Dear Forgetful,
Before answering your question I would like to recognize Tablet readers Gail Harvey, assistant principal of St. Saviour Elementary School, Park Slope, and her mother Eileen, a frequent caller to the Ask the Doctor show.
I am very sorry to hear about your mom.
The study to which you referred found that contrary to popular belief, there is a decline in brain function beginning as early as 45 years of age. Previously, it was believed that brain loss did not occur until at least age 65.
This is important because if we can identify a patient with early Alzheimer’s disease then we might be able to treat him or her with medications. Medications work best when started early in the course of the disease.
In your case, it is highly unlikely that you have Alzheimer’s disease.
Most people experience forgetfulness, such as misplacing car keys or forgetting a close friend’s name. This is suggestive of normal aging and also a consequence of our very busy lives.
Alzheimer’s disease has a repeated pattern of forgetfulness which can interfere with daily functioning.
It is interesting to note that in Alzheimer’s disease, friends and family notice the forgetfulness, while the affected person usually does not.
Worrying about forgetfulness can actually exacerbate memory loss.

Here are some signs of early Alzheimer’s disease:
• Repeating statements and questions over and over.
• Forgetting conversations or appointments.
• Routinely misplacing possessions and often putting them in odd locations.
• Forgetting the name of family members and everyday objects.
• Losing sense of what day, time, or year it is.
• Having difficulty driving and veering to one side of the road, provoking horn blowing by other drivers.
• Typically withdrawing from social activities and becoming a loner.
• Depression often accompanies the disease making memory even worse.
There are things one can do to help stall the onset of Alzheimer’s disease. Some important questions to ask yourself regarding your health are:
1. Is my blood pressure under control? (Elevated blood pressure can lead to strokes and tiny areas of destruction in the brain.)
2. Do I drink more than two glasses of alcohol per day? (Alcohol is toxic to the brain in high amounts.)
3. Do I smoke? (Smoking is one of the worst offenders for dementia.)
4. Do I have trouble sleeping? (This can lead to dementia.)
5. Am I depressed? (This worsens memory problems.)
6. Are my Vitamin D and Vitamin B12 levels low? (They have been shown to be protective.)
7. Do I exercise very little or not at all? (Aerobic exercise is best.)
8. Do I keep my mind active by doing puzzles or other brain stimulators? (Use it or lose it.)
9. Do I stay away from social relationships? (Do I belong to any church or community groups?)
10. Am I taking pills that might cause fatigue or memory loss? (An often overlooked culprit.)
If you answered yes to any of the questions, you’re putting yourself at increased risk for Alzheimer’s disease.
Review the checklist with your doctor and see what efforts you can make, either through medication or lifestyle changes to stay healthy, both in mind and body.
I thank you for your question, and please feel free to call upon me should you require a referral.

* Reprinted with permission of The Tablet

Dear Looking,
Your question is an important one. First I would like to briefly review the subject of what an ear infection is and why it is most likely children experience these.
An ear infection is a buildup of fluid in the middle ear, which lies behind the eardrum and contains the tiny bones that vibrate to help us hear.
There are tubes that help drain the fluid in the ear, known as Eustachian tubes. In children they are very narrow, and are easily blocked, causing a buildup of fluid in the middle ear. The fluid is a prime sight for germs to grow.
When the fluid builds up the child feels a lot of pain and may develop a fever or temporary loss of hearing.
The doctor can easily make a diagnosis of an ear infection by looking in the ear at the eardrum and seeing if it is bulging from the fluid.
He can also squirt small puffs of air at the eardrum to see if it moves. If it does, it is likely that there is no infection.
Now for the $64,000 question: Should antibiotics be used to treat the ear infection?
Well, a large organization of pediatricians recently has gotten together to issue guidelines on this matter. Their guidelines suggest antibiotics for use in children under age two and for those over age two who have high fever and signs of a severe infection.
Watchful Waiting Approach
For children over age two, they believe that “watchful waiting” is appropriate. This means that the child should be observed for two to three days before starting antibiotic treatment as most ear infections are caused by viruses which are not affected by antibiotics.
There is a need for clinical decision making, and medicine is not merely a cookbook. Each child should be evaluated individually, and each infection evaluated to determine the likelihood for serious infection or complication.
The bottom line is that in the vast majority of cases, in children over age two, antibiotics are not necessary.
I cannot comment on your friend’s case as I do not know the medical history for your friend’s son, or the nature of his infections.
For routine infections, as it seems your son has, your doctor is following the appropriate guidelines.
I believe that all parents should be questioning their doctors about antibiotic use. Due to overuse of antibiotics in the past, we are now facing new bacteria that are resistant to antibiotics.
There was just a new study published last week which found that due to widespread antibiotic use, normal bacteria which live in our body and help us in many different functions, such as digestion, have been wiped out. This is leading to an increase in weight gain due to difficulty digesting food, as well as immune system problems, asthma and general allergies.

Ways to Reduce Risk
Things that all parents can do to reduce their child’s risk for ear infections are as follows:
• Have your children vaccinated for the flu to help reduce the risk of contracting it.
• Prevent common colds by encouraging hand washing and not sharing eating or drinking utensils.
• Avoid secondhand smoke as this increases the risk.
• Breastfeed your baby when possible as breast milk contains antibodies that may offer protection from ear infections.
• If your baby is bottle-fed, hold him or her in an upright position. Avoid propping a bottle in your baby’s mouth when he or she is lying down.
• If possible, limit the time your child spends in group child care.
As always, consult with your doctor for your child’s care.
Parents must serve as advocates for their children and question doctors about antibiotic usage.
This is something your pediatrician should welcome as too often doctors feel compelled to write antibiotics due to pressure from parents.
Until next week, be well.

* Reprinted with permission of The Tablet

Dear Broken-hearted Mom,
Before I discuss your very serious topic, I would like to wish all our readers a happy and healthful new year, and give a special hello to Andrea Grasso and Mary V. Gallagher, who are loyal Tablet readers as well as friends from New York Methodist Hospital.
I am very sorry to hear about your daughter and your situation. Eating disorders can be devastating and often fatal. Over 10 million Americans have an eating disorder. The majority are young females, ages 15 to 25.
About 50% of young women and men with eating disorders have coexisting depression. It is sad that only one in 10 people with the disorder receive treatment and those who do get treatment do not get care in facilities that specialize in this problem.
Unfortunately, eating disorders have the highest death rate of any of the mental illnesses, about 20%.
An eating disorder is a serious condition in which a person is so preoccupied with food and weight that this becomes the prime focus of her or his life.
The three main types of eating disorders are: anorexia, bulimia, and binge eating. When someone has an eating disorder, the body does not get the proper nutrients, and as a result, severe physical problems can develop and become life threatening. Let’s review each of the three types:

Anorexia
Anorexia is a condition in which a person is obsessed with being thin. This can be carried to the point of deadly starvation. The signs and symptoms include:
a. Preoccupation with food
b. Social withdrawal
c. Intense fear of weight gain
d. Refusing to eat
e. Denying hunger
f. Menstrual irregularities

Bulimia
In bulimia, there are episodes of binge eating, followed by forced vomiting or excessive exercise. The signs include:
a. Self-induced laxative use
b. Vomiting
c. Visiting the bathroom after eating or during meals

Binge Eating
In binge eating disorder, a person eats large amounts of food, even when he or she is not hungry. This often leads to severe dieting, which is then followed by binge eating. The signs include:
a. Eating to the point where it becomes painful
b. Feeling depressed about overeating
c. Eating much more food than a normal meal
An eating disorder is difficult to manage by oneself. It basically rules a person’s life, and causes him or her to think about food all the time. There is often a feeling of shame and depression. The problem, as with your daughter, is that many people with eating disorders refuse treatment. It’s important to arrange an appointment with a doctor who is trained in this specialized area.
I would be happy to provide a referral if you do not already have a physician who can help.
For parents and other families out there, there are certain red flags that should be an alarm for early signs of eating disorders. They are: making excuses for not eating; skipping meals; withdrawal from normal social activities; and irrational thoughts where one thinks that he or she is overweight when this is not true.
The causes of eating disorders are not well known. Some people believe it is due to genetics, as it is more common in certain families. Chemical imbalances in the brain are also thought to be a cause. As I mentioned before, people with eating disorders often have mental health conditions. They may be perfectionists who are impulsive and have low self-esteem. Our culture, which glorifies thin models, and exerts peer pressure, may increase the desire to be thin, particularly among girls.
Certain factors predispose individuals to the disease. They are:
1. Being a young woman in her teens or early twenties
2. Having a family history of eating disorders
3. Constantly dieting
4. Being an athlete, or one who relies on his or her appearance, such as actors, or models.
In general, treatment involves psychotherapy, education, medication and nutrition. This is a serious disorder and I cannot overstate the need to have your daughter evaluated.
Some scary facts regarding eating disorders include:
1. 40% of Americans either have suffered from or have known someone who has suffered from an eating disorder.
2. More than 80% of women are dissatisfied with their weight.
3. 13% of high school girls “purge.”
In summary, eating disorders are life-threatening diseases, which are often accompanied by depression and other mental illness. Patients should get treatment as soon as possible to increase the chances of success.

* Reprinted with permission of The Tablet

Dear Worrying,
I am so sorry to hear of your problems. You are definitely not alone in experiencing this condition, as more than four million Americans suffer from generalized anxiety disorder.
I was just talking to loyal Tablet readers and friends, Joyce Pisciotta and Vivian Boolbol about this.
As you noted, you are well aware that your thoughts are not logical, but you obsess about them anyway.
The good news is that treatment for this condition is very successful. It consists of a combination of therapies in which you talk to a psychologist or psychiatrist, and combine this with medications that help your brain restore a normal chemical balance.
It is normal to feel anxious from time to time, as everyone has stress in life. The problem arises when the anxiety becomes overbearing and you cannot function properly.
The Christmas season, while joyous, can often be an anxiety provoking time, particularly as people get wrapped up in the present giving and financial stress that often accompanies it.
When stress interferes within everyday activities it becomes very serious. Not only can it interfere with your lifestyle, but it is also associated with serious medical problems that can cut your life short.
How can one tell that he or she has generalized anxiety disorder? One must have continual worry for at least sixmonths, and answer yes to five of the following seven questions.
1. Do you have difficulty controlling your worries?
2. Do you have difficulty concentrating?
3. Are you angered easily, and frequently irritable?
4. Do you sometimes feel like you might throw up when you are worried?
5. Do you have headaches and other aches and pains that have no cause?
6. Do you sweat/have hot flashes?
7. Does your worrying interfere with your job or school?
Of course, it is important to see your doctor to make the correct diagnosis, but answering yes to any of the five questions above is a strong indication that you have a serious problem.
Generalized anxiety disorder may be inherited and can occur in children as well as adults. In children, the anxiety may be due to fear of a nuclear war, terrorist acts or never seeing their parents again. Children with generalized anxiety disorder have difficulty fitting in with peers. The child may be a perfectionist who requires excessive reassurance and approval. He may be excessively critical of himself or have a fear of failure.
All children have worries, but it becomes a problem when they cannot function properly due to these anxieties. Visit a family doctor for a referral to a psychiatrist or psychologist.
I can’t believe that this is the last Ask the Doctor column for 2011. The year ended with a bang for my wife and me with the birth of our second grandchild, Samuel Hudson Stephens, who was born Dec. 10, and weighed in at eight pounds, seven ounces.
I wish you all a Merry Christmas, and a 2012 filled with joy, good health and happiness.

* Reprinted with permission of The Tablet

Dear Graveyard Shift,
Thank you for your good wishes. I was just discussing this issue with my good friend and colleague Dr. Antonio Mascatello. Many studies have been done which identify an association between night shift work and weight gain.
Recently, a study from Harvard noted that women who had an irregular work schedule that included night shifts, had significantly increased risk of diabetes — as much as 60%.
It is thought that the reason for the weight gain is due to the following:
1. The body’s natural clock is confused and it makes hormones that create a craving for food, particularly high in fat.
2. The food available to night-shift workers usually comes from vending machines or fast-food restaurants, both of which contain high fat and salt.
3. Sleep deprivation which occurs with night-shift work causes the brain to send out signals that make the body crave sugary foods.
4. The body’s metabolism slows at night, which limits one’s ability to burn fat and increase lean muscle.
5. Lack of sleep triggers the release of a hormone known as cortisol. This hormone causes the build-up of fat in the belly region and is also a factor in developing high blood pressure and diabetes.
I realize that many people who work the night shift have no choice. The good news is that are things that can be done short of quitting the job.
1. Plan what you eat for the shift. The plan should include substantial portions of food every four hours and a snack.
2. Good foods to eat are low fat and high fiber, and include grains, bread, fruits, and low-fat dairy products.
3. Don’t have a heavy meal before going to bed, as a full stomach makes sleep difficult.
4. Take a short nap, no more than 30 minutes before your shift. This increases brain alertness. A nap of more than 30 minutes makes you feel groggy.
5. Stick to a routine when working night shifts so that you go to sleep at the same time and eat meals at the same time. Sleeping from morning to afternoon is best.
6. Keep the room as quiet as possible and have shades that create a dark room. Turn off your phone and computer.
I am often asked how much sleep an adult needs.
The average adult needs in the range of seven to nine hours of sleep. You can do an experiment at home to see how much you need. Select a period of four days when you can sleep as long as you want. The hours of sleep you receive the fourth night should be the hours necessary for you.
In summary, nighttime shift work has hazards associated with it. These hazards are related to lack of sleep, increased weight gain, increased incidence of diabetes, and even an increase in cancer. It is important to devise methods to address the problems that are expected, such as the weight gain. It is important to sleep at the same time, morning to afternoon. The avoidance of caffeinated drinks and alcohol is necessary as these further interfere with the hormones the body creates.
One who works the night shift must pay careful attention to stay fit, both physically and mentally.
I wish you and your family well. Thank you for your interesting question and have a Merry Christmas.

* Reprinted with permission of The Tablet

Dear Vaccine Free,
The number of parents choosing not to vaccinate their children has increased dramatically over the past 10 years. This situation is extremely dangerous and could lead to the return of childhood illnesses once thought to be extinct, such as polio and measles. As an example, in Europe during the past year, there have been 30,000 cases of measles, and with world travel the same could easily happen here.
Inaccuracy of Lancet Study
It is troubling that many parents have made the decision not to vaccinate based upon erroneous information. In 1998, a study was published in the prestigious Lancet Medical Journal noting that childhood vaccines were responsible for the rise in autism. A chemical used as a preservative in the vaccines (thimerosal, a type of mercury) was thought to be the culprit. This study was later repudiated and found to be inaccurate.
Unfortunately, many parents still cling to the myth of an association, as increasing numbers of children are not fully immunized. It should be noted that thimeresol has been removed from almost all vaccines since the year 2000. In spite of this, the autism numbers have increased dramatically, which further serves to dispel the myth.
Parents who choose not to vaccinate their children should be aware that their decision affects everyone, including unborn babies and infants who cannot be immunized.
Some parents are afraid of the multiple injections that children receive. By the age of two months, they receive 24 vaccinations. While this is a large number and no one likes to see his or her child cry, the crying is far outweighed by avoiding serious illness or death.
In addition to the incorrect information that was published in Lancet, other factors in a parent’s decision for refusal to vaccinate include:
• The vaccine is its own worst enemy. As diseases that have killed thousands of children each year in the past became eradicated, people became complacent and forgot the gravity of having a young child deathly ill with diseases such as measles or polio.
• Some states allow parents to opt out of vaccinating their school-age children. A form must be completed by the parents prior to a child attending school. Some parents find it easier to ask for a waiver than take their child to the pediatrician for a vaccine.
• With today’s world travel, there is possible introduction of childhood diseases from Third World countries, where not all children have access to vaccinations.
In China, in spite of the fact that there have been attempts at mass immunization, there has been an outbreak of polio brought into the country from Pakistan. The disease spread because many children were not vaccinated. This could happen to our country as well, if parents stop allowing their children to be vaccinated.
You should explain to your daughter that by vaccinating her child, she not only helps your granddaughter’s health but the community health as well.
I believe the following is your best course of action:
a. Ask your daughter why she is not vaccinating your granddaughter. Explain to her that there is no medical reason not to vaccinate a child, unless there has been a documented allergy. Urge her to speak to her doctor for further information.
b. Explain that the risk from the vaccine is less than one in a million for a major adverse event. The local pain, or swelling, or fever that may occur is far outweighed by the benefit of not contracting a serious or life threatening illness.
c. Your daughter should be made aware of the inaccuracy of the medical report that had been published in the Lancet, which may have served as a basis for her decision.
I hope you explain to your daughter that the results of the study are inaccurate and not an acceptable reason to refuse to vaccinate a child.
In summary, I, too, am nervous about your daughter’s decision not to vaccinate your granddaughter. I believe that if presented with the correct information your daughter will change her mind, and understand the necessity of vaccinating all children. If you’d like, I would be happy to speak to her.
At Christmas time, when parents are buying so many gifts for their children, I hope that your daughter re-evaluates her thinking, and gives your granddaughter the gift of good health by getting vaccinated – it’s not too late!

* Reprinted with permission of The Tablet

Dear Depressed,
Before I get into the description of fibromyalgia, I would like to recognize a loyal Tablet reader, Barbara Balsamello, who helps to keep people relaxed in Dr. Sconzo’s office in Marine Park. Her smile is medicine for the patients in the office.
The condition you discuss could very well be fibromyalgia. I’m sorry for the loss of your husband and want you to know that whether it is fibromyalgia or depression, medications are available to help control your symptoms and help you enjoy life again.
People with fibromyalgia have pain throughout their body. They have difficulty sleeping and remembering things. It is thought that the brain magnifies the painful sensations people experience, so that pain in the joints and muscles becomes unbearable. The disease can be precipitated by a major loss, such as the loss of your husband. For some reason, women are much more likely to develop the syndrome than men.
Identifying Tender Points
To help determine if you have fibromyalgia, there are questions your physician will ask. To be considered widespread pain, it must occur on both sides of your body, and above and below your waist. There are specific spots in your body known as tender points. These are points that hurt when pressed with a finger.
There are 18 tender points, important to the diagnosis of fibromyalgia. These points are located in various parts of the body. To arrive at a diagnosis of fibromyalgia, 11 of the 18 tender point sites must cause pain when pressed. In addition, the pain must be present for at least three months to establish the diagnosis.
Tender point locations include the following:
• the back of the head
• between the shoulder blades
• the top of the shoulders
• the front side of the neck
• the upper chest
• the elbows
• the hips
• the inner knees
Accompanying the severe pain is fatigue and sleep disturbance. People with fibromyalgia often wake up tired, even though they report sleeping for long periods of time. The sleep pattern is frequently disrupted by pain, and many patients have associated conditions, such as restless leg syndrome and sleep apnea that further decreases the quality of their sleep.
As if having fibromyalgia is not enough discomfort, it should be noted that those with fibromyalgia may also have anxiety, depression, endometriosis, irritable bowel syndrome, and severe headaches.
No Clear Causes
It is not clear what causes fibromyalgia. We do know that it runs in families and there may be certain genetic mutations that make one susceptible to developing the problem. In addition, it may be triggered by severe infections as well as physical or emotional stress.
Doctors believe that it hurts so much because the brain misinterprets the pain and actually magnifies it. There are medications which lessen the symptoms, and allow people to live normal lives. These include anti-depressants, anti-seizure drugs and pain medication.
Reducing stress is important in the treatment plan. Take time out to take care of yourself. Deep breathin exercises, such as meditation, regular exercise, getting enough sleep, acupuncture and massage therapy have been helpful in treating fibromyalgia. In addition, it is important to pace yourself so that you don’t overdo it.
I strongly suggest that you visit a physician who is familiar with fibromyalgia. Usually, rheumatologists have greater experience than other doctors in dealing with this disease. I would be happy to recommend a physician experienced in its treatment, to evaluate you and begin a course of therapy.
Support groups are very useful. You will learn more about the disease and realize you are not alone in your suffering. At the present time there is no lab test that can accurately diagnose fibromyalgia. Physicians need to rule out numerous conditions with similar symptoms before diagnosing it.
The first step in treating your problem is to verify the diagnosis, and rule out any treatable causes for your depression and pain.
The good news is that you will be able to resume you normal lifestyle and enjoy your family and life in general.
Please call me if you have any difficulty finding the right physician. I wish you well.

* Reprinted with permission of The Tablet

Dear Heel Pain,
The description of your problems sound very much like plantar fasciitis (PLAN-tar fashee-EYE-tiss). One of the most difficult parts of your problem is the pronunciation of the disorder.
I’m sorry to hear about the difficulty you’re having. Unfortunately, for people who must stand for prolonged periods of time, such as athletes and soldiers, pain often develops in the heels and feet.
While there are several possible causes for foot pain, such as a stress fracture or nerve impingement, plantar fasciitis is a strong possibility in your case. The plantar fascia is the supporting tissue that connects the heel and toes on the bottom of the foot. Plantar fasciitis occurs when the fascia becomes strained. Repeated strain can cause actual tears in the ligaments or supporting structures. This leads to pain and swelling — symptoms you are experiencing.
Upon visiting your podiatrist, a diagnosis can be made, ruling out other conditions that mimic the process. An X-ray of the foot is often obtained to help evaluate for possible stress fracture of the toes.
Plantar Fasciitis
(PLAN-tar fashee-EYE-tiss)
Occurs when connective tissue on the bottom of the foot becomes strained, causing heel pain and swelling.
Plantar fasciitis occurs most commonly in people 40-60 years of age. It can occur from an injury or may be related to a generalized arthritis that affects other joints of the body as well. Sometimes the cause is never found.
Factors that increase the risk for plantar fasciitis:
1. Women between the ages of 40 and 60 are most likely to develop this condition.
2. Activities that place a lot of stress on the heel and surrounding tissue, such as ballet dancing and long distance running.
3. Flat feet, or high arches, or even an abnormal way of walking can lead to the condition.
4. People who are obese are more likely to develop plantar fasciitis.
No single treatment works for everyone with plantar fasciitis. There are many things you can do to get relief:
1. Give your feet a rest. I realize that in your profession this may not be practical.
2. Try not to walk or run on hard surfaces.
3. Put ice on your heel to reduce pain and swelling. Anti-inflammatory medications, such as Motrin, Aleve or aspirin, may help as well.
4. Stretching your calves several times a day, especially when you first get up in the morning, is beneficial.
5. I suggest you look carefully for shoes that provide good arch support and cushioning in the sole. Consult with your podiatrist.
6. Your podiatrist may give you heel cups or shoe inserts.
7. Sometimes the doctor may give you splints to wear at night, and shots of steroids into the heel to reduce inflammation.
8. Most people do not require surgery.
9. Patience is necessary as the healing process may take six-12 months.
Unfortunately, heel pain can affect other parts of the body, such as the knee, hip, or back, due to the change in one’s gait. Regular ice massages may help reduce pain and inflammation. Low impact exercises, such as swimming or bicycling, are preferable to running or even walking, and help you to stay in shape without further aggravating your condition.
For those who do not have this condition, the following can help prevent the onset:
1. Maintain a healthy weight.
2. Choose supportive shoes.
3. Do not wear worn athletic shoes. It is wise to purchase new shoes every 500 miles.
I wish you well and hope you take comfort in the fact that this is fairly common, particularly among athletes and police officers and can be successfully treated.
The condition will most likely resolve after six months to a year, so I urge you not to panic.
It is important to visit a podiatrist – a physician who specializes in this condition.
I would like to take this opportunity to wish all our loyal Tablet readers and NET viewers a very Happy Thanksgiving as we take this time to count our blessings.

* Reprinted with permission of The Tablet

Dear Sad,
Thank you for writing to me. It is important that you have recognized your problem and want to do something to deal with it.
I hope that talking about your condition will help others out there who find themselves in the same predicament, particularly at this “most wonderful time of the year.”
Depression is a medical illness, similar to other disorders, such as diabetes, in which there is an imbalance of chemicals — in this case, in the brain. You cannot just snap out of it.
You need medical help consisting of medication and counseling to overcome the problem. It will not be a one-time treatment, but a lifelong process.
The good news is that you can be helped and you have made the biggest step — recognizing that you have a problem and being willing to seek help.
There are different types of depression, both mild and major. Feeling sad when someone close dies is a natural occurrence, but not leaving the house for a month or not being able to function in your everyday life requires help.
Symptoms of Major Depression
How can you tell if you have this serious form of the disease?
If you experience five of the symptoms below, every day for almost the entire day over a two-week period, you are suffering from major depression.
1. You have a sad mood.
2. You have diminished interest and feel no pleasure at all.
3. You have significant weight loss without dieting.
4. You have insomnia/increased desire to sleep.
5. You have restless/slowed behavior that is observed by someone else.
6. You have fatigue or loss of energy.
7. You feel worthless or have excessive guilt.
8. You have trouble making decisions or concentrating.
9. You have repeated thoughts of death or suicide.
Remember, the above symptoms must be present almost every day for two weeks without being due to the effects of medication or a medical condition like low thyroid activity.
People who are depressed often have an alteration in their brains with abnormal amounts of certain chemicals produced.
It appears to be inherited and affects women twice as often as men.
It may be related to an early childhood trauma, either physical or mental.
There is help available in the form of medications and counseling. In addition, a treatment that might sound barbaric is actually quite innocuous and helpful — shock therapy, or ECT. It produces improvement almost immediately.
It is sometimes necessary to admit a depressed person to the hospital as there is an increased risk of suicide in the first few weeks after starting antidepressant medications, particularly in young adults.
You must seek help immediately. Please contact me if you have any problems getting help.
Benefits of Religious Services
A new study published last week demonstrated a connection between happiness and optimism in women who attended religious services at least once a month.
These people had as much as a 30% decreased chance of being depressed. They were also 20% less likely to die during the course of the study.
While there is no guarantee that you will live longer or be less depressed, the study concluded that the benefits of attending religious services might include calming effects in stressful times, improved social relationships, and discouraging harmful habits.
Beating the Holiday Blues
For those who are anxious about the Thanksgiving and Christmas blues, I would like to leave you with some tips which may help.
1. If you are lonely, seek out church or other community groups and volunteer.
2. Stick to a budget — money is the number one source of stress this time of year.
3. Take a time out and treat yourself to a spa, a massage, or even a quiet walk or time alone.
4. Make a schedule that allows for enough sleep and exercise.
5. Be realistic — not all holidays have to be perfect. And even with the best of plans, something inevitably goes awry.
6. Acknowledge and respect your feelings. It is okay to be sad if your loved ones have recently died and will not be there to celebrate with you this year.
Please keep me updated on your progress.
Until next week, be well.
Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.
Battling Depression
Fast Facts:
• Depression is a medical illness caused by a chemical imbalance in the brain.
• There are two types — mild and major.
• Recognition of your condition and willingness to get help are the biggest steps on the road to recovery.
• Treatment is available.

* Reprinted with permission of The Tablet

Dear Time after Time,
Millions of people diet each year, only to find that the weight lost returns soon after the diet is discontinued. This happens to 95% of dieters.
A recent study demonstrated a strong association of appetite and weight gain with body chemicals known as hormones.

Some hormones make you hungry, and others make you feel as though your stomach is full.
In this study, 50 participants were given a strict diet to follow for three months.
The average weight lost was 30 pounds. At the end of one year, most of the dieters had gained back a good deal of the weight they had lost. This was in spite of the fact that they were placed on maintenance diets and had appropriate counseling.
Blood tests were analyzed and it was discovered that the hormones responsible for making someone feel hunger had risen after the diet. The increased appetite caused weight gain.
These results are very interesting, and may be helpful in the long-term approach to weight loss. Perhaps medication can be developed to block the hormones that cause increased appetite.

For some, the most appropriate treatment may be weight loss surgery, which is reserved for people 50-100 pounds overweight. This surgery has been shown to be very effective for long-term weight loss, as well as curing associated diseases, such as diabetes.
I think that it is unfair to state that someone has no willpower because he or she cannot maintain weight loss. There clearly are strong factors in our biology that cause us to lose and gain weight. Nevertheless, it doesn’t do us any good to “blame it on the hormones.”
Diet is not rocket science. It is essentially the combination of the calories one takes in with food versus the number of calories that one expends with exercise and bodily functions. If we take in more calories than we expend, we will gain weight. It is as simple as that.

Some strategies to lose weight are as follows:
1. Each person must develop a plan with his or her doctor to determine the best way to lose weight and keep the pounds off. A safe target is one pound a week, which equates to decreasing your calories by 500 a day.
2. Moderation is important. Studies show that vigorous exercise can lead to an increased appetite and increased weight. Instead of killing yourself at the gym with power workouts, one would be better suited to do moderate exercise such as walking 30 minutes for five days a week.
3. Motivation is important. You are not just losing weight to make yourself look or feel better. It will also help you to live longer and be healthy for your children, family, and friends.

I wish you luck in your diet, and hope that this gives your husband some insight into the difficulties that all dieters have.
Look at diet as a marathon, not a sprint. The commitment to lose weight is not just for weeks or months, but should last a lifetime. As Frank Sinatra sings in “That’s Life,” “Each time I find myself laying flat on my face, I just pick myself up and get back in the race.” Don’t give up.

*Reprinted with permission of The Tablet