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Eat What You Kill - July 2024

July is a great time for the outdoors. The heat of summer is in full swing and gardens are flourishing. The hard work of planting season is starting to pay off and dentists are cursing the season of sweet corn. With the gardens supplying a fresh supply of fruits and vegetables, has your diet improved? What are the ways to improve your diet?

The general American diet is low in fruits and vegetables as well as fiber. Our portion sizes are much too large leading us to overeat, and overeat the wrong foods. Typically the plates of Americans are filled with very high caloric foods that are also nutrient poor. Many of the daily breads we eat have the fiber rich nutrients left out from their production in favor of the less nutrient portions. The NIH has followed the expansion of portion sizes from when they began in the 1970s and their large expansions in the 1980s and 90s. They note the very real and strong correlation between the increase in portion sizes and the increase in American’s average weight. When tracking the portion sizing of food today and comparing it to the same food 20 years ago, we see an easy increase of 1,595 Calories over a day of consuming today's larger portions. With the daily recommended Calorie intake around 2,000, we see that we are easily over consuming Calories. Many people complain that they begin to diet and eat right with little effect on their weight. It is possible that even with the more healthy eating that dieters are still over consuming in their Calorie intake during a day due to maintaining the typical portion sizing that they had before. 

Good dieting starts at the grocery store. Controlling what you take home greatly impacts the food choices you make. If you don’t have sweets and junk food available in your house then it is that much harder to eat it in a moment of weakness during a craving. The healthy foods are only located on the periphery of the grocery store. The junk food is sitting in the middle as the copious amounts of preservatives in it doesn’t necessitate the electricity for refrigeration or the fresh deli. A good rule of thumb is if it doesn’t rot it isn't healthy. My wife has been experimenting with the sour dough bread trends and has purchased some of the “fancy” bread from the deli and bakery area of our grocery store. We had a surprise when the bread became moldy after just a few days. Our typical sandwich bread lasted for weeks easily. It was a large wake up call to rethink our choices. 

The next area of dieting is choosing more fruits and vegetables. The fruits have the sweetness we crave, but when we are used to the artificial sweetness of over processed foods we have a harder time recognizing their sweetness. It takes a good two weeks for our body to readjust to the changes we make whether they are lifestyle changes to form a habit or changes to our diet. A strong two weeks of eating right will help form a habit and reset your palate to enjoy the natural sweetness of nature’s bounty. Vegetables are a filling substance and have great fiber. These are important to regulate our gut health. And the sweetness of fruits make for snacks that are filling and satisfy that sweet tooth. Growing your vegetables in your garden is a great option to build a hobby outdoors and better your diet. 

Lean meats are where we outdoorsmen can thrive. Harvesting your own meat and prepping it can really make a difference. Trimming the fat will help cut out unneeded calories. Once upon a time this fat was needed when food was scarce and calories were not met. Today’s American society doesn’t have these problems of calorie deficiency, it is more a problem of over consumption and over consumption of the wrong foods. 

Making these modifications can greatly impact your health and you will feel it in your daily energy, focus, and strength. Another benefit will likely be seen in the common symptom of acid reflux. Heartburn and acid reflux is a too common occurrence for the average American. Much of this can be improved with these diet modifications we discussed. Unfortunately, there are other strong factors that are pushing against diet modification being the only change that is needed; and those are the dreaded proton pump inhibitors (PPI). These medications have been much beneficial in the short term and have grown to an extreme popularity and ease of access. They are available without a prescription meaning they have been wrongly thought to be safe and harmless. There are many things to consider when taking these medications as they do have cons to oppose their pros. 

PPIs work by decreasing the acid production by binding to the parietal cells in the stomach. The parietal cells are the cells in the stomach responsible for producing the stomach’s acid. But, they are also responsible for the production of intrinsic factor. Intrinsic factor is needed for the transportation and absorption of vitamin B12 leading to those on long term PPI use having higher incidence of vitamin B12 deficiency. PPIs also have been linked to Osteoporosis or lower bone densities. The decrease of stomach acid affects the vitamin D and calcium pathways leading to net loss of bone density. The inhibition of parietal cells of the stomach from PPI use also makes the survival of bacteria and yeast more likely. PPI use has been associated with higher levels of Helicobacter pylori, Clostridium difficile and small intestine bacterial overgrowth (SIBO). PPI use is also associated with higher incidence of pneumonia and diarrhea from irritable bowel syndrome (IBS). With all these ways PPIs can do harm we now see why PPI use is only recommended for short spurts when treating heartburn symptoms. 

If acid reflux is something you struggle with, medications can help short term but diet changes are likely needed to change the cause of the problem. SO reap what you sow, eat what you kill, and watch out for heartburn and the medications that treat it. Talk with your doctor about the treatment plan right for you. Doctor’s orders. 


References: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447051/

https://www.nhlbi.nih.gov/health/educational/wecan/news-events/matte1.htm

Medicinal Mushrooms - May 2024

There has been a shift in the culture toward more natural ways one can be healthy. Some look to supplements from natural herbs as ways to get their bodies nutrients and maintain their health. Some notable “natural supplements” have been mushrooms that claim to have medicinal properties. Mushrooms like lion’s mane, cordyceps, and reishi have been used in non-western medicine for thousands of years. Is there any truth to these medicinal mushrooms?

We all enjoy the start of spring with mushroom hunting and note the blessings of the plants sprouting and reviving for another springtime. It warms my heart to get back out into the woods on the warmer days of April in the search of mushrooms. With the edible mushrooms we find, I wonder what other mushrooms we should gather up as well. 

I am not a coffee person, but I had been hearing about some different coffee alternatives with claims that it was a beneficial way to start the morning with the mushroom additives in these drinks. They also had claims of improving mood and focus for the day. Well I certainly didn’t want to be missing out on some possible benefits of jump-starting my morning, but I also didn’t think these claims were necessarily truthful. So like any lifelong learner, I set out to see if these claims of medicinal mushrooms had any truth to them and if there were any adverse effects from ingesting them.

I remember back to the large classes of biology when I was in university and a class of plant pathology that I particularly enjoyed. There I learned some medical advances we have gained from mushrooms. We discovered penicillin from watching how mushrooms fight off bacteria. And one lesson that stuck with me from this class was that the powerful hallucinogen LSD was discovered by a scientist, Albert Hofmann, from handling mushroom spores known as ergot. The LSD was absorbed through his fingers and I imagine his journals written under the influence of this experience must be quite interesting to read. The professor of my plant pathology class also described how ergot and the LSD it manifested may have been a contributing factor to the Salem Witch Trials. So knowing that mushrooms can have both beneficial properties like penicillin as well as very harmful properties like the production of LSD, it is important to treat them with the respect they demand.

One of the mushrooms that has a lot of claims of medicinal properties and is in most of the products is lion’s mane (Hericium erinaceus). It is also known as yamabushitake. It is said to have properties that improve mood, focus and concentration. It is also said to improve diabetes, heart health and digestion. That is one great mushroom! Looking at the studies that lend favor to these claims, they do show data that suggests these claims are true. However, the studies typically have a small sample size and are done fairly short term. Also, the number of studies that were done on human subjects is fewer. The animal studies did show improvement in the mice’ anxiety and the lion’s mane did improve their blood sugars. Therefore, we don’t know if the crossover to having similar results in humans occurs, but it does suggest that it's a good possibility. The tests performed also did not find adverse effects of lion’s mane.

Cordyceps is another mushroom that has claims of many health benefits. Chinese medicine has also been using it for many, many years to treat diarrhea, headaches, and kidney disease. While it is also the star infection source of the popular game and TV series “The Last of Us” it is comforting to know that the infection they depict of this fungus is purely fantasy. It will not infect your brain and turn you into a zombie the way it does to insects because the fungus cannot live in warm blooded creatures. Studies have shown with mice subjects that cordyceps had improvement in the blood sugar of mice with diabetes, improved runs through a maze for mice and slower progression of cancer in mice. While these studies were done in mice there hopefully will be a beneficial crossover for humans. The studies, overall, are not necessarily showing improvement in fatigue, cognition, diabetes and the immune system for humans, but they are not showing harm to humans either. Hopefully, more studies will come to show there is indeed a crossover of the cordyceps’ beneficial effects to humans.

Reishi also known as lingzhi is a fungus well known in Chinese medicine for its beneficial effects to immune systems. There have been a few studies that suggest pathways for how it is benefiting the immune system. There have also been studies that have shown the extracts of reishi may show benefits in the fight against cancer. The tests showed the extracts of reishi were able to kill the cancer cells in vitro and similarly had beneficial reactions with in vivo studies with mice. The studies with reishi did find conflicting evidence for liver damage associated with use of this mushroom extract. So there may be a possibility that the mushroom causes some harm. 

Overall, these studies show there really may be something to these claims that medicinal mushrooms can have. The studies are limited in the participants of human trials but their use has been around for a very long time in Chinese medicine to show that they are relatively safe. However, there are many people that have adverse effects from many types of mushrooms and are even allergic to them. Before taking any supplements or additives to try to augment your health, discuss them thoroughly with your healthcare professional to determine a proper plan that is both beneficial and safe for you. 

The studies and products available to these supplemental shrooms show many different ways of preparing them to receive their potential benefits. There are extracts of the mushrooms and ways of just cutting them up to put on a sandwich. The extracts seem to be more associated with the medicinal properties of the mushrooms being more available to be absorbed by your body, but the dosing of them doesn’t seem to be established without more human trials. So now that we know these mushrooms are relatively safe and that there may actually be something to their claims, talk with your healthcare professional about if they are safe for you and have an alternative to your morning coffee. Doctor’s orders.


References

Lion’s Mane- https://www.healthline.com/nutrition/lions-mane-mushroom 

Cordyceps- https://www.healthline.com/nutrition/cordyceps-benefits 

Reishi - https://www.healthline.com/nutrition/reishi-mushroom-benefits 


Allergies Ahoy! - April 2024

April is here and it brought the pollen with it. Dust and pollen is in the air and in my eyes. Seasonal allergies are definitely in full swing. With our love for the outdoors, how do we maintain our time in the spaces we love without getting all teary eyed in all the wrong ways? 

The main ways that allergies get started in the spring is through pollen. Pollen is part of the reproductive system of plants. Since plants cannot move they have to spread their pollen and potential to reproduce in creative ways. In order to match up the pollen with the stigma to complete pollination the pollen must somehow travel there. Luckily, the plants have devised multiple clever ways to achieve this. Some use animals, like bees, to carry the pollen. These are the plants that I love because these types of plants are goldenrod, roses, and pretty flowers. Better yet, these plants don’t typically flare up our allergies. Their pollen is heavy and doesn’t fly in the wind much, but it does go “poof” on the windshield of the side-by-side as I drive through the field of goldenrod. Other ways the plants spread their pollen is through the air on the wind. These flowers are usually more camouflaged and not as pretty looking as they don’t need to attract bees. They just shoot their pollen into the wind and don’t care if the majority of it gets into my eyes and nose. They also don’t seem to mind the curses I mutter at them as I am overcome with allergy symptoms. This is the cursed ragweed. This green, ugly plant is the cause of our suffering. It shoots its pollen in the wind and causes upward of 15% of people to get allergies from it alone. Or worse, the dreaded cockleburs that I curse in spring and again in fall. They love to spread their reproductive particles on me year round; in the spring with their indiscriminate pollen shooting and the fall with their spiky seeds covering my dogs and myself. 

Ways that we can help limit our allergies from flaring up is to try many simple steps to lessen the pollen we are exposed to including spending less time outdoors. I know, a terrible idea. I am not going to heed that one, but it is technically an option. Okay, onto the others; an easy first step is to change the air filters. They say you should do it about twice a year so I like to do it when I change the thermostat from heating to cooling and again in the fall when it gets changed back to heating. So that is about this time of year. Having a fresh filter will help to catch the dirt, dust and pollen from blowing around the house. It is easy to forget this step of maintenance, but travel down to the depths of the basement where your furnace is located and there you will find a filter that is in need of a change. There are many degrees of filters from standard cheaper ones to “CDC fall out shelter level” (not their actual titles). With my level of allergies, the fairly standard grade at a cheap price seems to work well. For those with more severe allergies, investing in a standalone air filter may be of worth. I know during the days last autumn when Canada was blowing smoke in our face, a quality air filter got some good use. So we all agree that we are going to go outside, but when we do, wearing sunglasses will not just protect our eyes from the dreadful melanoma but can also help keep the pollen out of our eyes and help with allergy symptoms. Importantly, when we come back in from the weeds, it is key to strip off the pollen infested clothing and wash it. This helps prevent our exposure to the pollen, let alone the poison ivy and whatever critters we tract in with us. After stripping out of the outdoor clothes, it is important to wash our bodies before bed to help get rid of the pollen and other allergens. Nighttime is when some symptoms can flare due to lying down with sinuses that are already strained. The next steps of washing are to wash your bedsheets weekly. This will help with the dust and other allergens that accumulate there from getting a close relationship with your nose when you sleep. Washing the dogs and other pets is also a key maintenance step. Their pet dander ranks high on the list of allergens and they also like to bring in pollen and other allergens from the outdoors. The combination of pets and their close proximity to your nose should be limited, so that means having them sleep somewhere other than in your bed. Your allergy symptoms will thank you as well as your good nights of sleep. Opening windows in the house is something that should be given a little more thought. We took a great deal of effort adhering to the vast cleaning regimen detailed above and I am not sure we wish to squander it by letting the allergens easily bypass our defenses. So choosing carefully when to open the windows should be the next step. A good way to know is by following the weather forecast for pollen and other allergens. There are pollen counts and other allergy “weather forecasts” available on most of the weather apps and websites. They can help us to stratify the risk of having the windows open for the day. 

There are a few medications that help to mitigate the symptoms seen with seasonal allergies. The watery, itching of the eyes and nose that is runny or stuffed solid can be improved with antihistamines. And for those with Asthma or COPD the right combination of inhalers can make the world of difference. Talking with your doctor and pharmacist can help you minimize your allergy symptoms. 

Overall, the outdoors are something to be enjoyed and to enjoy them to their fullest extent this spring we need to control our allergy symptoms. Wear some protective eyewear, change the filters, wash yourself, pets, clothing and bedding, and watch the pollen forecast to lessen your exposure to the allergens. Also, get the right allergy regiment by talking to your doctor and pharmacist. Doctor’s orders.

The Feast of Kings- March 2024

The great American lifestyle has achieved a wonderful thing. In the great prosperity of these fine United States, we are all able to eat and drink like kings. We are able to easily find any food our heart desires as if we are all lords demanding to be brought another lamb leg at the grand feast after an epic battle. We eat and drink the delicacies of half a world away. The stores are all filled with apples and oranges year round and the walk-in coolers seem to have a never ending supply of alcohol. These factors all allow us to feast as if we are kings and makes us susceptible to “the disease of kings.”

Gout is a very painful disease process. It is commonly called the disease of kings or a rich man’s disease due to the way it occurs. Gout is a build up of uric acid in the blood that leads to its crystallization in the periphery of the body. It commonly settles in the joint space of the big toe and other joints in the hands and feet. As the needle-like crystals settle into the joint space, they cause immense pain with every little movement. Typical test questions usually describe the patient overcome with pain from the “whoosh” of the doctor’s coat causing a breeze over the area. 

The buildup of uric acid usually comes from multiple factors that lead to the kidneys not being able to filter and excrete it fast enough. It could be from decreased filtration or just a larger intake of the precursors of uric acid.  Obesity, decreased kidney function, heart failure and diabetes can all impact the kidney’s function leading to an increase in uric acid. Even some medications like ones for blood pressure can increase your risk for gout. These risk factors mainly come from their change in the balance our body has with the uric acid it produces. The balance changes when the excretion of uric acid cannot be completed as quickly or when the production of uric acid is increased, like from multiple nights celebrated with steak and alcohol.

Modifying the risk factors for gout will help you control the attacks of gout. Making sure your diet has the delicious meats you have hunted but also has the correct mixture of fruits and vegetables will help offset the proportion of red meats and alcohol to other forms of sustenance. Weight management will have a positive effect on your kidney function and make it easier for your body to excrete the uric acid buildup. There are some risk factors for gout that are not modifiable. Having a direct family member that suffers from gout increases your risk of developing gout attacks as well. The genes they passed on to you may put you at a higher risk of developing gout due to the ways that your genes dictate your body to degrade the precursors to uric acid and excrete them. And it is those precursors for uric acid are where the disease gets its famous nicknames. 

Uric acid comes from the body breaking down proteins; namely purines. So all the wonderful meat that we spend our time hunting and then rubbing and marinating and smoking and then finally and deliciously consuming with a nicely paired wine or other type of alcohol increases our purine intake. As our body changes that delicious sustenance of purine rich food into energy, so we may do it all again, it makes a byproduct of uric acid. That uric acid is not necessarily a problem as the kidney will filter it out and we just excrete it on our next trip to the bathroom. That is until the intake and production of uric acid gets too much for the excretion part to keep up. For example, when you take a wonderful winter vacation to the nice warm beach of Mexico and celebrate with lots of seafood and many drinks each day for a week, chances are the multiple days of that kingly lifestyle and great feast will overcome the already delicate balance of uric acid excretion the body was maintaining with the midwestern diet of steak. The uric acid then builds up in the blood and forms nice needle-like crystals in the cool periphery of the body and finds a nice home like the joint for the big toe.

Symptoms of gout usually occur in the feet or wrists. It is most noticed in the joints where the crystals like to build up and the movement is able to create the great pain known to gout. These spots are likely where the crystals find it easier to form. With the hands and feet being farther away from our center they are slightly cooler. It is the colder, slower flowing blood that the crystals form their painful, needle-like shape and take root.

The main thing to do once the gout attack starts is to not make it worse. So modifying the diet to avoid all the kingly vacation foods will help the excretion catch back up and be able to decrease the uric acid levels. Some NSAID medication, such as ibuprofen, will help with the pain and the inflammation. Once the balance has been restored and there are no longer bouts of pain, a controlling medication like allopurinol may be started with the help of your doctor to help improve your balance of uric acid and we can continue to live as the kings we all are. 

Heart Health- February 2024

February is American Heart Month. With the CDC reporting that 1 in 5 deaths in 2021 was due to heart disease, we should look into ways we can improve our heart health. From my extensive education in medical school, one of the things they taught us is that hearts are important for life. What a great lesson that was; simple and direct but no less true. Let’s learn ways that we may preserve our hearts and improve their health.

What ways are there to measure our heart health? One of the best ways to measure a heart’s health is to measure how well it can perform. So we measure it by giving it a lot of work to do like when we exercise, then we look at how well it handles the stress we put it through. We smartly call this an “exercise stress test.” During this test the patient walks on a treadmill with many wires measuring the electrical activity of the heart. We interpret the electrical activity as the function or motion of the musculature of the heart. If there are abnormalities in the electrical conductance of the heart it suggests that the muscles won’t be performing at their best. This could be from a problem with the “electrical wiring” of the heart, but more commonly, it is from the blood supply to the muscles being “clogged.” This clog doesn’t allow enough blood flow to supply the oxygen needed when the heart muscles are getting a good workout. It would be good for you to consider what your metabolic equivalence is. This is a rough indicator to tell the amount of stress your heart may be able to handle. 1 metabolic equivalent (MET) is considered the amount of oxygen consumed at rest while sitting. An important measure is that you are able to complete 4 METs such as climbing a flight of stairs without stopping or going for a brisk walk. To better your heart health, talk to your doctor for safe ways you may increase your exercise tolerance. After all, there is a reason that certain medication commercials have a warning telling you to ask your doctor if your heart is healthy enough for certain “exercises.”

If you are not able to complete good exercise it is a good indication that your heart health could use improvement; after all, I heard that hearts are important. Cholesterol is a way to get a sense of the possible “clog'' in the arteries of your body and the arteries that feed your heart. Knowing if you have high cholesterol and the makeup of that cholesterol is an important factor for your heart health. Your doctor can assist you in acquiring some blood work to look at your cholesterol and help you with ways that you may improve the cholesterol and, in so doing, improve your heart health. Cholesterol levels are typically reported in total cholesterol and then good (HDL) and bad (LDL) cholesterol. If you need to improve your cholesterol levels a great place to start is with avoidance of tobacco products. Quitting smoking is a difficult but not complex task. It will make so many great improvements in your health and quitting will really change your heart health in an extremely positive way. Another way to lower cholesterol is to lower your fat consumption. Decreasing the saturated and especially avoiding trans-fats in your meals will improve your cholesterol. What better way to get some lean meat than to be an outdoorsman? Harvest some of your favorite meat and prepare it by trimming the fat to create lean meat. Plus the work that you put in leading up to that harvest I bet was some good exercise. Don’t forget that exercising most days of the week and losing weight are great ways to lower your cholesterol as well as the other benefits they give to your heart health. 

Exercising most days of the week will benefit your heart health. Moderate intensity exercise (METs 4+) for more than 30 mins most days of the week showed that people not only lost weight but improved their good cholesterol (HDL) and their overall heart health. Some good ways to incorporate more exercise into your day are to take a brisk walk during your lunch or schedule some dedicated exercise time at a gym or with an exercise group. Bonus if you incorporate a friend as it will improve their health and keep you on task with your goal by having a partner to help push you. 

When hunting, we know that damaging the heart is a great way to bring down an animal fast. I see that with no heart, a quality, fit, and prime of his life, white-tailed buck runs about 100 yards before he collapses and becomes my prized harvest. Unfortunately, my luck is that he runs to the bottom of the deepest ravine he can find, but it shows just how great the heart matters. With heart disease being so prevalent in humans, we all need to make sure that our hearts are in the best shape possible for the rut or just everyday life. So look into your own heart health by asking about your cholesterol levels, your exercise tolerance, and ways that you can improve them. Doctor’s Orders.

New Year's Resolution- January 2024

January is the start of a new year. With many practices of reflecting on the year past and looking ahead to the year to come, it is a good time to set goals. Many people call them New Year’s resolutions and the most popular ones revolve around one’s health. They are commonly goals to exercise more, lose weight, eat healthier, quit smoking, and reduce stress. With popular jokes poking fun at how these resolutions only last a couple months and that being confirmed with a Forbes survey showing that 8% give up after one month, 22% at two months, and another 22% at month three, it seems that we can use assistance in our goal setting skills. 

Reflection is a powerful tool that helps to assess whether you are on the course that you wish to be to attain your goals. January is also international quality of life month. What better month to encourage us to evaluate our lives and assess if we are where we wish to be? As we look back on the previous year and make goals for the year to come we need to make sure the goals are SMART: specific, measurable, attainable, relevant, and time bound. Making a goal planned around these aspects makes sure that we may see progress as we inch towards it and it assists us to stay motivated towards the goal that we have set for ourselves. Writing down the goal makes it a physical object and more real than a goal that is only a thought.

A specific goal is one that is clearly stated and narrow enough that it is known if it has been achieved or not. It can further be specific to state what will be done and steps that will lead to that goal. A measurable goal ideally has a gradual measurement rather than an achievement that is either “yes or no”. Being able to measure the gradual progress leads to better encouragement that there is headway being made towards the achievement of the goal. Seeing that progress is being made is very helpful to the psyche and adds encouragement to stick to the goal. Make sure that the goal is attainable. It should be a goal that may be accomplished within the time frame set. The goal should also be relevant to what you wish to accomplish and fit with your values. Making the goal have a time limit helps us to be motivated to have a due date as we all procrastinate. I also find it helpful to have a designated time to start towards the goal and times that I have scheduled to work towards it. I know that my mind makes many excuses as to why I should put things off for tomorrow and making goals and little goals within goals helps to keep me accountable and motivated to work towards the lofty ones. 

With the majority of New Year’s resolutions being health related to weight loss and smoking the best way to accomplish these is to create it to be a lifestyle change. Now changing major aspects of your life is difficult but not complicated. It takes perseverance and commitment. With long term changes it is very important to create a routine in order to establish a habit. I know when I get out of the habit of working out it is hard to restart it. Then, overdoing it when I do get back to the gym leads to muscular pains that discourage returning the next day for more and can even necessitate a period of more rest from the gym. I tell patients to start very small; we all seem to say that we have little to no time for more exercise so this is a great first goal to build momentum. I usually suggest setting aside a quick 3-5 mins to lie on the floor during a time that you hope to build into a dedicated exercise time. As you lie on the floor, think about the goal, envision a small workout, take some time to think about the day, some meditation-like time. And if you feel like it, as you are on the ground, try a few crunches, it doesn't need to be many as you have already completed the first goal of getting some time set aside and are lying on the floor. The extra credit you do will motivate you to do the same the next day. Perhaps the next day, keep the time commitment and lie on the floor and start with the few crutches of 5 or so. Keep this going until you have accomplished a week of keeping the time commitment. Then, congratulate yourself on completing a large step towards your goal. You have created a healthy habit.

Giving up smoking is a great goal to start at any time. Smoking has an addiction part to it that can make it difficult. Again, it is a difficult goal but not a complicated one. There are medications and other nicotine replacements that aid with the nicotine addiction, but I find the harder part is the lifestyle habit. The times people reach for their smoke is when they are stressed or as a habit at certain times of the day. And breaking that habit seems to be the hardest part. Also, the aspect of having a friend group that are smokers makes it difficult too. However, that difficulty can be an advantage if you incorporate them all into quitting with you or ask them to be your accountability partners. Good friends are ones that challenge us to become better. Make your smoking goal stepwise by setting specific dates to be cutting back on smoking and having a strict quit date. Set a date to discuss with your doctor for medications to assist with medications for nicotine addiction. 

With these steps of reflecting on your past year, looking forward to the next year, assessing your quality of life, and then writing out a SMART goal with steps to achieve that goal with specific dates, you will be much more successful in the completion of your goal. So remember international quality of life month this January and through your reflection set some goals for the coming year making sure that they are SMART. Doctor’s orders.


Reference

Davis, S. (2023) New Year’s resolutions statistics 2024, Forbes. Available at: https://www.forbes.com/health/mind/new-years-resolutions-statistics/ (Accessed: 14 December 2023). 

Winter Is Coming... For Your Health- December 2023

Winter is a time where deaths increase. There is no doubt that the cold kills more than the heat. This may be due to people lacking proper heat in their homes, the increase of illnesses that circulate in the winter, or perhaps a combination of factors. One thing that cannot be denied is the flood of people to the emergency department with the first snowfall. Car accidents, falling on ice and frostbite all make their way to the ED with the first snowfall. The group we will focus on now is the group of people that come with their first heart attacks. 

The typical story usually starts with a fairly healthy elderly man of 60-70 years old or an unhealthy 50 year old man. They mowed their own lawn all summer and maintained a nice lawn that they frequently yelled for the neighborhood kids to stay off. Then the first snow comes and dang it if they aren’t going to be out there shoveling it themselves. So they bundle up and set out to shovel their driveway and sidewalk. During the shoveling they notice that they are breathing extra hard and are out of breath, but they put it off as they have put on a few pounds over the years. They aren’t as capable as they once were, but definitely don’t believe they are too old or weak to maintain their house. After a bit more shoveling, they notice that they have a stitch in their side and some tightness of their chest. They may take a short break and the chest tightness resolves. So they set out again and finish shoveling. Then, they start to notice that that chest pain has returned, and this time it is not going away. They start to rub their chest over their heart and tell their wife that they are short of breath. It is at this point that the wife makes them head to the emergency department to get checked out. There is certainly a reason that married men live longer.

The emergency department assesses them as failing their “at home stress test” because they developed chest pain during their exercise. A cardiac cath will be ordered and they may get a cardiac stent placed. But that is only how the lucky ones fare. Unfortunately, many others have a larger and quicker blockage of their coronary vessels; they, unfortunately, do not make it to the emergency room before collapsing in their driveway. Heart attacks carry a high mortality rate and of those patients that survive about 20% will die within one year after their heart attack. And the majority of those are in the first month of the heart attack. Indeed having a heart attack is a very big alarm that we are all extremely mortal.

Identifying the symptoms of a heart attack is important to identify the need to seek care promptly and prevent mortality. Symptoms of a heart attack most often include chest tightness and shortness of breath. But also watch for pain or numbness in the arm or neck. If you develop these symptoms it is important to have them properly evaluated in a timely fashion. Women are a mysterious bunch and don’t we all know it. Even in medicine women are more likely to present with atypical symptoms of heart attacks when compared to men. Meaning women may have other symptoms than chest pain and shortness of breath. It may be stomach aches, arm pain or numbness, or jaw discomfort.

Talk with your doctor about ways that you may modify your risk factors for heart attack. 90% of the causes of heart attacks for men and 94% of the causes for women are modifiable; smoking, obesity, exercise, high cholesterol, and high blood pressure are all risk factors that can be managed. One can drastically reduce their risk for heart attacks and strokes by changing these factors. Diabetes combined with high blood pressure makes an excellent recipe for heart disease that leads to heart attacks. However, proper management of diabetes and blood pressure nearly negates all the increased risk. Therefore, proper visits to your primary care physician to catch and manage these conditions can drastically reduce your risk factors. As they say, an ounce of prevention is worth a pound of cure.

Smoking is the number one risk factor. Quitting for just 6 months drastically cuts your risk for heart attacks. Stopping smoking is commonly talked about but isn’t achieved as often as I would like. It takes some real willpower to stop. Luckily, there are all sorts of resources to aid you in quitting. There are some medications to help with nicotine cravings, but a lot of it is your willpower. Getting in touch with others to quit with you and support groups can help. There have also been many people that tout acupuncture and hypnotism as aiding them to quit smoking. Overall, quitting smoking at any stage will be very beneficial for you. 

Exercise and weight control has so many benefits for your health. Taking real control can reverse difficulties with blood pressure and diabetes. Regular exercise will lend you more energy, decrease your inflammation and improve your mental health. With the winter blues coming, regular vigorous exercise will keep those blues at bay. Decreasing your risk for heart attacks is just one more benefit of what proper exercise can do for you. 

This winter, stay healthy with regular exercise and quit smoking. Don’t over exert yourself with a large chore when you haven’t been as active in awhile. When the first snowfall does come, get the neighborhood kids out shoveling snow. It builds their character. For those extra stubborn men, watch for the signs of a heart attack for yourself and your neighbors. Doctor’s orders. 

Dignified Death- October 2023

Hunting season is the best of all the seasons. The time of harvest is celebrated all over. With all the time to sit and think in the treestand thinking of the great life the deer has lived, there is the acknowledgement of one’s own mortality. Working in the hospital with those that are very sick I have seen many people that haven’t taken the time to ponder their own mortality. It seems to be taken for granted the quality of our medical system that when you have severe pneumonia or a heart attack you think of it as a few days resting in the hospital before you bounce back. Many of us know a few people that have survived their brushes with death and think that their own “first heart attack” is another milestone of life similar to buying their first car. Recently, I had to help a couple patients that were at the end of their life. The vast knowledge that I have accumulated, the extra care, and the world's best medications were no longer going to help them. It was time for them to pass on in a smooth transition to what is beyond us here on this small rock that circles around a small sun. It was time to pursue their plans for a dignified death. 

A part of hunting is death. But it is not a cruel act; it is part of the nature of the animal kingdom. Any hunter worth his salt will find a quick and effective way to bring a swift death to their target. Then as they harvest the meat they thank the animal for their life and thank them again as they eat. The hunter may choose a harvest of a large buck in their prime maturity or an older doe that is at the end of her maturity. Also, we have all known of the times that a harvest is selected in terms of mercy for the animal. All have the ups and downs, and none necessarily a lesser life lived than another. 

Death is often looked upon poorly here in the United States. I admire the culture of Latin nations that celebrate a “día de los muertos” at the beginning of November. They have depictions of skeletons everywhere and honor their ancestors who have passed. It seems their view of death is not seen as a loss but as a celebration that their ancestors have joined Christ in Heaven. In medicine, I would like to see a larger emphasis put on the great work of the palliative care and hospice teams. These care teams, I believe, are often underutilized. Passing to death will be a part of all those who live and there should be dignity and mercy when that time comes for each of us. 

Palliative and hospice teams are an important part of medical care. Because, just as the hunter strives for a successful harvest with a quick death for their target, so too must we strive for a well thought plan for our own death; one that has comfort and is obtained as a smooth transition without fear. A plan that does not go too far in futile attempts to cling to life. We must weigh the quality of life and the things we each enjoy individually to decide where that line is for each of us. It is different to everyone and none more or less correct than another. While some would choose to do multiple trials of chemotherapy others would opt for time spent traveling. Palliative and hospice teams are great in working with my patients to pursue their goals and discuss the wishes of what is correct for their end of life care. Some would say that a swift death, meaning a quick decline, after you are past maturity is the most appealing. And that certainly seems like a good choice; being able to pass in your home with your loved ones instead of after a long time in a hospital and multiple attempts of revival on a body that has met its end. Others choose for multiple medical interventions or care in a nursing home to live out their days, and more time with loved ones can’t be wrong either. 

Death is the one thing we all have in common. It will reach all of us. Important steps for you to accomplish before that time would be to obtain a power of attorney for healthcare or healthcare POA. This is a designated person by you who you have explained your end of life wishes to such as the instances where you would not want further treatment or the circumstances where you would not want measures like mechanical ventilation or chest compressions. Discuss with them all the different situations that you can think of and discuss the medical care you would and would not want in each scenario. They need to know what the correct end of life care for you is. The other documents to obtain would be a will and a form with your code status like a POLST form. 

This halloween look at death in a different light. See the greatness that will be experienced in our time beyond this world and possibly celebrate día de los muertos at the beginning of November. Thank each hunt for the life well lived, consider your wishes for your own care at the end of your life, and be sure you get a healthcare POA. Doctor’s orders.

Prep the Sleeping Giant- September 2023

Hunting season is here again. And the rightly named “sleeping giant” will be taking to the outdoors to harvest God’s great creatures. It is estimated that the US has over 15 million hunters. And those hunters of Wisconsin, Pennsylvania, West Virginia, Michigan, and Idaho outnumber any military force in the world with 2.3 million hunters. Texas out numbers any nation’s military might by itself and the states with most hunters by percent of population are South Dakota, Wyoming and Montana. It is safe to say that Japan was right to christen it as the sleeping giant. Just like any military force proper preparation prevents poor performance. So let's review some preparatory items to keep you healthy. 

With bird and small game hunting making sure your hunting partner has been to the vet to get up to date with their shots and tick prevention. We don’t need man's best friend becoming sick, making them need to stay home and not be able to go. Or worse, getting an illness from the hunt. Also important is avoiding hunting if you yourself are feeling sick. We are more susceptible to illnesses when we already have our immune system challenged. It is like when we are fully focused on one task and three more slip by unnoticed. 

With most birthdays being in the fall, now is the time to put together a good list for your big day. Things to consider would be a new knife set or a sharpener. Having the proper tool for cleaning game and having it properly sharp decreases infection as a good, sharp knife doesn’t drag as much bacteria. Sharp knives also make it less likely to knick bowel. Consider a good vacuum sealer for maintaining the harvest in your freezer. Investing in a large deep freeze or building a walk-in cooler helps with making sure the meat won’t spoil when hunting on warm days. 

Now that we have sufficiently added to our wish list. On the day of the hunt, making sure to harvest the prime candidates to eat. My great-grandpa always said not to shoot a sitting rabbit. The idea being the quick and energetic ones were healthy and therefore safer to eat. The idea works in principle. We want to harvest animals that are not likely to have disease so that they are safe to eat. Look for game that appear healthy and when dressing take note of areas that appear to have disease. Use gloves and that freshly sharpened knife kit to timely dress and remove the intestines to prevent the meat from spoiling. Other ways to prevent meat from spoiling is to rapidly cool the meat especially if the outdoor temp is over 65°F. Using a cooler or freezer is a great idea or placing bags of ice in the carcass. 

Identifying spoiled meat is important to preventing ingesting food that may cause you to be sick. We’ve all had some food poisoning and are not up for repeating those times. Take note of the meat’s appearance, color, texture, and smell. Proper meat will be free of visible disease like pus, bugs and worms. Good game meat like deer has a proper deep brown or red color. Watch out for green colors that can be a sign of spoiled meat. The texture should be a nice firm and smooth texture that somehow begs a good slap after removing it from the carcass. Bad texture would be meat that is loose and easily breaks apart. The smell of meat is an important indicator of whether meat has turned. Using the ol’ college technique of if it makes you gag, don't eat it is a good place to start; if it smells like garbage then that is where it belongs. Overall, the smell should be fresh. 

Infections we hope to avoid are things like tularemia, commonly seen in rabbits, as well as others such as E. coli, Salmonella, trichinellosis. For deer, there is the fear that Chronic Wasting Disease can be a severe problem for humans. It is similar to Mad Cow disease in that there are abnormal shaped proteins, called prions, that make your normal shaped human proteins become an abnormal shape and therefore useless. While there hasn’t been strong evidence that there’s transmission to humans it has been shown to transmit to monkeys. Therefore, there is a good chance it is infectious to us as well, and I’m not looking to put it to the test. It’s best to look closely at your harvest and remember there is no guarantee that it is healthy meat. Doctor’s orders



The Silent Killer - August 2023

High blood pressure is a common condition that affects the body’s arteries. It is so common that the CDC reported in 2021 that nearly half (48.1%) of adults had the diagnosis of hypertension, meaning high blood pressure. They further stated that only 1 in 4, of those diagnosed with high blood pressure, have it controlled. That means that 3 in 8 American adults struggle with keeping their blood pressure under control. I’m no gambler, but if I knew I had 3 in 8 odds of losing big, I would be very worried. The leading cause of death in the US is heart disease and elevated blood pressure is among the top factors that lead to heart disease. The World Heart Federation puts high blood pressure at the tippy top of the risk factors for death globally. With very few physical symptoms able to be noticed, there is a reason they call high blood pressure… The Silent Killer.

I think that a blood pressure cuff should be a part of everyone's health cabinet. Checking your blood pressure can be a great step when you aren’t feeling the best. Fluctuations in blood pressure can be associated with headaches, lightheadedness, as well as signs of heart problems. Having more blood pressure readings other than ones from your doctor’s office are helpful in diagnosing hypertension. Hypertension is the medical diagnosis of high blood pressure. The average blood pressure is 120/80 and hypertension is when there are more than one reading of 140/90 or higher. Having blood pressures that are elevated leads to damage to your body's arteries. Fortunately, there was a great creator of the human body and this damage will be repaired. When the body repairs the tiny damage to the arteries it further strengthens them so that there won’t be future damage. This leads to thickening of the arteries making them stiff. It is that thickness that leads to problems associated with hypertension years down the road. 

Throughout the day your blood vessels change their diameter multiple times. This change in diameter helps to regulate our blood pressure as we change positions throughout the day. For instance, when we lie down our vessels need to expand to relieve pressure from the pumping of the heart. It is very easy to pump blood all through the body when it doesn’t have to fight gravity. Then as we stand up there is greater pressure needed to elevate the blood to get to our brain. Our body’s ability to perform this change in vessel diameter deteriorates with age leading to thickening of blood vessels with age and increased chance of having higher blood pressure as we age. 

Hypertension has close ties with heart disease. This association comes from the tiny damage done to the vessels allowing for greater and faster plaque build up in the vessels. That build up of plaque and the thickening of the arteries leads to narrowing of vessels. When that narrowing happens it has a special term called heart disease. This narrowing of vessels increases the chance that they clot off entirely. When that happens the body doesn’t get the oxygen supplied to the area and the cells there die. If it occurs in the heart it is called a heart attack and if it occurs in the brain it is called a stroke.

So as hypertension lingers and is not correctly addressed it leads to some devastating complications. Having a blood pressure cuff amongst your other health supplies can be a real asset. The best way to check your blood pressure is to be in a relaxed environment sitting in a chair with back support and your feet flat on the floor. Many of the cuffs are electronic and automatic. You just apply the upper arm cuff and press the button once in position. The goal is to have a blood pressure that is under 140/90. The research has shown that many people are having blood pressure that is putting them at risk. 

So we know that this is a serious issue and that so many people are affected. What are the best ways to decrease your blood pressure? Like with most aspects of medicine it is important to change your lifestyle and diet to help with your blood pressure. Weight loss has been shown to be of great benefit for those who are overweight. Just 10 pounds can greatly affect your blood pressure to safer levels. Modifying your diet to consume less salt has been shown to improve blood pressure. The DASH diet was specifically developed to prevent and treat high blood pressure. It even stands for dietary approaches to stop hypertension. There are many recipes that follow the DASH diet and it is a good place to start when looking to modify your diet to lower your blood pressure. 

Performing regular aerobic exercise can impact your health in all sorts of beneficial ways. Lowering your blood pressure can be seen from 30 minutes of moderate physical activity. Walking is considered a moderate level of activity and a long walk around your neighborhood can meet that recommendation. Other lifestyle changes like quitting smoking have been shown to help lower blood pressure. Quitting has also been shown to improve your health in many other positive ways as well. Alcohol consumption has been linked with a raise in blood pressure. So it is important to limit alcohol intake to one drink daily for women and 2 drinks for men. Even with proper diet and lifestyle changes medications are sometimes needed to improve your blood pressure. Luckily these medications are among the cheaper ones and are widely available. 

Checking your blood pressure will help you better understand the risks for heart attacks and strokes. Be sure to discuss your personal risks with your doctor and discover how your blood pressure measures by getting a blood pressure cuff to use outside of office visits. Doctor’s orders.



Blood Type and Blood Suckers - July 2023

I was sitting in the backyard with my wife enjoying a beautiful sunset and sipping the cool evening air along with a delicious chambourcin wine. Suddenly, I heard a complaint. “I’m getting eaten alive.” I was having no trouble enjoying the night air, but my wife, the royalty that she is, apparently used her Disney magic to call nature to her. But instead of the cute songbirds to help her it was a mass of mosquitoes to feast on her blood. She pondered, “Why do they all go after me?” I of course answered correctly with, “Because you are the sweetest.” But that got me thinking about what the alternative correct answers are. 

I have heard that mosquitoes prefer a specific blood type and they prefer women as well as loads of other theories of why they seem to prefer some people over others. Some say it’s a perfume or cologne, others say it's the extra sugar in their blood. But what is the right one?

Mosquitoes like all animals on earth come in male and female. And it’s the females that are the blood suckers… We will skip over all the comments that come to my mind because I know what’s good for me. The female mosquitoes use the protein from our blood to produce their eggs. A study from 2019 showed that a mosquito that is known to transmit the dengue virus seemed to prefer those with type O blood and type A seemed to be least favored in the study. There was no conclusion of why this was as the blood type selection didn’t seem to affect the number of eggs they produced. There have also been repeat studies that did not see an association on mosquitoes preference for a blood type. So, it is a mixed conclusion if there is really a preference for a specific blood type.

A known attractant of mosquitoes is carbon dioxide. The antennae of mosquitoes have an affinity for CO2 and the humans that expel more CO2 have been found to attract more mosquitoes. People with higher metabolic rates will then be more likely to be attacked by mosquitoes as they exhale more CO2. Pregnancy is a state that increases the metabolic rate. And it has been well studied that pregnant ladies are favored by mosquitoes. It is thought that the extra CO2 and possibly some other unknown smells is what attracts the extra attention of mosquitoes. Other things like working out would also increase your metabolic rate and increase the CO2 expired.

Smell does seem to be the main way that attracts mosquitoes. As different aldehydes have also been noted to attract mosquitoes. This has been seen with studies that found that alcohol consumption increases one's attractiveness to mosquitoes. Drinking alcohol can lead to a higher metabolic rate and also produce different aldehydes (odor) for the blood suckers to smell. Other odors like certain perfumes or colognes may be more attractive, so if you find that one seems to attract them more, pick a different scent for a better night out. 

One of the main factors in being a savory snack for mosquitoes is your natural skin microbia and DNA that produces your natural odor. It is thought that these factors are major components of the differences seen in mosquito selection. Twin studies saw that identical twins had a similar mosquito attraction and fraternal twins showed a difference. This suggests that DNA is a large role of the mosquito's selection process. 

So now that you know that you are a tasty treat and there is perhaps little to do in changing your sweetness. Protecting yourself from them is the best alternative. Citronella, DEET, picaridin, oil of lemon eucalyptus, and permethrin are all ways of keeping the mosquitoes at bay. For family times outdoors know that oil of lemon eucalyptus should not be used in children under 3 and follow the directions of DEET and picaridin products for children. Aerosol products aren’t ideal for children as they can inhale the chemicals that may be an irritant. It is best to use roll on products or spray your hands and wipe them on young ones.  The EPA as a good chart listing various repelant products and their time effectiveness. Permethrin is a favorite of mine as it protects from mosquitoes and ticks. I just need to remember to apply it to my clothing beforehand to let it dry. 

Don’t be afraid to step outside this summer. Those mosquitoes can be mitigated with the right chemicals. While the other factors are harder to change, use protective clothing and some sprays to enjoy the long summer nights. Doctor’s orders.


References:

Manushika Prasadini, Dilakshini Dayananda, Sachini Fernando, Iresha Harischandra, Nissanka De Silva. Blood Feeding Preference of Female Aedes aegypti Mosquitoes for Human Blood Group Types and Its Impact on Their Fecundity: Implications for Vector Control, American Journal of Entomology. Volume 3, Issue 2, June 2019 , pp. 43-48. doi: 10.11648/j.aje.20190302.13


Joel Henrique Ellwanger, Jáder da Cruz Cardoso, José Artur Bogo Chies. Variability in human attractiveness to mosquitoes, Current Research in Parasitology & Vector-Borne Diseases, Volume 1, 2021, 100058, ISSN 2667-114X, https://doi.org/10.1016/j.crpvbd.2021.100058.



Fun in The Sun- June 2023

Well summer is nearly here. School has let out. The food plots are planted. The hot days of June have started, and that daylight is really stretching out. Time to enjoy some long days in the sun soaking up nature. But let us remember the sting of the sunburn before it happens to us. A quick chore outside like tending the garden or the everlasting chore of mowing can quickly show us the power of direct sunlight on the fair skin of an outdoor lover. This overexposure to the sun can really add up over the years and increase the risk of skin cancers. Let's see what can be done to prevent skin cancer and also catch it before it is too problematic.

Every country doc spends their day checking the farmers’ and outdoor lovers’ skin for skin cancer. Preventative measures for skin cancer weren’t as well known or as popular 40 years ago and the patients who spent their youth outside have an increased risk of developing skin cancers. The best way to prevent skin cancer is to avoid overexposure to the sun. Sunscreens and protective clothing are a necessity on even short times outside in these months where the sun's energy is most directly on us. Protective clothing has become more popular with many sporty brands and options. I see many options for sunshirts in the advertisements for fishing attire. Look for the clothing with UPF advertised. UPF stands for ultraviolet protection factor. Ultraviolet radiation is the type that leads to sunburns, damage of the skin, and increased risk of skin cancers. A UPF of 50 means that only 1/50th of the radiation passes through the material which is 2%. Most cotton shirts have a UPF of about 5. This lower rating is from the looser weave that allows the light and the associated radiation to more easily pass through. UPF clothing has a special weave that allows for less light and radiation to pass through. Remember that this radiation is light radiation and not the same as nuclear radiation. So don’t go thinking you’ll be ready for a trip to Chernobyl just because of your slick new threads. The skin cancer foundation recommends UPF clothing of 30 or greater. Look at the tags of the clothing to see the UPF rating and how long it will last with washing it regularly.

The other way to protect your skin from the harms of sun exposure is sunscreen. Sunscreen best protects when applied 30 minutes prior to sun exposure. Sunscreen’s strength is measured in SPF, meaning sun protection factor. SPF is only a measure of protection against UVB type of radiation and doesn’t measure UVA. Some sunscreens do protect from both UVA and UVB. These are the lotions that you should seek out. Look for the magic words of “broad spectrum protection.” These words will ensure that there is UVA protection along with the UVB. The amount of protection you get increases with the increase in SPF. An SPF of 30 protects from 97% of the UVB rays and SPF of 50 blocks 98% of the rays. The numbers are an estimate of how many times longer you can stay in the sun before you burn. So an SPF of 30 means that there is an estimate that it will take 30 times as long for you to burn. I find that this estimate is not as reliable as summer activities of swimming and sweating usually defeat the sunscreen before the SPF estimation. Also the sunscreens full protection doesn’t last longer than 2 hours no matter the strength of the SPF. Look for broad spectrum sunscreen with a SPF of 50 or even greater if the price is right. Make sure to apply it every 2 hours.

Now that we know how to protect our skin from further damage, how do we catch skin cancer early? The first place to start would be looking at places of increased color of the skin like moles. The ABCDE rule will help assess the moles. Asymmetry, border, color, diameter, and evolution. Bring your moles to the attention of your doctor if the mole appears asymmetric, has an irregular border, changes color over the mole, is larger in diameter, is changing in size or color, or is just the one that is odd compared to the others around it. Keep in mind a partner may be needed to check the common places skin cancer likes on the face, ears and top of head. Catching these spots early is key so they can be treated. Usually a quick shave off or freezing can treat the precancerous or worrisome moles and cutting them out can further verify if it is a spot to worry about. 

Overall, keep enjoying those sunny days. These June days have some of the most intense sun rays and they will continue throughout the summer. Soak up your vitamin D in the sun’s rays, just remember to wear your protective clothing or sunscreen for your outdoor activities even if it is a quick chore. Doctor’s orders.  



My Greatest Fear- May 2023

Well it is nearly summer, and with the wonderful sunshine and rain the bugs have blossomed along with the flowers. With the wilderness comes the mosquitoes and ticks. One of the great things about medical school is you spend weeks and weeks learning all the intricate details and processes of diseases that harm you. You study your days away alone in the library and are overcome with a sense that you have every single problem you learn about. And while I have overcome most of those irrational fears, there is still one disease that chills me to the bone. This disease is spread by the lone star tick. While most of the ticks I have found crawling on me after trudging through the Illinois backwards have been dog ticks, I did recently find a lone star tick crawling on me after only walking through my mowed yard. I was able to calmly take a photo of the beast on me before I elicited a very manly warcry that in no way would be described as similar to a scream like that of a little girl. Let's discuss the lone star tick and the evils associated with the disease it carries: Alpha-gal Syndrome.

Alpha-gal syndrome is a food allergy that develops from the alpha galactose sugar molecule. This sugar molecule is not found naturally in the human body. When it is transferred from the lone star tick directly into your bloodstream as it is feeding on you, your body can then recognize it as foreign and trigger your immune system. Once your body has been sensitized the next time it encounters that alpha galactose sugar it will create an extreme reaction known as anaphylaxis. That next encounter with the alpha galactose molecule will come sooner than you think as nearly all mammals have the molecule except for primates. This means that a person that is sensitized to alpha-gal will need to avoid exposure or suffer the allergic reaction known as anaphylaxis. As we consume these alpha-gal sugars regularly we are usually not developing sensitivities because the alpha-galactose molecule is changed through the process of cooking and digestion. The sensitisation is much more likely to occur if it is sent directly into your bloodstream along with some other foreign material (backwash) from the tick.

Anaphylaxis is a deadly allergic reaction. It consists of hives and itching, as well as swelling of the face, lips and tongue. This swelling can lead to closure of the airway. You might start wheezing at first as the now limited air breathed in races through a narrowed space. Then the swelling grows and closes that space completely creating suffocation. This can happen very rapidly; within minutes of exposure to the molecule. Emergent help is definitely needed to protect the airway and keep those afflicted with anaphylaxis from perishing. Epinephrine auto injectors (Epi-Pen) are helpful to create some time to make it to the emergency room. The epinephrine in the injectable device helps to calm the reaction, but it has a limited effect that wears off after about 10 or 15 minutes. 

All this shows is that those who have this allergy must avoid meat. In other words they are forced to be vegetarian!! That is a fate I would only reserve for the most violent of criminals. The main way to treat alpha-gal syndrome is to avoid exposure to meat and if exposure does happen to occur then having an epinephrine auto injector on hand to administer life saving medication. Better hone those fishing skills as non-mammalian meat may be the only source of meat one could enjoy with alpha-gal syndrome.

Now that we will all be sharing these nightmares, how do we stay safe from forced veganism? First, keeping ticks off of yourself and identifying them quickly when they have decided to make your body a home. Wearing protective clothing is a great first step. Checking yourself after spending time in nature, or have a friend help check you. Reference Brad Paisley’s song “Ticks” for more on that. Some chemicals such as permethrin can be applied to clothing much like mosquito repellent. And both repellants should be utilized when exploring nature. 

It is important to note that ticks need to be implanted on you and feed for some time to be exposed to their diseases. If the tick is still flat and not engorged on your blood then you may not have been exposed to them long enough to contract their diseases. Once you peel those suckers off you, you need to dispatch them properly. Some people report they drown them or burn them with a match. To me, this is not the time for half measures. I use my trusty pocket knife to cut them in half. I’m not sure I can identify how long a tick can hold their breath underwater, but I’m fairly confident they need their other half to function. 

If you do find your new enemy implanted on you, here is how to properly remove them. First, breathe. Calm breaths and find yourself some clean shorts as well as some tweezers. Ticks secrete a cement like substance to help their head stay implanted in you so ripping them off quickly usually decapitates them with their head still inside you. That is a less than ideal outcome. Using the tweezers, grip as far down on the head as possible and apply some gentle traction away from your skin. Do this without squeezing their bounty of blood back into yourself. You don’t want your blood back once it has mixed with their cooties. As you have enough traction to tent your skin up a little, hold and wait for them to detach. Then, snap a photo of the tick so you can identify it later. Next, exterminate that parasite! You can identify the tick based on where the lighter spots are located on its body. Hopefully you are not at risk for the most dreaded alpha-gal syndrome. The other diseases passed on by ticks are nearly all treatable with prompt antibiotics. So contact your physician to get some for yourself and get back to the outdoors. Doctor’s orders. 



Shooting Sports as Meditation- April 2023

Mental health has been growing awareness of personal wellness. With diagnoses of anxiety and depression on the rise, finding ways to relieve your stress in healthy ways is important. Meditation has been found to be a helpful activity that can lower stress and improve wellness when practiced regularly. Meditation is about focusing on the present moment and forgetting the past and future stressors.  The Mayo Clinic lists some types of meditation including guided meditation, mantra meditation, mindfulness, tai chi, and yoga. They say that meditation can be achieved through a walk or prayer. I’d like to propose an additional form of meditation: shooting sports.

Shooting sports meet the elements of meditation. During your shooting you must have focused attention, controlled breathing, as well as an appropriate atmosphere. You must tune out your past and future stressors and maintain complete focus over your breathing and sight picture. Shooting is a mental sport. I perfectly portray the mental aspect as I hit the first 4 targets with a relaxed and carefree attitude; then I realize how well I’m doing and completely miss the last target as my headspace is disrupted. My mental discipline could definitely use some work. Mental discipline is the key to proper shooting technique and practicing this discipline is the essence of meditation. When lining up the perfect sight picture, one needs to focus on proper breathing. They need to slow their heart rate, have a posture with the right muscles fixed tight and with others completely relaxed. They also need to have as few muscles moving as possible to achieve a clean fire on target. This vast amount of concentration is very similar to the components of traditional meditation.

My experience with shooting started from a young age. With my beginner bow, I remember being out in the yard practicing hitting the target from 10 yards. This progressed to hitting the target from all sorts of distances. As I became older, I then started shooting “soda” cans my dad had emptied with a pellet gun. This brought me even more joy as what young boy doesn’t enjoy improving a skill with a light amount of destruction; shooting a can until it is a mangled piece of metal. Little did I know, this skill I was developing could be a form of meditation. The skills of controlling one’s breathing, coordination of muscles for balance, and developing a proper release are important skills that are a part of any sport. Later, I grew to love shotgun sports and bird hunting. I love the aspect of working with a dog. With their job to spot and retrieve the birds and mine to neutralize and ground the bird, it is a symbiotic relationship that adds a different skill to develop. It is quite the accomplishment when the hard work put in goes well. 

Another part of meditation is the aspect of connecting to nature. There is a therapeutic aspect of being away from society and connecting with nature. In meditation, the aspect would be in the quiet setting that makes it easier to focus on your inner breathing and avoid distractions. Being enveloped in nature is a great spot to have a quiet setting without distractions. Luckily, shooting sports need an open space commonly close to nature. I certainly note the peaceful meditation that one can achieve in the deer stand. I find the peace of the morning hunts is especially great. There is something great one experiences when watching the world wake up in the quiet of a treestand. This I feel embodies meditation to a tee. 

The health benefits of meditation are touted to be an improvement of physical and mental health. Mayo Clinic states that meditation allows processing of stress, increased self-awareness, reducing negative emotions, lowering resting heart rate and lowering blood pressure, as well as improving sleep quality. I think that when shooting sports are practiced right these same benefits may be achieved. I find that a couple rounds of skeet shooting help to relieve my stress, slow my thoughts down and make me focus on the moment. It definitely helps to recharge and prepare me for another work week. My physical health improves when I control my breathing and focus on my balance as I swing though to break the clay. I also note that there is great joy in the slight destruction of a clay bird. This is especially seen on stations 7 and 8 where I have honed my skills to turn the clay to nothing more than dust in the wind. There is no doubt that a good day of shooting can improve one's mood. With research showing that meditation can help with management of anxiety, chronic pain, heart disease and high blood pressure you need to get to the range more often. Doctor’s orders. 



Sleep Like a Baby - February 2023

Around Thanksgiving, I was blessed with the birth of my daughter. With this great joy has come a great loss of sleep. I greatly value my sleep. I try to get between seven to eight hours of sleep each night and become very irritable and develop headaches if I repeatedly don't meet my  sleep needs. Taking care of a baby is hard work as they need frequent attention throughout all hours of the day. Throughout my life I've been a great sleeper always falling asleep very quickly and having little trouble sleeping through the night. Now, however, I'm able to sympathize with my patients that find it hard to get to sleep and sleep throughout the night. With this new found sympathy let's review what creates a good night's sleep.

A common complaint that I hear is that patients find it hard to fall asleep. They state that they start lying in bed at one time but don't fall asleep until many hours later. They use such things as Benadryl, melatonin, and even alcohol to get to sleep. There are many products out on the market that claim to help with sleep, but, unfortunately, many of them prevent the deep restorative sleep that is the beneficial part that is very much needed. 

Sleep is classified into stages. There is REM and non-REM sleep with non-REM broken down into 3 stages of sleep: stage 1, stage 2, stage 3. The sleep cycle starts with stage 1 and progresses through 2, then 3, and to REM. It takes about 90 minutes to complete the cycle. 

Stage 1 is a light sleep and the transition between being awake and sleep. About 5-10% of time sleeping is spent in this stage and it is the best to be woken up from as it will be a smooth transition. Stage 2 has a larger role in sleep as most time spent sleeping is in stage 2, about 45-55%. Stage 3 is commonly referred to as deep sleep. About 10-20% of sleep occurs in non-REM stage 3 with children spending more time in this stage than adults. It is harder to wake people from this stage of sleep and if it occurs they can feel very tired and take longer to become fully aroused. Stage 3 is also where some sleep disorders occur such as sleepwalking. 

REM sleep stands for rapid eye movement which is a defining feature of this stage. Dreams occur in this stage. This stage is among the most important stages of sleep. It is important for the deep restorative sleep and healing of the body. There is still debate, but it is thought that REM sleep is where important memories are stored and less important ones are lost. It is thought that the brain does this by reinforcing some neural pathways and triming others in this stage. There has been some research studying the learning process if sleep occurs right after learning a new task. REM sleep is also accompanied by some disorders such as sleep apnea and narcolepsy. 

Those with trouble drifting off to sleep sometimes find that sedatives like trazodone or benzodiazepines may help. While these medications help get to sleep by reducing stage 1 they are not good options for long term use due to many adverse side effects and show weak evidence to support their use. The tradeoff of using these medications is that it is easier to fall asleep, but there is also less time spent in REM sleep making the deep restorative sleep harder to obtain. Melatonin is another medication that is commonly used to improve sleep onset. Melatonin is part of the circadian rhythm; the day/night cycle. The lower doses of melatonin showed the most improvement in studies but also only obtained weak support for their use. Similarly, diphenhydramine (Benadryl) showed minimal evidence of improving sleep quality between its use versus a placebo. Overall, we have not found a great medication to improve sleep as there are large trade offs and many adverse side effects that make use of medications for sleep limited to temporary use instead of long term use.

Among the best practices for improving sleep quality is to address your nighttime routine and sleep environment. Sleep hygiene is the key to improving your sleep. As we increase the use of technology we find that this negatively impacts our sleep. The lights from TVs and phones disrupt our circadian rhythm. It is best to avoid screens at least 30 minutes before bed. Removing TVs from bedrooms and striving to associate the bed and bedroom with just sleep will help train your body to fall asleep fast. Reading, while better for preparing the body for sleep over screens, if done in bed will worsen your sleep hygiene and increase time needed to drift off to sleep. Reading before bed is a great way to learn as it may make learning easier to sleep right after reading something. It is best to read out on the couch our outside the bedroom to best associate the bedroom with sleep.

Having a nighttime routine is key. Keeping consistent bedtimes will allow your body the best rhythm to establish. The American Academy of Sleep Medicine recommends many ways to improve your sleep hygiene. They recommend keeping a consistent sleep schedule that allows for 7 hours of sleep. They suggest that if you're not able to sleep after 20 minutes of lying in bed to get out of bed. This will best associate the bed with sleep. Adjusting the temperature of the bedroom to be comfortable and cool can aid in sleep. Reducing fluid intake, avoiding alcohol and caffeine before bed has also shown benefits. And as always, proper diet and exercise have been shown to improve sleep quality.

As I will be up every 2-3 hours changing diapers and feeding my new bundle of joy, I have adjusted my room to best aid my sleep with dim lights and am working to limit my caffeine and electronic use to aid my sleep. Also, optimizing these other aspects of sleep hygiene have also benefited me. My recommendations are to not ”sleep like a baby” for they wake up far too often in the night. 



Preventing Falls- Brittany Hauter, OTR

INTRODUCTION

         When you’re buying a house people often say location, location, location. In the same way, the environment of your home can make a large impact on you and your loved ones staying at home longer. Your home can prevent hospital stays, inpatient rehab stays, or eventually long-term placement needs. Everyone wants to age gracefully (and safely) in the comforts of their own home and keep their sense of independence as long as possible. 

Prevention 

       Falls are one of the top major causes of mortality and severe injuries in older adults. It is estimated that 30-40% of individuals over 65 will have at least one fall each year1. Some risk factors that lead to increased falls are poor balance, gait and visual changes, medications, advanced age, some medical diagnoses, and cognition decline.


       It doesn’t matter how cute or sentimental that rug in your living room is, get rid of it. If you have somebody in the home with less than ideal balance, rugs, clutter, and untrained dogs can lead to unnecessary falls and fractures. Encouraging elderly individuals to stay off ladders and roofs  (no matter how bad your gutters need cleaned) is going to help prevent a potential fall. Having rails on every staircase or having a ramp to enter the house could be a game changer. Footwear also makes a huge difference! Stay away from flip-flops; instead use gym shoes or slip on shoes with a rubber bottom. 


       Being independent with your activities of daily living, ADL, (bathing, dressing, going to the bathroom, and essentially caring for yourself on a daily basis) leads to the feeling of accomplishment. Independence in these enables one to live alone at an older age. I tell my patients that it doesn’t really matter how you get the tasks done, as long as it is completed in a safe way and it works for you. Shower chairs, grab bars in showers (not the suction cup kind),  tub transfer benches, reachers,  sock aides, dressing sticks, long-handle shoe horns, elastic shoelaces or slip on shoes are all great options to increase independence with ADLs. These are great to help prevent a potential injury as you can use most of them sitting down but also help with recovering from a back, hip, or knee surgery. If you are getting up multiple times in the middle of the night to walk to the bathroom in the dark and half asleep, consider getting a bedside commode for nighttime toileting or a handheld urinal. Looking into something like a Life Alert or adding the fall app on the new Apple Watch could help someone who lives alone from falling down and not being able to call for help. 



With all the mobility devices out there you have many options to pick from but what is the safest for your situation? Four wheeled walkers with seats and brakes are great if you have COPD, use supplemental oxygen, or fatigue easily but don't have balance issues. With these, you’re able to take seated rest breaks, if needed, or use the seat to transport dishes, laundry,or other items around your house. When using them, make sure that the brakes are locked when you go to sit down and stand up and they are only unlocked when you’re actually pushing the walker. Two wheeled walkers are my favorite (yes the ugly silver ones with wheels on the front and slides on the back). These are perfect if you’re unbalanced or if an individual is recovering from an injury and is non weight bearing. They are also great for the precautions after a knee or hip surgery. Two wheeled walker or bariatric two wheeled walker can hold an individual's full weight on it without tipping over. When using these, make sure you push up from the surface that you’re sitting on before grabbing the walker. And when seating, reach back for the surface that you’re going to sit on before sitting to ensure you are the appropriate distance away from the seated surface. A cane is a good option if you’re having pain in one of your lower extremities, or have pain in an upper extremity and are unable to use a two wheel walker. Crutches are good for younger individuals, usually athletes with injuries who have a good balance but need to offload some weight. 



In the therapy world we often ask patients how they do their IADLs. This includes cooking, cleaning, laundry, grocery, shopping, driving to doctors appointments, etc. I am thrilled to hear when older adults are living alone or that they have friends or family members who are able to come and help out with this. Having support to help out with IADLs can make a huge difference between staying at home or needing a higher level of care. Most people want to age gracefully at home but might need a little extra help with some of their weekly activities. If a family member can’t help out, hiring a caregiver for a few hours a week might outweigh the cost of assisted-living, independent living, or skilled nursing facilities. Caregivers can help an individual do all of their IADLs and also help with showers and getting socks and shoes on before leaving the house.

Next steps

         If you’re worried that you or your loved one may be at a higher risk for falls, reach out to your PCP about occupational therapy. They will assist in setting up a home evaluation or some outpatient therapy that may decrease the risk of falls.


Sources

ACEs Over Cowboys- 3/10/21

How much impact do social aspects have on one’s health? Recent studies in healthcare suggest that the area of social health has a larger impact than what was previously thought. This has led to certifications in Trauma-Informed Care and studies on Adverse Childhood Experiences (ACEs). These studies suggest that there are many undiagnosed individuals who fall into these categories and calls for primary care physicians (PCP) to be able to screen and identify patients that fall into these groups. To do this, physicians are asked to build rapport with patients and spend the time necessary to be able to fully assess if a patient has had trauma in their past. But do primary care physicians have the time to add this to their already overwhelmed schedules?

It has commonly been said that a PCP has a patient panel of about 2500. A 2016 JABFM article estimated it to be more accurately describes as between 1200-1900 patients. Although, they do note that it is particularly difficult to quantify the number of patients in the public sector because patient’s use “ambulatory care sporadically.” Therefore, only about one-third of practices were able to report their patient panel size. A 2018 Survey of physicians found that 80% reported that they were at capacity or above capacity for their practice. 88% of physicians responded that some, many, or all of their patients have serious impediments to their health from social situations. I don’t believe that these physicians that describe themselves as at capacity or over capacity have the necessary free time to adequately access the social aspects that are seriously impeding so many of their patient’s health. 

Adverse childhood experiences (ACEs) are known to cause serious effects on one’s health. ACEs are “potentially traumatic events that occur between 0-17 years of age.” ACEs include things like directly or indirectly experiencing abuse or neglect, instability in the home through divorce, separation, or imprisonment, or household substance use. The CDC calculates that 61% of adults have at least 1 ACE and 16% have 4 or more ACEs. With ACEs being linked to chronic health disorders, substance use, as well as having a negative impact on education and careers, the CDC recommends 6 categories to help prevent ACEs; among them are mentoring programs, enhanced community support, and enhanced primary care. They further explain their vision of “enhanced primary care” as providing “brief screening assessments” followed by “referral to intervention services and support.” This quick screen and referral make sense when considering that PCPs are overworked and do not have time to provide the time needed to tease out the layers that comprise the social situation. I argue that PCPs are in a unique position to better assess the social situations that are linked to the health disparities attributed to ACEs if they have the proper time. The PCPs are well acquainted with the patient and their health concerns. They have a rapport with the patient and can better link the social aspects with the health history that is already known. 

Practices that have direct payment models like direct primary care (DPC) practices often have lower patient panel sizes and spend a great deal more time with patients than high volume traditional clinics. These DPC practices have great rapport with their patients and are able to dive into the social aspects that make up a patient’s health. I argue that these practices are able to provide a better version of “enhanced primary care” that is able to assess for ACEs, link it to the health disparities, and also take the extra time to tailor the healthcare to meet the needs the individual patient needs. I believe that the greater satisfaction that DPC physicians have in their job provides them with drive and inspiration to meet the other aspects the CDC calls for to prevent ACEs: mentoring programs and enhanced community support. I have seen DPC physicians have close relationships with their communities. They often give back to their communities with their free time. The high rates of burnout in the gunslinging, high volume, traditional clinics are estimated at 78% with 46% considering changing career paths according to the 2018 physician survey.2 These high rates of burnout discourage physicians from giving back to their communities with the limited free time they acquire. The happiness that DPC physicians experience allows them to provide the mentor programs and community development as well as the enhanced primary care the CDC calls for to prevent ACEs.

The push to provide enhanced primary care is better suited for those in the direct pay model of DPC than for the cowboys of the high-volume traditional clinics. The DPC physicians may provide more time with patients better assessing their social aspects, identifying ACEs, and then linking that to their well-known medical history. They are further able to prevent ACEs by giving their free time to community and mentoring programs. So, I encourage you to choose ACEs over cowboys. 

Royal Pains- 3/10/21

My favorite medical show is “Royal Pains.” No contest. Best one there ever was. It exemplifies the glory of primary care physicians and the relationships they have with their patients. While growing up, my family and I would watch episodes of “Royal Pains” and my parents, being physicians, would shout out differentials as the show progressed. The show depicts an ER physician cast out of the corporate medicine world for making the right, moral decision. He then takes a vacation to the Hamptons after his whole world has collapsed around him and soon develops a medical practice based on a direct payment model. His accountant brother runs the financial side of the business allowing Hank, the protagonist physician, to be able to focus on the medicine side with no distractions. Hank falls in love with his role as a primary care physician. He treats all types of people in the Hamptons from the ultra-wealthy to the lowly fisherman who pays in the day’s catch. 

Growing up I knew that I wanted to be a physician, but I always wished I could do it just like Hank. House calls and providing great quality care to whomever is in need of it. No worries about payments or meeting metrics of specific items in the note, having reimbursement tied to whether my patients actually complete smoking cessation. And if there is a little “MacGyver medicine” with random things in the immediate vicinity then even better. 

I feel that today’s physician shows are all screaming the same message. “The Resident”, “New Amsterdam”, “The Good Doctor”, they are all depicting the moral physician fighting against a broken system. They show rules being bent to meet the patient’s needs and to provide better care. How is this not a reflection of the community’s feelings of the healthcare system we live in? It seems everyone would be much happier with Hank’s system of direct payment. It would bring happier physicians and happier patients. Luckily, I found that system: direct primary care (DPC).

“Royal Pains” shows great traits that a DPC clinic should have to be successful. Hank’s successful practice was based on trust built through quality relationships he made in the community.  A couple of patients receiving quality care from him spread the word about how great a doctor he was, and this led to random people through the community calling him for their medical needs. His practice boomed from there. Hank was very flexible in his practice. His private practice was thrust upon him. He transitioned from the safety of a salary in corporate medicine for the FUN of private practice. He flexed to the needs of his community. His PA, Divya, provided a SUV stuffed with portable medical equipment making Hank’s practice mobile. Assert yourself, Hank fights for his patients calling in favors to get his patients the care they need. He also asserts himself to his mysterious and powerful landlord laying out his rules and boundaries for their relationship. Hank will not be taken advantage of in the relationship as a physician or a friend. 

We should all be like Hank. We should be the physicians we dreamed of as children. Providing moral medicine to those in need; asserting ourselves to not compromise our boundaries. We should create great relationships with the members of our communities. All of this is possible through the direct payment model that puts physicians and patients in charge of the healthcare. I know that my dreams will be coming true as I pursue my passions through my DPC practice. So strap on the DIY, entrepreneur mentality. Muster all your “Outta-my-way-I’m-going-to-doctor” attitude and make the jump to DPC. Practice your medicine morally.  Do DPC and practice medicine the way your community wants. 

Shooting Sports as Meditation

Mental health has been growing awareness of personal wellness. With diagnoses of anxiety and depression on the rise, finding ways to relieve your stress in healthy ways is important. Meditation has been found to be a helpful activity that can lower stress and improve wellness when practiced regularly. Meditation is about focusing on the present moment and forgetting the past and future stressors.  The Mayo Clinic lists some types of meditation including guided meditation, mantra meditation, mindfulness, tai chi, and yoga. They say that meditation can be achieved through a walk or prayer. I’d like to propose an additional form of meditation: shooting sports.

Shooting sports meet the elements of meditation. During your shooting you must have focused attention, controlled breathing, as well as an appropriate atmosphere. You must tune out your past and future stressors and maintain complete focus over your breathing and sight picture. Shooting is a mental sport. I perfectly portray the mental aspect as I hit the first 4 targets with a relaxed and carefree attitude; then I realize how well I’m doing and completely miss the last target as my headspace is disrupted. My mental discipline could definitely use some work. Mental discipline is the key to proper shooting technique and practicing this discipline is the essence of meditation. When lining up the perfect sight picture, one needs to focus on proper breathing. They need to slow their heart rate, have a posture with the right muscles fixed tight and with others completely relaxed. They also need to have as few muscles moving as possible to achieve a clean fire on target. This vast amount of concentration is very similar to the components of traditional meditation.

My experience with shooting started from a young age. With my beginner bow, I remember being out in the yard practicing hitting the target from 10 yards. This progressed to hitting the target from all sorts of distances. As I became older, I then started shooting “soda” cans my dad had emptied with a pellet gun. This brought me even more joy as what young boy doesn’t enjoy improving a skill with a light amount of destruction; shooting a can until it is a mangled piece of metal. Little did I know, this skill I was developing could be a form of meditation. The skills of controlling one’s breathing, coordination of muscles for balance, and developing a proper release are important skills that are a part of any sport. Later, I grew to love shotgun sports and bird hunting. I love the aspect of working with a dog. With their job to spot and retrieve the birds and mine to neutralize and ground the bird, it is a symbiotic relationship that adds a different skill to develop. It is quite the accomplishment when the hard work put in goes well. 

Another part of meditation is the aspect of connecting to nature. There is a therapeutic aspect of being away from society and connecting with nature. In meditation, the aspect would be in the quiet setting that makes it easier to focus on your inner breathing and avoid distractions. Being enveloped in nature is a great spot to have a quiet setting without distractions. Luckily, shooting sports need an open space commonly close to nature. I certainly note the peaceful meditation that one can achieve in the deer stand. I find the peace of the morning hunts is especially great. There is something great one experiences when watching the world wake up in the quiet of a treestand. This I feel embodies meditation to a tee. 

The health benefits of meditation are touted to be an improvement of physical and mental health. Mayo Clinic states that meditation allows processing of stress, increased self-awareness, reducing negative emotions, lowering resting heart rate and lowering blood pressure, as well as improving sleep quality. I think that when shooting sports are practiced right these same benefits may be achieved. I find that a couple rounds of skeet shooting help to relieve my stress, slow my thoughts down and make me focus on the moment. It definitely helps to recharge and prepare me for another work week. My physical health improves when I control my breathing and focus on my balance as I swing though to break the clay. I also note that there is great joy in the slight destruction of a clay bird. This is especially seen on stations 7 and 8 where I have honed my skills to turn the clay to nothing more than dust in the wind. There is no doubt that a good day of shooting can improve one's mood. With research showing that meditation can help with management of anxiety, chronic pain, heart disease and high blood pressure you need to get to the range more often. Doctor’s orders.