Monday, May 28, 2012


A question from a reader...

I just wanted to ask you what juice you recommend. I love drinking orange juice and mango juice mostly but I try to drink in moderation because I know they are loaded with sugar.  But, anyway ....I wanted to know if you have a preference for a specific brand or what not because now a days it is so hard to find 100% natural juices that don't have a lot of sugar and if they do have sugar none of that fake sugar (high corn fructose syrup stuff).  I drink no sodas and stick to water, gatorade, and juices.  

I also heard lemon juice is really good for you.  Is that true? 


Laura :)


Juice...hmm. This is where I'm going to throw you off a bit. I have noticed in the prevalent Spanish community that I work in that there is a misunderstanding that "juice" is good for you. As a whole, juice has a lot LESS nutrition than calories. For instance, the mango juice you drink has around 120 calories in 6 oz, and 26gm of sugar. Sure, there is a little vitamin C, but in my opinion, not nearly enough to counteract the empty calories. So, juice is an obvious better choice over soda...but water, and crystal light are better options. If a juice is a necessity, stick to the 50/50 (half calorie) kind, or the juices which do hold a lot of nutritional value, like pure squeezed orange juice (with the pulp). Again..the key is not to necessarily rid yourself of the things you love (including juice), but to enjoy moderation!

...and as far as the lemon juice is concerned..I am not directly aware of any overt health benefits, but a quick google search did educate me on a lot of "homeopathic" uses of it!...hmm..maybe some research is in order....:)

Dr. Tiffany

Wednesday, May 23, 2012

Bad Habits....for your Heart..

Recently, posted an article titled "17 Worst Habits for Your Heart". So, being that it is all about my favorite organ, the heart...I thought it would be good to read, and share my thoughts.
I will not post and comment on all of them, because honestly a few are common sense, but let's see the interesting ones...

1." Leaving Hostility and Depression Unchecked" I could not agree more! There have been numerous publications linking stress to heart disease. Remember, like I always cannot make anyone else happy, if you are not happy. Put YOU first!

2. "Ignoring the Snoring" I really like this one! Snoring may be a sign of OSA or, Obstructive Sleep Apnea. Most people who have this are overweight with large necks, but smaller people may have anatomic reasons for the sleep apnea. Why is this important? Because sleep apnea may be contributing to your heart disease! One of the first things people have done when they are diagnosed with some heart problems, including uncontrolled high blood pressure, is a sleep study to evaluate for OSA. What are some symptoms? Well, snoring for one, and also feeling very tired after having a full nights sleep.

3. "All or Nothing" This particular post was about exercising. You know these people..they go to the gym 2 days a week and "make up" for not going the other 5 days. This can be dangerous as you may strain your muscles, but moreover, its not likely that it is helping your heart. Remember, slow and steady with exercise. And if I haven't said it enough...5 days a week for 30 minutes of AEROBIC exercise! :) Plus, this helps you get in the whole "routine" mode.

4.  "Overeating" Self explanatory. As a whole, this country eats WAY TOO MUCH. Whatever you are being served in a restaurant, it is likely the "serving size" should be less than HALF the plate. Learn to wean yourself from the amount of food you eat. Chances are, you can still enjoy everything you love, just in moderation. THIS is how I stay thin. I just watch the amount of food I eat. I typically eat 1/2 to 1/3 of what my peers eat. And ya know what? I'm not hungry...I have trained my body overtime to only NEED that much food to be full..and you can too!

5. "Assuming You're Not at Risk" DO YOU HEAR THAT, LADIES?? HELLLOOOO!!! PLEASE PLEASE LISTEN!!! You DO NOT have to be a "fat male" to have a heart attack! Being a mom, running around, being STRESSED (see #1!) all may blame your medical problems on these things..but stop! The #1 KILLER of women is heart disease! KNOW YOUR NUMBERS!

6. "Eating Red Meat". You know why I loved this one? Because I have said it repeatedly on this blog! haha. I was first! (just kidding!) I will have maybe a total of 8oz of FILET (a lean cut) a MONTH. Let's put it in simple terms: red meat= bad. Period.

7. "Being a Health Procrastinator" See #5. Oh, and not having a test done doesn't mean that you don't have a disease, it just means that you don't want to know. And, honestly, that's just ridiculous! My favorite story...a patient at my hospital was being admitted. I ask her.."Do you have any medical history?" Her reply..."No, doctor". The logical next question from me.."Ok, when did you see your doctor last?"...Her reply, "Um..20 years ago". So, this DIABETES I just diagnosed her with that had already affected her nerves could have potentially been prevented. Silly.

Any Questions? ;)


Monday, May 21, 2012

A Weight Loss Miracle Pill?

...or not?

I decided to write a post on this today because a patient asked me about it, and it seems to be gaining more and more popularity.

This new weight loss medication, Qnexa, looks like it will be getting approval by the FDA within the next 3 months. This medication will likely be reserved for those people with a BMI >35 (severely obese). This observation is based on the studies that have been done with the medication, although there may be less stringent restrictions. I am guessing that the limitations will be a BMI >30 or BMI >27 with risk factors (like diabetes or high blood pressure). Calculate your BMI here.

The clinical trials showed the average weight loss was 14.4% body weight with the high dose and 6.7% body weight for the lower dose formula. A different study showed that 48% of study patients lost >10% of their body weight with the high dose.

So, how's it work? Qnexa combines phentermine and topiramate into one extended-release, once a day capsule. Phentermine is a popular weight loss medication, that works by suppressing appetite and stimulating your body's metabolism. Topiramate is classically used as an anti-seizure medication, but in Qnexa, it is being used in combination with the phentermine to alter the way that food tastes. The food will not taste bad, just different.

So what's my take on it? Well, obviously I would say combine two OTHER things, like diet and exercise. Try this first...always! But I am realistic and understand that some people really do need a little "push" or help. This medication does appear to work really well for weight loss. But do not think that it doesn't come with side effects. The most common side effects noted were tingling sensations, insomnia, altered taste sensations and constipation. Fewer people also noted palpitations, runny nose and sinus infections.

So, overall, I would never advise a medication over good old diet and exercise, BUT...if you really have tried everything and are having a difficult time losing weight "on you own" this may be a great option for you!

When the medication gets final FDA approval, I will be sure to post..:)

Tuesday, May 15, 2012

MVP...Mitral Valve Prolapse...

We are not talking MVP as in Most Valuable Player...we are talking Mitral Valve Prolapse. It seems that a lot of people have it, yet no one knows what it is. Moreover, people who do have it are all freaked out about it...lets settle the

So, MVP is is a condition where the mitral valve (the valve that is in-between the upper and lower part of your heart on the left side) leaflets are floppy, and thus do not close tightly. The "prolapse" means that part of the mitral valve is "prolapsed" or bulges into the top part of the heart, where it shouldn't be. 

MVP is the most common heart valve abnormality, and affects women much more so than men. Most people with MVP have no symptoms at all, but a small percentage may experience palpitations (feeling of heart racing), chest pain or anxiety. Usually, this condition is benign (harmless), but in a small amount of cases, it can cause other abnormalities which can be dangerous. One of these abnormalities is called Mitral Regurgitation, which is where the mitral valve leaks, and allows blood from the bottom part of the heart back into the top part. 

MVP is diagnosed both at bedside by a doctor using a stethoscope, and also by an ultrasound of the heart, called an ECHO. As mentioned before, many people with this condition have no symptoms and require no further treatment. However, the patients that have mitral regurgitation with MVP require closer monitoring. 

As far as treatment is concerned, if a patient has just MVP and no symptoms, no treatment is required. MVP with symptoms can sometimes be treated with medications to help with those symptoms (chest pain, palpitations). In rare cases, the MVP may cause severe mitral regurgitation, in which case the patient may need surgery to get their valve repaired or even replaced. Also, some patients with MVP have to take antibiotics prior to some dental procedures or other medical procedures, but these guidelines have changed in the past few years. Before, ANY patient with MVP had to get antibiotics before a deep dental cleaning, and that is not the case anymore.

 Hope you all enjoyed this little you know everything there is to know about MVP!...(ok...well maybe not EVERYTHING!...)

Saturday, May 12, 2012

Menu De-Construction...IHOP!

I have been on a mini vacation this week for a good friend's wedding in Philadelphia (it's been BEAUTIFUL here)...and I know it has been a while since the last here we go...Menu De-Construction time!

One of my guilty pleasure restaurants is IHOP. I'm pretty sure they put some sort of addictive product in their pancakes (so good!). Anyhow, there ARE good options for this restaurant, so I figured I would share them with you, along with the "no-way" choices to stay away from. I am going to stick to the breakfast food...because quite honestly I don't know anyone who goes to IHOP for lunch or dinner..:)

Two x Two x Two
Egg white omelet with tomatoes, green peppers, onions, and diced ham =  200 calories; add the 2 pancakes to make it a meal and you add 300 calories. Total= 500 calories (This is my usual meal..with a cup of coffee)

Simple & Fit- all options around 400 calories (good options!) I like the two x two x two

As a rule, stick to either egg substitute or egg whites. Turkey sausage is better than pork sausage. Avoid bacon and avoid the french toast/crazy loaded pancakes. I LOVE the pancakes here, so I get it...but try and just stick to 2 of the regular pancakes (and go light on the butter!)

NY Cheesecake Pancakes...these alone are over 1000 calories!
Colorado Omelette- 1120 calories
3 Double Blueberry Pancakes- 640 calories (just for the pancakes...can you believe it?!)
Two eggs, Hashbrowns and Toast (with the pork sausage)-1260 calories
French Toast Combos (on average)- 1100 calories
Pick-a-Pancake Combos (on average)- 1100 calories

So again...stick to these rules...maximum of 2 pancakes (preferably the regular pancakes), egg whites or egg substitute, sub turkey for pork sausage. Stay away from the French Toast, Crepes, and anything with the work "stuffed" in it.

Remember, like I always say...don't deprive yourself of the things you love...just modify your food decisions to fit into your diet. If you never allow yourself a pancake every once in a while you will go crazy!!

Tuesday, May 1, 2012

Time is Brain!

May is National Stroke Awareness month...and seeing that this is the 4th leading cause of death in the United States, I figured it's a pretty important topic to talk about!

Let's start with a...

Question 1: Who is more likely to die from a stroke?
                   a. Women
                   b. Men

Question 2: Symptoms of a stroke include all of the following EXCEPT:
                    a. Confusion
                    b. Abdominal Pain
                    c. Trouble speaking
                    d. Paralysis of part of the body
                    e. Sudden, severe headache

Question 3: The time frame from when your stroke symptoms start to when you see a physician can dramatically alter the treatment that is given to you.
                    a. TRUE
                    b. FALSE

Question 4: People who smoke double their risk of stroke.
                   a. TRUE
                   b. FALSE

Big Stroke...not good!
Let's do a little background work here. There are TWO types of strokes, ischemic and hemorrhagic. Ischemic strokes happen with something (plaque/cholesterol) BLOCKS an artery, and thus blood supply, to the brain. A hemorrhagic stroke happens when a blood vessel in the brain BURSTS, causing a bleed inside the brain. Ischemic strokes are more common, occurring in about 90% of cases of stroke.

Believe it or not, women are more likely to die of a stroke then men. Why? Mostly because we live longer, and the incidence of stroke increases with age. Again, just like heart disease, this is not a "man's" affects us too!

Time lost is Brain lost!
The MOST IMPORTANT thing I could ever, EVER possibly voice on today's post is the importance of TIME in stroke symptoms. As physicians and healthcare providers, we say "Time is Brain" meaning that the longer a person with a stroke waits to get medical care, the more brain (and function) is lost. Also, it is very important for your doctor to know exactly what time the symptoms be sure to check your watch. The time frame of symptoms may change the treatment in the ER.

Here are some of the "biggie" symptoms of a stroke. REMEMBER...if you or a family member begins to experience these symptoms CALL 911. DO NOT WAIT. ..:)

Sign's of stroke:
1. Sudden numbness or weakness of the face, arm, or leg- especially if it is on just one side
2. Sudden confusion, trouble speaking, or trouble understanding
3. Sudden trouble seeing in one or both eyes
4. Sudden trouble walking or loss of coordination
5. Sudden SEVERE (like worst EVER) headache.

What things can you do to help prevent stroke?
Just like in my previous posts about reducing heart disease, this holds true for stroke as well. NOT smoking (smokers have double risk of stroke), keeping blood pressure normal, having a healthy cholesterol level, and daily diet and exercise will all help to keep your risk of stroke low.

1. a.
2. b.
3. a.
4. a.

Until next time....