Michael Lin

On Feeling Low

Recently I saw Tom*, who has been having a difficult time for the past year, particularly for the past six months.  

"Michael, I just haven't got the same amount of steam I usually have, and my sleep is terrible," Tom says. He was having a particularly bad time at work, being bullied by his manager, making more and more demands on him and being critical of his work. "This made things bad, but when I talked with my wife, we agreed that it's actually been tracking downhill for the past 2 years, well before troubles at work. "

Now, while he loves his work, it does not give him the same amount of satisfaction. He finds it difficult to fall asleep, and wakes up at 3 am, thinking about things that needs to be done. He has a lot of things that needs to be checked off, but has been procrastinating - very unlike him. His sex life has taken a hit too - "I want to be intimate...but I just can't be bothered. I don't have the same motivation as I used to."

Tom describes himself as a happily married man in his 60s, with children and grand children, a job he is very good at and has always enjoyed, with no financial or social worries. Which makes him very puzzled, "because I have nothing to be stressed or worried about. The issues with my manager have been sorted, and life should be good," he told me.

There is a family history of depression, and after we discussed the issues he's been having with his life, we come to the conclusion that he is depressed. 

If you feel you may be in a similar boat, ask yourself these question.

Are you depressed:

1. How is your sleep? Too much or not enough can be a sign.

2. Do you feel more tired than usual? 

3. Appetite? 

4. Motivation - how is the drive to do things and finish tasks?

5. Concentration - mind wandering, or losing focus? 

6. Have you been feeling sad and low more than usual? 

7. How's your sex life? 

8. Has your confidence about yourself been affected? 

9. Do you have the same satisfaction with activities you usually enjoy?

These can hint at symptoms of depression.

 Visit these websites for more information, or see your doctor!

  *Name and demographics have been changed to protect the patient's identity.

 

On Dieting

Summer is around the corner, and I have more and more people coming to talk to me about their weight and the age-old topic of...Diets!

There are various incarnations and methods floating out there, but there are a few Great Golden Rules to go by when it comes to losing weight.  

1. If it doesn't take long to lose the weight, it won't take long to come back either.

Most weight loss within a matter of days or weeks, especially during 'crash' dieting, is attributed to losing water. When the human body suddenly has a lot less energy intake, it uses up all the glycogen stores - which is our body's supply of ready-to-use sugar. A lot of water is stored with glycogen, and therefore when this store is used up, the water is lost from the body. This may account for anything up to 10 kg of body weight, depending on the weight the person begins with.
As soon as the person starts to eat again, the glycogen and water is stored into the body again, and all the 'weight loss' returns.

2. We can eat more than we burn off.

2 kilometer run burns around 150 calories.  Twice around the block, 15 minutes.

7 small squares of chocolate (30 grams) is around 150 calories. A few chews, 5 minutes

(even the healthy option has a lot of energy - 2 slices of toast cut wholemeal bread: 200 calories.)

3. Protein and fibre keeps you fuller for longer.

From a 'feeling hungry' point of view, having more protein in the diet (eg. egg, beans, nuts, meat, poultry, fish), will keep you fuller for longer. It takes the digestive system a bit longer to digest and absorb, and releases energy at a slower pace, as opposed to simple sugars in candy - which releases energy quickly, but leaves you craving for more. Fibre, will also physically increase the bulk of the meal, making you feel fuller, with less calories.

4. Chew slower, eat less

Chewing slower will allow the food we eat to be absorbed better, as well as increasing the time between mouthfuls. Less time shovelling food down the throat means less calories.

5. Treat yourself!

One of the greatest misconceptions is that losing weight means no treats. Have regular and scheduled times for whatever your vice may be: ice cream, cake, candy, fish n chips...make sure you make time for these. Large amounts – once a week eg. A fish n chips meal. Small amounts: two spoonful of ice cream, once every second day. Doing so will motivate you to avoid those unnecessary snacks in exchange for your favourite treat, as well as keeping the cravings at bay.

6. Take your time

10 kg of body weight takes about a year

Of Snot and Sniffles: Part Two

Often, it may be difficult to tell the difference between a viral and bacterial infection. And to make it even more complicated, they can be happen at the same time or one after another! Your doctor can make a diagnosis by taking a history and examining you closely.

With viral infections, it is about controlling the temperature, taking plenty of fluids, and resting so our body has the energy to fight off the bug that is causing havoc.

What about the flu jab (influenza vaccine), does it work?
This is a complicated area.

Let's first look at how the flu jab works.

Clever scientists have worked out that the flu usually causes problems, because when they invade our body our immune system, or the the soldiers of our body, are not prepared.

Most of the time they have never seen that flu virus before, and so are slow to react. This gives the bug time to attack, making us sick. Usually 3-4 days after the virus attacks, our soldiers finally muster, and fight back, and it takes another 3-4 days to mop up all the bugs that are floating around.

Hence why we often continue to feel worse for the first 3-4 days, and then start to improve after that.

The flu jab prepares our soldiers.

Each flu virus has their unique uniform (protein coating), which is recognisable by our soldiers. The flu jab takes the uniform of the virus (not the virus itself), and injects it into our body. Our soldiers then look at the uniform, and learn that whatever comes into our body wearing this uniform the next time, is an enemy.

The 'practice drill' of encountering the enemy uniform, can makes us a bit unwell for a few days, and that is our soldiers practicing, rather than an actual 'flu' infection. Because there isn't actually any flu in the jab!

The 'flu' virus changes their uniform all the time. Every year it changes, and that's why there is a flu jab for every year.

Sometimes I will see people who comes in unwell, and I tell them “You've got the flu,” to which they answer with surprise “but I've had the flu jab this year!”

In New Zealand, most of the time we take the type of flu from North America's winter – 6-months before our winter.

We are counting on the fact that most of the travellers will be from that part of the world, as we are both English speaking countries.

However there are still South American flu, European flu, African flu, Asian flu that are floating out there, and we would not be protected against these, if they should land on the Land of the Long White Clouds.

In short, most doctors would recommend people who are more susceptible to becoming unwell, for example those with chronic breathing issues like asthma, and other chronic illnesses like diabetes, to get the flu jab each year. It reduces some of the risks of becoming unwell on top of their medical conditions.

However, if someone is usually fit and well with no long term medical conditions, it then becomes a personal choice whether to get the jab or not. I often recommend, however, even if someone is fit and healthy, that they protect those around them that may be susceptible by getting a jab themselves so as not to pass it to the vulnerable loved ones.


Of Snot and Sniffles: Part One

Recently on the Kapiti Coast, there has been a large surge in the 'flu', or more specifically the Influenza B virus. I had received the notification from Regional Public Health, and within one week, I was seeing a whole lot of children with it.

What is the 'flu'? When should we get worried about a fever? What can we do? Does the 'flu' jab (vaccine) work?

These are a few of the most common questions I get asked.

The 'flu' is the Influenza virus. It causes high fever, usually above 38.5 degrees Celsius. Other symptoms may range from a little bit of colourless runny nose, slight dry cough, body aches/headaches, to no major symptoms at all except for the fever.

The 'flu' is to the 'common cold', as the Bengal tiger is to the domestic cat. The 'flu' packs a lot more punch, and in rare cases may be fatal. Whereas the common cold may cause a low fever, with the same range of symptoms as the 'flu' but not as severe.

A fever, is a core body temperature of 37.5 degrees Celsius or higher. Core body temperature can be measured by a tympanic thermometer (poke-in-the-ear), or a standard pen-style thermometer under the tongue, armpit, or if you prefer the retro-style: up the bottom.

Often times my patients/parents of patients ask what is a temperature that should cause worry.

I always go by: if a temperature responds to treatment, then it is not a cause for concern.

It is when a temperature that does not decrease despite all the appropriate treatments, that we get worried. What are the appropriate treatments, I hear you say?

There are two main ways of treating a fever:

  1. Physical methods: Stripping the child down in a warm room. Using a tepid facecloth, continuously wipe the back of the the neck, armpits, and groin (the part where the thighs joins to the body. NOT the genitals). These are where the major blood vessels in the body travel close to the skin, and can quickly bring core temperature down within minutes. Tip: cool the cloth off after a few wipes as you'll find it quickly heats up with body heat. Often the child will complain of being cold, or shiver - this is normal, as the body thinks it should be warmer than usual in illness.

  2. Medicine: Most commonly, paracetamol and ibuprofen. These two medicines reduce fever and pain in different ways, do not interfere with each other, and therefore work very well with each other to reduce the fever and aches of any illnesses. They are also generally mild enough to use on the youngest children. Ask your doctor about the suitability of these medicines for your child.

What about antibiotics?

Antibiotics work for a bacterial infection, but not for a viral infection. Bacteria and viruses are two different types of 'bugs'.

To be continued...

 

Passing Time Gracefully

“I would hate to get old, I never want to get old!”

Similar sentiment in my patients of the younger generation are not uncommon. When asked why, the reasoning is often similar: getting old is synonymous to reduced quality of life.

Instead of trying to change their mind, I keep a straight face at their seemingly naïve declarations, and thought about why these young adults would think this way.

My examination took me in a different direction, however, after a little looking around.

I remember the fact that as we age, the muscles in our body weakens upwards, starting from our feet and legs.

Practically speaking, this starts as 'slowing down' in the beginning, turning into 'unsteady' and for some, eventually into 'lost my confidence on my feet'. It is a sad reality that I see everyday with my older patients.

One patient recently told me, “You never really think you have a problem, until something happens and then it really brings it home.” He had a fall, but was lucky he did not injure himself. Now he attends balance exercise classes to prevent it from happening again.

The best way to stay well, and prevent injury, is to follow the Law of Process – success is in preparation every day, not in one day.

Not only does balance exercise help with physical movement, but you will find yourself moving with a lot more confidence. This is something everybody and anybody can benefit from, no matter your age, level of fitness, and body type.

You could either practice in your own home, or attend a class. Ask your doctor or physiotherapist for information about balance classes near you. Attending a class also has the added benefit of socialising!

Here are some entry level exercises to start with at home. If required, stand close to something sturdy you can hold on to for additional balance. Do this regularly, and build it into a part of your daily life eg. Just before having breakfast, or when you clean your teeth.

  1. Weight Shifts: Stand with your feet hip-width apart, and your weight equally distributed on both legs. Next, shift your weight to your right side, then lift your left foot off the floor. Hold for as long as you can maintain good form, for up to 30 seconds. Return to the starting position, and repeat with the other side.

  2. Single leg balance: Stand with your feet hip-width apart, and your weight equally distributed on both legs. Place your hands on your hips. Lift your left leg off the floor and bend it back at the knee. Hold for as long as you can maintain good form, for up to 30 seconds. Return to the starting position, and repeat with the other side. For experts, reach forward with your foot, as far as possible, without touching the floor.

A Kaumatua (Maori elder) told me – it is our responsibility to show and teach the younger generation, and pass on our knowledge so they can make better decisions. Youth is not stupidity, but they need to be shown the way.

I could not think of a better way to put it!