when I remind her that she was convinced she had Alzheimer's.

Most cases are not as dramatic but is Vitamin D deficiency another one of those 'silent killers'?
Andrew Weil recently wrote an article stating that he is raising his recommendation for Vitamin D to 2000 daily (something most of my patients are already doing) because of a recent study out of the University of San Diego California which suggested that raising vitamin D levels could prevent one-half the cases of Breast cancer and two-thirds the cases of Colon cancer.
Hello this is HUGE!! As Dr Weil points out: a 50 percent reduction in Breast cancer would have saved the lives of more than 20,000 American women in 2009.

Vitamin D is thought to affect the immune system, it controls the utilization of calcium by the bones and so is important for bone strength, lack of it contributes to fatigue, it helps seniors retain their balance. It is important for cardiovascular health, in Diabetes, Psychosis and every month a new article comes out with different attributes.

In short, we need it! You can get it through fortified foods like milk and cereals but the main way is either supplementation or the sun. The latter recommendation being what cost my dermatology colleague his job because he suggested patients go out in the sun for half an hour a day without sunscreen.

Bottom line vitamin D is beginning to be recognized as a critical vitamin, if you have not had yours checked, do it now and take the necessary steps to keep it above a level of 32 (ideally closer to your age).

As always wishing you good health

Dr Tuakli

Latest mammogram recommendations

2010-01-03T19:25:00.000-08:00

I have been asked by some patients what my thoughts are regarding the new mammogram recommendations. Quite frankly they don't make sense to me and will not change my current management of patients at all. Why?

Well first of all they are exactly what they claim to be "guidelines", I can choose to follow them or not. In this case I would rather not.

Mammograms are problematic from the standpoint of radiation however I have seen MANY patients diagnosed with Breast Cancer as a result of them. One of the most concerning trends has been the discovery of breast cancer in younger and younger women, the idea that they would not be diagnosed because they would delay their mammograms to the age of 50 is scary.

The bottom line is, as with most things in medicine, tailor the recommendation to the patient. It is important to have an on going relationship with a physician who knows you and who will make recommendations based on his or her knowledge of you and your particular situation, not based on guidelines. For example prolonged use of certain contraceptives, family history, breast exam findings are all things that would change how often and when a particular patient should get a mammogram.

Remember guidelines come and go, they are not set in stone and neither is your wellness. It should be a dynamic process arrived at by rational thinking and on going education.

When insurance companies finally start paying for thermograms we will have alternatives that don't involve radiation that may be more appropriate for some patients.

Until then for most people mammograms are the best they can afford ......
If you are at high risk remember to avoid caffeine, take indole-3, do regular self breast exams, do not take Provera and follow your doctors screening schedule.

Wishing you a healthful 2010

Dr Tuakli

Is the fedex man delivering more than just packages?

2009-11-18T19:22:00.000-08:00

There is a story that is told in medical history about a milk delivery maid who was dubbed 'Typhoid Mary' because she single handed contributed to the biggest typhoid epidemic in England. An interesting story often told to very green medical students as an introduction to the term "carrier".

A patient of mine came in recently with the Swine Flu H1N1) he was very sick and was still wearing his Fedex uniform. I advised him that the type of work he was doing and his exposure to the elements would only make him sicker, needless to say I put him out of work for a week.

As I looked at this poor person with bloodshot eyes, sweating and coughing up a storm, I had cause to rethink our (the Health Establishment's) definition of 'High Risk' patients i.e those who are eligible to recieve the H1N1 vaccine. Surely the delivery man innocently delivering packages from one establishment to the next and potentially picking up infection at one and depositing it at the next, is at high risk. Not only that, he (or she) presents a risk to the community at large as he proffers his pen with a grin and the instruction to 'sign your name!' before darting off to the next densely populated building.

In my office we have been lucky enough to have had the H1N1 shot throughout the 'shortage' and we have religiously followed the Health departments instructions to limit its use to high risk individuals; children ages 6 months to 24 years, healthcare workers and pregnant women. As of this week I have opened it up to many more people that I consider high risk such as teachers and metro workers.
I have been struggling with the idea from the beginning that students need to be vaccinated but not those who teach them. Maybe I am more sypathetic because my husband is a professor or just because I have NEVER seen my 17 year old son as sick as he was with the Swine Flu. He rarely gets sick but this bug made him as sick as a dog! (He came down with it 3 days before I recieved my supply of vaccines ...........).

Anyway to cut a long story short, come on and get your H1N1 vaccine, lets curb this epidemic. It takes 2 weeks to develop a good immunity so hurry in, next week is Thanksgiving and yes, if you drive a UPS truck ................ you are welcome too!

It really IS an epidemic this time!

2009-10-29T17:50:00.000-07:00

Yes, we have H1N1 shots in our office and Yes, I recommend them!
We have been inundated with people who have flu-like symptoms as well as people coming in for the vaccine. It really qualifies as an epidemic this time around. The local school board is posting the percentages of absenteeism for every school that has at least 10% of the kids out sick and there are no schools that are NOT on the list! One school was recorded twice with almost 20% of the students out sick.
One of my patients came in today with a red eye, body aches, fever, headache and generally feeling yucky and mentioned that at her elementary school (she is a kindergarten teacher) 10 teachers were out sick on the same day which resulted in general chaos as they tried to move the teachers and volunteers around to fill in the gaps.
One anecdotal observation: I haven't seen a single patient who has tested positive for Swine flu on culture who doesnt have a cough and a fever. Interesting since with regular flu you dont always have a cough. Body aches and sore throat are also extremely prevalent symptoms.

What to do? Well, first of all if you have any of these symptoms Stay Home! Spray your door knobs and counter tops with Lysol or the equivalent. Cough into your elbow and put hand sanitizer on your hands frequently. Get treated early.

We treat all our patients aggressively with homeopathic remedies, vitamins and supplements along with prescription anti-virals. Almost all are better within 3 days ............... except for that cough! If you start treatment late that cough can drag on for weeks. Inhale steam as much as possible and avoid cold drinks.

Prevention: Always the best option.
Get your Flu shots, both regular and the H1N1 (call the office if you need one). Stop by and pick up your "Well Being" and Vitamin C and Cod Liver Oil take them thru the winter, its going to be a rough one.
Stay out of crowds.

Warning:
Beware The Flu is usually worse after Thanksgiving ( after all the hugs and kisses). This year it started really early and with a vengeance, and if it is going to get worse after Thanksgiving we all need to be pro-active!

Peri-menopause is a tough one!

2009-08-16T19:11:00.000-07:00

It has been my experience in the last 20 years that the Peri-menopausal period is actually harder than menopause itself.
I want to discuss some of my theories as to why this is so, but first what is Peri-menopause?

Peri-menopause is defined as the time during which a woman's body transitions into menopause, it can be from 6 to 10 years and ends 1 year after a woman has had her last period. It usually starts to occur in the 40's.

Many women are taken by surprise when they begin to experience peri-menopausal symptoms as they are unfamiliar with this phenomenon. Often they expect the cessation of their periods to be the first sign. Whereas period irregularities are often an early sign, they are more likely to become erratic and varied, longer or shorter in length and different each month.

Peri-menopause is a time when hormone levels are fluctuating wildly, and the changing symptoms demonstrate this. Moodiness and depression may set in because of unaccustomed feelings, people who have never had headaches before can develop migraines. The memory declines but not consistently and women may begin to feel a little 'fuzzy' and very vulnerable. The latter occurs particularly in professional women who are used to being able to make split decisions. And then there's the weight gain ! Almost invariably across the board there is more deposition of truncal fat in spite of regular exercise and weight control methods.

Inconsistent sleep and night sweats cause a lack of rest and this adds to the irritability and depression, women find themselves anxious for no specific reason and may lose their motivation.

Changes in the sexual arena can also be expected and once again may fluctuate with hormone levels.

Remember that this is also a transition for families who are suddenly surprised at the changes in a woman's persona but often are too tactful to mention it. The people around you are a good barometer they tend to notice a whole lot more than you give them credit for!

So why is it so tough?
Well, first of all because it is unexpected, it seems so sudden there is no time to adjust. It often occurs at a time when the woman has a lot of responsibilities, having achieved a certain professional level with a completed family to take care of. Stress is a huge aggravating factor in Peri-menopause and the sudden overwhelming sense of not being able to handle things is very common. For many women this is the first time they have ever had 'anything wrong' with them.

Secondly, it is not often discussed so women don't know where to seek help, they may not even be aware that there is help and so this generates a feeling of isolation. A reluctance to discuss the symptoms while attempting to handle it by themselves. They are not alone! Millions of women have the same problem they just dont talk about it. Whereas the syndrome of Menopause is well known the precursor is not.

Lastly, there maybe a sense of loss, women know something is changing and it may not be a state they are ready for. they know intuitively things will never be the same again. Skin changes, memory changes, lots of gas, dizziness and joint pains may also accompany this condition. One thing is for sure these are physical and physiological changes, its not all in your head!

In my next blog I will discuss ways to deal with these symptoms and how to improve the quality of life as you proceed to menopause.

Be well, lively and healthy until next time.........................

Dr Tuakli

Hi from Honduras

2009-07-01T18:18:00.000-07:00

Last week our blog came from the Andes in the southern hemisphere and now we are coming to you from Central America. What a difference in weather, time, and culture---In Peru it was winter time and it was cold and drizzly, and in Honduras it was hot & humid.

My family and I were on the island of Roatan, which is part of the Bay Islands located north of mainland Honduras. It is known for its stunning beaches, pirate history, and a wonderful mix of natural and ethnic diversity. In all my travels I truly believe that Paya Bay in Roatan is one of the most tranquil and idyllic places on this planet. The Paya Bay Resort exudes a special energy that calms the soul and gives new meaning to relaxation and regeneration. Next summer, I plan to organize a weeklong retreat with free seminars on anti-aging and bio-identical hormone replacement at this resort. I would be happy to supply details to anyone who is interested.
One of Roatan's main attractions is its barrier reef (the second largest in the world) which attracts divers from all over the world. In addition, there is a host of other activities including yoga, kayaking, meditation, hiking, and just watching the sunset from your hammock on the beach. Paya Bay is a very secluded and private spot of the island, and it gives one the sensation of being at peace & harmony with yourself and nature.

I have been volunteering to work in Honduras for several years now, and three years ago went to Roatan to work at the Clinica Esperanza, a clinic established by a nurse from Ohio, Ms. Peggy Stranges, to provide basic health care to islanders regardless of their status. I came upon Paya Bay quite by happenstance, after working in the clinic for a week I decided to take a weekend on a part of the island more remote and less populated. What a discovery! I cannot wait to go back and hope that I can encourage others to experience this small slice of paradise known as Paya Bay, Roatan, Honduras.

All good things must come to an end---as we departed a military coup d'etat was taking place and we learned upon arriving in Washington, D.C. that the president of Honduras was exiled to Costa Rica and an interim government was established. Notwithstanding this unfortunate turn of events, the Bay Islands (Roatan, Guanaja, and Utila) are not a center of political unrest and they are culturally and geographically distinct from the mainland. Fortunately Paradise remains untouched!
Remember to find time to relax and to stay emotionally and physically healthy. Until we meet again, Dr. Tuakli

Travel Health

2009-06-06T20:30:00.000-07:00

Hi from Peru!

I am in Lima at present and finally have a little time to Blog.

It is the winter time here and it really gets chilly in the evenings. Riding around in a cab is quite an experience, kind of like being on a speeding race track with a cacophony of horns as background music. The price of the taxis is equally amazing, no more than $5 to go all around the city, I must admit the price is right.

This is the time of year when many people travel and I would like to talk about some of the things I advise my patients to do before they embark on international travel. There’s nothing like getting sick to ruin a trip, it will make you wish you had never gone in the first place.

Having a travel consult with your doctor is always a good idea and plan ahead, sooner is better than later. Try and get your consultation done at least 60 days before leaving as some vaccines like hepatitis A are only useful if you get both shots and they cannot be taken closer than 30 days apart.

Believe it or not the leading cause of illness in travelers is Diarrhea not exotic diseases like Yellow Fever or Swine Flu even though shots for these conditions may be useful. Diarrhea mainly occurs because travelers are exposed to bacteria that their systems are not familiar with not because the people are dirty. When foreigners come to the US they get Diarrhea too.

Why is Diarrhea so important? Well, let’s say you get Diarrhea then become dehydrated (especially in a hot country). You would then need to be taken to a medical facility where the first step would be to give you an IV, is the needle clean? Is the fluid sterile? You have no way of knowing how hygienic the facility is and all of a sudden a ‘minor illness’ becomes a big deal. There is a protocol that we give our patients to all but eliminate the likelihood that Diarrhea will spoil their vacation.

When you go to some countries you may need special medications, such as medication to prevent altitude sickness. This may be the case for example if you plan to come to Peru and go to Macchu Pichu.

Remember that allergy season is different in different places, for that reason and the possibility of reacting to different foods take along some Benedryl if you have allergies.

Your doctor can review your medical history and suggest Preventive Health strategies specific to your condition. There is a lot more to staying healthy abroad than just taking shots. As far as shots are concerned there may be many that are helpful ranging from updating your Polio vaccination to Meningitis depending on where you are going but some are 'no brainers' for everyone such as up to date Tetanus and Influenza shots.

If you are going to a mosquito infected area remember to pack some long sleeves and pants to wear after dusk, that’s when they tend to bite. Remember if the mosquitoes don’t bite you, you CANT get Malaria or a whole host of vector borne diseases. Its pretty basic and well worth bearing in mind.
On the subject of insect bites, my favorite insect repellant is Skinsensations by Cutter. It doesn’t smell, is not greasy and easily sprays on without making you feel hot. Most hardware and drug stores have it.

Finally, Don’t forget your Sunblock! It should protect against both UVA and UVB rays.

Hasta Manana!

As always wishing you the best of health .............. wherever you are!

Dr Tuakli

PANDEMIC , HERE???!!! WHOA, JUST A MINUTE!

2009-05-03T11:37:00.000-07:00

As a proud alum of both Harvard and Johns Hopkins Schools of Public Health, I think I have been taught by the best to think information and issues through while not deserting 'common' sense.
The current level of alarm in the general population regarding the Swine Flu colloquially known as H1N1 seems unwarranted at the very least. Why?

A little research into influenza in the United States reveals that there are 200,000 hospitalizations and 36,000 Americans die annually from Influenza related complications. If that is the case and according to the CDC it is, 20 times more people died in the US this flu season than have died in Mexico during this 'epidemic'.
Also the people who have died in Mexico have been a small percentage of the people who actually contracted the virus down there. In fact so many people got the virus that there is increasing immunity there and the numbers of new cases are decreasing.

Initially, as I understand it from a top official from the CDC, it was only the cases that were hospitalized that got tested. As a result it looked as if everyone who had it was dying. whereas in truth it was only the sickest of the sick who were in hospital.

When you add to this, the fact that most people in Mexico do not get vaccinated against any flu viruses and that the nutritional status of the average Mexican is not as good as that of the average American one starts to wonder if the label 'Pandemic' might not have been a little hasty.

And then there's this new nomenclature for Swine Flu: 'H1N1' which sounds more high tech and
sci-fi than Porcine Influenza but actually the predominant Influenza A strain in this country during the 2006 -2007 season was a H1N1 virus just a different strain.

I could continue on with the science but I wont except to point out one more fact and that is that a person who contracts influenza A is most contagious for the first 4 days, lasting at most for a week after they develop symptoms. Do not be afraid of people who were in Mexico at Easter!

A group of 27 high school students in Colorado were apparently asked not to attend their high school graduation because they had been on a senior trip to Mexico. None of them were sick!

The point of this blog is the following:
let's not generate panic and deflect resources where they are not needed.
The strain of Influenza isolated so far is no more virulent than the strain that circulated here this winter. This is good news. We can anticipate far less morbidity and mortality from this Flu than we have in the average Flu season yet we don't close entire schools every time a student comes down with the Flu.

Hand washing and the other preventive measures I mentioned in my prior Blogs should make us all feel a lot safer. Its amazing how often the best solution is a low tech one with all due respect to my esteemed colleagues.
I would be interested to read your comments

As Always Stay Healthy.
Add years to your life and life to your years!

Dr Tuakli

Don't drink from that cup!

2009-05-01T06:25:00.000-07:00

The latest (as of this morning) confirmed figure of cases of H1N1 (swine flu) in Maryland is 9, I have no doubt that it will be higher by this evening.

Try not to take young children into crowded places, this is not the best time to go to the ball game with them. Avoid crowded malls and shows.

If you are Catholic you should skip communion, it is not a good idea right now to drink from a common cup!

Remember hand washing is your best defense. Children cannot help touching everything, so keep them safe!

Be healthy

Dr Tuakli

SWINE FLU UPDATE !

2009-04-30T20:02:00.000-07:00

The WHO has now upgraded the threat of the Pandemic to level 5. Which means that a global outbreak of the disease is imminent.

In the meantime there have now been 3000 cases with 168 deaths in Mexico. The number of cases in the US exceeds 100 and there are 19 in Canada. I understand that schools in Texas are closed.

Several patients have called to ask for prescriptions of Tamiflu. That is not a good idea, first of all if everyone started to take Tamiflu daily there may not be sufficient supplies for people who are actually sick. Secondly, we don't want to generate resistance to the medication by indiscriminate use.
The best bet is to wash your hands frequently and avoid obviously sick people. Wear a mask, if necessary, in health facilities and crowded places. Seek medical attention immediately for all fevers and flu-like illnesses.

Don't panic, stay informed and take charge of your health. Avoid risky exposures.

As always wishing you optimal health and happiness

Dr Tuakli

SWINE FLU UPDATE

2009-04-30T08:26:00.000-07:00

As of yesterday the WHO had updated the Pandemic Alert level to phase 4. This means that there is actual evidence of person-to-person transmission of the swine influenza.
There were 91 confirmed cases in the US with one death in Texas. No cases have been confirmed in Maryland.

Remember, hand washing is of the utmost importance and keep some alcohol-based hand rubbing solution with you. Use it after being in public places like the bank and post office.

There IS treatment for this condition and it is important that it is started early.

If you have any of the typical symptoms of the flu, particularly if you have a high fever make an appointment with your primary care physician as soon as possible.

In the meantime, dont panic! Remember this is actually a preventable condition if you are diligent.

Its Spring! A wonderful time of renewal and optimism

Choose to be Healthy !!!!

Dr Tuakli

SWINE FLU, A Public Health Care Emergency !!!

2009-04-27T18:47:00.000-07:00

Tonight I am going to talk about a potential health problem called the Swine Flu. Although the initial symptoms of Swine Flu are pretty similar to the Flu we are all used to it can rapidly get out of hand because humans don't have any immunity to it. It is called Swine flu because it is usually found in pigs.
Even when a person does not get a Flu shot, because of years of exposure to human Flu strains they have a certain ability to withstand the worst symptoms of the flu but with Swine flu there is no innate protection. This is why the World Health Organization has announced the possibility of a pandemic.
A pandemic is worse than an epidemic in the sense that it involves a much wider area of the globe and many more people and thus can take a lot longer to get under control.
There have been 40 confirmed cases of Swine Flu in the US so far. 7 in California, 2 in Kansas, 28 in New York City, 1 in Ohio and 2 in Texas. As you can see there is no defined geographic distribution of the spread and it is assumed that most cases are from travel or contact with a traveller, in these days where thousands of people fly from A to B daily it could just be a couple of days before we are in the throes of an epidemic. Currently this Swine Flu Outbreak is defined as a Public Health Emergency .
PREVENTION is always better than cure!

Wash your hands frequently, avoid sick people. Try to stay in good health, take vitamin C, get plenty of sleep. Drink plenty of fluids and eat nutritious food.

If you have an 'Flu-like" illness be seen quickly. Symptoms may include high fever, chills, sore throat , sweats, body aches and cough.

If you get sick antiviral medication can make the illness milder so you can feel better faster. They can also prevent the more serious complications. The problem is that if you don't start the medication within 48 hours it may not be effective. Because of this we will most often treat a patient 'empirically' before the culture result is obtained. It is important to avoid all aspirin products including peptobismol when you have the flu especially in children under 18.

The medicines that treat the Swine Flu, Tamiflu and Relenza are 70 to 90 percent effective at preventing the Swine Flu.

A person is contagious for 7 to 10 days with the Swine Flu.

In children, according to the CDC emergency warning signs are:
Fast breathing
Bluish skin color
Not drinking enough fluids
Lethargy
irritability
Fever with a rash
Seeming to get better and then return of fever and worsening cough

In adults, emergency signs requiring urgent medical attention include:
Chest pain
Shortness of breath
Sudden Dizziness
Confusion
Persistent vomiting

I hope this information is helpful. Please feel free to call our office for any further assistance you may need.

Dr Tuakli

IS IT HOT IN HERE?? You bet!

2009-04-26T18:56:00.000-07:00

Wow! Talk about spring fever, from 60 degrees to 92 overnight.
I was doing Soccer Mom duty today and I was burning up.
Yes, it was hot today and it certainly doesn't help those with hot flashes. If you thought you were going crazy at least no one noticed that you were sweating more than everyone else but remember there are ways to relieve the flashes and all the other symptoms of hormone imbalance.
For people who prefer not to use hormone replacement there are many herbal supplements which can be quite effective but far and away the most effective management is hormone balancing with bio-identical hormones.
Hormone replacement is not just for the over 50 crowd anymore it is used for younger women for severe PMS and other imbalance related disorders.
But this is not just about hormone imbalance, Spring is a great time to get your health in general well balanced and on a good path. One of the parents today proudly displayed that he had lost 25 pounds just by stopping sodas.
Just do it! Off with all the winter woolies, get off the couch and get moving! You can no longer use the weather as an excuse for not walking. If you don't already have a pedometer, you need one.
We always over estimate exactly how much we walk, shoot for 10,000 steps a day. It's a lot harder than it sounds. It's amazing how little we walk in this country, I often have a hard time making 6000 steps here and yet when I'm in Europe at the end of the day I realise I have done 12,000 just moving around and boy do I feel it.

The warm weather also ushers in the good fruit and vegetables in the supermarket. The prices of course have sky rocketed which means eating well and reasonably, takes a little more planning than previously but...... you are worth it. Try to drink some pomegranate juice during the week and some sort of salad daily.

Sunblock! What a dilemma. Over 80% of patients in my area are vitamin D deficient this time of the year and the best (for some the only)source of vitamin D is the sun. So weigh the pros and cons, if you can get half an hour of sun exposure a day it would help. Darker skin tones need more but if you are very fair skinned and at higher risk of skin cancer you may just have to break down and rely on the supplements. You are going to need at least 1000 units a day!
Either way keep your sunblock handy for prolonged sun exposures. They say any SPF above 45 is wasted. Dont forget to use your Stop Aging Skin Therapy twice a day, it is fantastic.

A little Heads Up. This summer I will be working at the Clinica Esperanza in Roatan, Honduras
and checking on one of my favorite seniors a former Dean of a Law School in Peru who is now 94!
I will also be in Europe later in the summer so the best time for appointments is before June.

Remember Spring time is about renewal. Get energized, get healthy, its not a dress rehearsal!

Add years to your life and life to your years!

Dr Tuakli

Susan Boyle! What an inspiration.

2009-04-15T19:31:00.000-07:00

I am making a major departure from my normal blog to talk about Susan Boyle!
Wow! I am not one for television but I happened to see a blurb about Susan and watched a video of her performance on Britain's got Talent (or something of the sort!). I must admit I found it really inspiring. I can only imagine what guts it took for an unemployed 47 year old Scotswoman from a small village to travel down to London and follow a dream. When she got there she had to endure the snickers and thinly veiled insults of a host of people before she got her chance on the big stage.
Did I mention that she is somewhat uninspiring to look at, and according to her she has never been kissed?
Well, the old adage "you cant judge a book by its cover still holds true".
When Susan opened her mouth to sing her song about a dream she ROCKED the house including Simon Cowell and all the judges.
If you have not yet seen the video I highly recommend it, it is inspiring and very touching. guaranteed to melt your heart!

OK Susan, now on a professional note:
Life is just beginning at 47 you are going to need my help! I can help you become vital and self assured and optimistic. With a sharp mind and tons of energy.
Just like my patient MW who was in yesterday. She turns 90!!! next month and I am hoping to post a picture of her on my blog when she does (if she gives me permission).
She drove to my office yesterday and shuttles other seniors around. She bowls twice a week and is only on one medication, she really is quite amazing.

Life is full of great miracles and you are one.

Wishing you much success,

Add years to your life and life to your years.

Dr Tuakli

Resolving Headaches and other Symptoms

2009-04-15T18:43:00.000-07:00

I had a patient come in today with surprisingly good news. "I feel great" she said
"almost all my symptoms are gone. I can now focus on my foot pain because I feel so good!"
When the patient was referred to me by the local health food store 2 weeks ago and she began to tell me all the things that ailed her, I wondered where to start. Her over-riding concern was the headache she was getting daily along with some dizzy spells but as the tale unraveled she had a host of other complaints too.

Given the number of physicians she had seen in the past I wasnt expecting miracles.But when all else fails start with the basics!
I put her on magnesium and gave her a book to read about self help for headaches, ran some routine tests and asked her to make a follow up appointment.

Magic! Apparently that's all she needed to get rid of her migraines,she completely changed her diet, stopped caffeine and wine and there they went!
Interestingly enough it seems a lot of the other symptoms she was having were tied in with her migraines so once we fixed them, everything else just fell into place.

As she said earlier today: Once I was given the information I had the tools to take control of my condition, and that's all I needed.
Aah! how nice if all my cases were that simple.

Its your life take control!

Buying Blinds,Balancing Hormones and Trekking from Pennsylvania!

2009-04-12T17:47:00.000-07:00

Having prescribed Bio-Identical Hormones for nearly 20 years, I have many amusing anecdotes that I tell from time to time. i thought I would share some of them on my blog.
When a new patient requests Bio-identical Hormone Replacement we perform a thorough review of their medical history and symptoms. In addition, I consult with them so that they have a good understanding of how Hormone Replacement works and together we determine if they would be a good candidate for Hormone Balancing.

One day, after a long discussion with a patient who had driven down from Pennsylvania, she stood up and said with a big smile on her face "I'm so glad I decided to buy those blinds!".
Baffled I asked her what she meant, the ensuing story was amusing:

She went on to explain that she had ordered some window treatments. The installer brought his wife along with him to the job. While he was installing the blinds, his wife noticed my patient fanning herself and sweating incessantly. This resulted in a conversation about menopause and the installer's wife referring the customer to me!

That story tickled me and I always chuckle when I recount it.

These days she tells another one that I like, she says her husband refers more patients to me than she does! She says when they go out to dinner with his friends and their wives he leans over to his friends and whispers "Your wife should see my wife's doctor!" or when his friends complain about their love life he tells them to fill up the car and drive down to Columbia.

Happy Easter! Still waiting for Spring.

Dr Tuakli

More stuff on men

2009-04-07T20:23:00.000-07:00

There are a host of complaints that men have that can be indicative of hormone deficiencies or Andropause. These complaints often include weight gain, and a lack of stamina.

For many men aged 35 to 50 the major concern is loss of lean body mass (muscle) around the middle and decreased libido. On occasion there may also be depression, sleep disturbances and loss of vitality.

I think the biggest surprise is how early men begin to manifest signs of hormone imbalance and deficiency. One often associates women with menopause starting in the late 40's not realizing that men can start a decade earlier.

The difference with men is that the changes are not as dramatic as Menopause and so men tolerate them better and gradually get acclimatized to feeling less than optimal.

What to do?
Well, first figure out your baseline in your early 30's.
Did you know that the average testosterone level in men is much lower than it was 50 years ago? Scientist's dont know why this is the case. It may have something to do with the food supply, fertilizers, hormones in meat etc.

Secondly , get a saliva test to check both your hormone levels in the tissues and the balance between them, this would include your sex hormones as well as the adrenal and thyroid hormones.

With this information your Growth Hormone level and the blood chemistry profiles you will be able to evaluate your risk factors for morbidity and mortality.

Many studies have shown a direct link between a man's testosterone level and his risk of early death from all causes including cancers.
We always knew testosterone was important for a man's well being and now we have proof!

Keep your hormone levels optimal, one of the best ways to:

Add years to your life and life to your years!

(Come in and get your levels checked, it could save your life)

Its about Men too!

2009-04-05T19:37:00.000-07:00

Many people are guilty of focusing a lot of the attention of hormone replacement on women and as a result men tend to come up as an after thought. I think one of the reasons for this is that the vast majority of patients we see are women.

Women have no problem seeking help once they realize it is available and they need it. Men on the other hand, are reluctant to seek care. They often need to be dragged in by a partner or a well meaning friend.

Surprisingly enough however, men need hormone replacement and anti-aging just as much if not more than women do. How so?

Well for starters women can be acutely aware when their hormones are not balanced and of course for many, the signs of Menopause are inescapable.

In men Andropause tends to be more subtle and the changes from insufficient hormones more insiduous but no less destructive. I have had patients who have tolerated impotence and loss of muscle strength and weight gain until the sudden arrival of Diabetes wakes them up to their predicament.

Men need hormone replacement, detoxification, vitamin supplementation and tune ups regularly and prevention is better than cure. There is so much science available now, NO ONE should settle for feeling less than optimal.

I realise that I too have been guilty of blogging mostly about women's issues, but now I will write a fair amount about men as well.

It is extremely gratifying when a man who was very skeptical at first returns with a big smile and firm handshake and says "Thank You" !

There is also a role of Hormone Replacement for men who are already diagnosed with a disease state.

GS is an 85 year old male. He has been coming to see me for a long time, I remember when I first met him he was frail and didnt breathe very well because of long standing emphysema. The doctors had not given him a happy prognosis and advised him that he would not be able to be independent or live without oxygen for long. This was seven years ago.

Fortunately, for both of us he is a fighter and we both had the same goals i.e make the time left functional and as disability free as possible. In other words, make the best of whatever lung tissue he had.

G stopped smoking and literally took control of his health, he changed his diet, took supplements and had a wonderfully positive atitude. He did really well and with good preventive care we kept him 'healthy'. I told him to keep his pulmonology follow ups and hadnt heard from him for a few months, I assumed all was well.

Late last year he called my office and told my staff he could not walk across a room without becoming extremely breathless and as a result he could not even make it in to my office. He had been given a slew of pharmaceutical agents and oxygen and was becoming weaker by the day. He asked if them to find out from me if I had any suggestions. That was a little challenging without seeing him but I suggested some supplements and medicine adjustments and hoped for the best.

Sure enough he became strong enough to come to the office and we now have him on Hormone Supplements as well, he looks and feels great. We are ready for another seven years!

there are several points to this story:

1, Don't wait until you are on your last leg

2, Men can be significantly helped by an anti-aging program

3, Even if you are frail from disease that is irreversible, you may be able to regain enough of your strength to improve the quality of your life.

4, Its never to late to take control of your health!

Have a great week, add years to your life and life to your years.
Its your health enjoy it!

Dr Tuakli

Needless suffering!

2009-03-26T19:19:00.000-07:00

Everytime I see a new patient for HRT (Hormone Replacement Therapy) I am amazed at how much women are suffering with menopause and how few people are aware that there are alternatives.
A patient I saw today looked so unhappy I wanted to just reach out and tell her "It will be OK". Despair was written all over her face.
She must have felt my empathy because after the consultation she surprised me when she said
"at least someone cares!".

As strange as it may seem I am so used to being a woman's last resort, they come in devasted by how they feel and how difficult it is to find help.

It just boggles my mind that in 2009 the medical profession still refuses to acknowledge menopause for what it is : a syndrome that often requires treatment. No snide comments or knowing winks 'you know she is going through the change' or 'its a natural process suck it up' and do we really care who's mother went through menopause without so much as a hot flash? This is 2009 and we are baby boomers, working and juggling, stressed to the max, already out of balance before menopause deals us the final blow.

It occurred to me today where a large part of the problem lies: With us the doctors!
In medical school menopause is barely mentioned and then in passing with a reference to the bad health conditions that occur after it but not as a medical entity that itself should be taken seriously.
Until the medical establishment and then the public at large takes it seriously, patients will not feel comfortable discussing the full extent of their complaints.
I have said ad nauseum: there is more to menopause than hot flashes, there is more to a woman than a uterus! And not only can hot flashes be debilitating, menopause is a syndrome not a symptom. It is a constellation of symptoms affecting almost every organ in the body. It is a bona fide condition which should be handled as such and considered worthy of treatment. Women should not be made to feel apologetic because they 'can't handle it' nor should they randomly be given medications for sleep, depression and anxiety without having the benefit of a full evaluation and treatment of the underlying cause.

IT IS TIME TO START A CONVERSATION about those issues that affect the quality of the lives of women - Menopause can adversely impact the lives of those closest to us and it is time we gave this syndrome the public attention it deserves. The Public Health impact affects not only women but families and friends, workmates and relationships.
If you know someone who is suffering needlessly with menopausal symptoms please spread the word and let them know there are treatments available that will restore their quality of life.

Add life to your years and years to your life

Dr Tuakli

Vitamin and supplement testing

2009-03-22T19:26:00.000-07:00

Oftentimes people ask me ''what would be a good vitamin regimen for me?" as if there is a fixed regimen that works for everyone and all I need to do is tell them what it is.
Unfortunately it is not quite that simple but the answer is important none-the-less. Vitamin and supplement deficiency cause a lot of symptoms ranging from deafness and macular degeneration to dizziness and hair loss. One of the commonest deficiency symptoms is fatigue, unfortunately this can be caused by iron deficiency, vitamin D deficiency, deficiency of zinc iron, iodine and thyroid, vitamin B12 deficiency, inadequate anti-oxidants, different hormone deficiencies and on and on!
As with all good medical care it is better if the regimen is tailored to the individual patient rather than a one size fits all approach.
Fortunately this question can be answered with a simple blood test, check out a list of some of the deficiencies that can be tested for on the Weight Control page of my website. That test, plus an evaluation of your hormone and iodine levels can be the key to a whole new quality of life.

Its your health, take control !

Have a great week

Helping you to add life to your years and years to your life....

Dr Tuakli

BOTOX and FILLERS in time for Easter!

2009-03-15T17:58:00.000-07:00

We will be having a special day to get ready for spring. Botox and Fillers on sale April 4th at our Columbia office.
If you used to think smoothing out wrinkles and looking bright is only for the rich and famous, think again. Its really not as major as other 'cosmetic procedures' and takes only about 30 minutes. Make a subtle yet noticeable difference.
See you there!

The WISDOM study waiting for spring!

2009-03-15T15:11:00.000-07:00

Hi welcome back.
Got the winter blues? Let's talk about the symptoms of menopause.

This week I want to mention a study that many in this country are not aware of regarding HRT. Most people know about the Women's health Initiative study (WHI) which was stopped at the NIH after the results of women taking Prempro and Premarin did not look good.
However it seems that when some positive studies come out there is not as much publicity.

The most recent large scale Hormone Replacement study published is the WISDOM study taken from a trial of 5000 women in the UK, Australia and New Zealand.
WISDOM stands for Women's International Studyof long Duration on Oestrogen after Menopause.
This study was actually going on at the same time as the WHI but the investigators decided not to stop it when the WHI study stopped.
You can read the full study in the British Medical Journal, part of it was discussed in May 2008
and part in the August 21 2008 edition (BMJ 2008:337 a 1190).

The May edition discusses the fact that there is much less risk of venous thrombosis (blood clots in the veins) especially in the first year when it is usually higher if the (O)estrogen is not taken by mouth.
The August article dwells on quality of life issues, something which is, to my mind at least, just as important as keeping people physically healthy.

The study essentially shows that hormone replacement improves the physical and emotional well being of menopausal women (big surprise!).

There was SIGNIFICANT improvement in 'vasomotor' symptoms (i.e hot flashes, night sweats etc), sexual functioning, sleep problems and aching joints and muscles (now that IS a surprise!).

I have to admit that does pretty much sum up my clinical experience over the past 2 decades.
The VAST majority of women who come in for hormone replacement are complaining of:
Hot flashes, zero sex drive, anxiety/depression, sleep disturbances and general malaise.
The unfortunate thing about the study is that they used the Premarin (yep, the horses urine) and Provera (yes, the one that can increase the incidence of breast cancer).

So what's the bottom line?

You CAN treat Menopause and feel better, you just have to do it safely. Every woman should choose what's RIGHT for her, no two women are the same. Stay away from things that are not natural to the HUMAN female and keep reading and educating yourself about your choices.
Remember:YOU CAN FEEL BETTER!!!! Yeah!

Have a good week, add years to your life and life to your years!

Dr Tuakli

Welcome to our blog!

2009-03-04T19:06:00.000-08:00

Hi everyone,

We have a new website and blog and I am excited about having a forum to provide valuable information about your health. In the coming weeks I will be discussing the benefits of Hormone Replacement Therapy (HRT), Cosmetic treatments, Weight-Control treatments, and interesting case studies of health topics that interest our community of bloggers.

In our office patients who are interested in HRT fill out a symptom monitor questionaire at their initial visit to measure their symptoms of hormone imbalance from 1-10, with 10 being the worst. This week I had a lady in her early forties who had a 10 out of 10 on 13 out of 15 symptom categories such as depression, estrogen dominance, sleeplessness, irritability, and low libido. Her symptoms imply that she has a severe hormonal imbalance which means that we need to conduct tests so that we can ascertain the cause of her problems. We sent her for saliva testing, urine iodine testing, blood work, and vitamin screening. We will follow her case on future blogs to track her treatment and results.

This weekend we Spring Forward an hour! Remember to set your clocks as we move towards Springtime.

As always, our goal is to add years to your life and life to your years,

Dr. Tuakli