Geriatrician, Hospitalist, Patient Advocate, Healthcare Educator

The Winter Blues

Photo by Aaron Burden

It is common for people to feel down or a little depressed in the winter. For many, it is dark in the morning when heading to work, and by the time they head home again, it is dark again. With this, it feels like the whole day just slipped away. The winter blues or seasonal affective disorder actually affects many people in late fall and early winter. The rational behind this is that there are shorter, darker days in the winter with less daylight so there is higher production of melatonin which can cause lethargy and symptoms of feeling down. It is also felt that a drop in a brain neurotransmitter, serotonin, that affects mood may also contribute to triggering low mood.

Some ways to prevent and treat this feeling are:

  • See your doctor, sometimes vitamin D deficiency can make you prone to seasonal affective disorder. The sun is a source of vitamin D. There is a correlation between those with less exposure to sun and depression. Vitamin D produces the happy hormones serotonin and dopamine and with Vitamin D deficiency, there are less of these happy hormones. Make a point to incorporate vitamin D fortified milk, cereal, and juice in your diet and get about 10-30 minutes of sun exposure a day.
  • Stay active-exercise, that boost of energy will make you feel better
  • Take advantage of the sunlight and go out in the middle of the day to be able to get some “light therapy”
  • Socialize with friends and family
  • Eat healthy
  • Pick up a new activity or hobby be it cooking, reading, knitting, piano, or whatever you fancy

Sleep Explained

Photo by Gregory Pappas

With those of us that are wearing smart watches and tracking our sleep at night, it can get confusing with the sleep scores and breakdown provided. What we do know is that sleep is vital. Sleep is one of the most essential things to function and it is important to understand what sleep does for the body. After all, we do spend about a third of our lives sleeping. Sleep allows our bodies and minds to recharge to get us prepared for the new day and all that gets thrown at us in everyday life.

It is recommended that adults get about 7 to 9 hours of sleep a night. During this period, we go through different stages of sleep consisting of a sleep cycle. Each sleep cycle lasts 90 to 110 minutes long, giving us about 4 to 5 sleep cycles a night.

Sleep is divided into non-rapid eye movement(NREM) sleep ranging from stages 1 to 3 which accounts for 75% of total sleep and rapid eye movement(REM) sleep which is stage 4 of sleep and accounts for 25% of total sleep. Furthermore, stages 1 and 2 consist of light sleep and stages 3 and 4 of deep sleep.

Here is the breakdown:

Light sleep

Stage 1(NREM)

  • dozing off stage, we transition from wakefulness to sleep
  • lasts 2 to 10 minutes

Stage 2(NREM)

  • we spend about 50% of total sleep in this stage
  • lasts about 10 to 60 minutes
  • the start of muscle relaxation, slowed breathing, and heart rate

Sometimes, you may feel like you’re starting to fall asleep and then experience a sudden muscle jerk or contraction. This is called hypnic jerk or hypnagoic jerk or “sleep start”. This occurs in stage 1 or 2 of sleep. Hypnic jerks are a type of sleep myoclonus, are common and random.

Deep sleep

Stage 3(NREM)

  • lasts 20 to 40 minutes
  • brain wave activity slows down, delta waves begin to emerge so also known as delta sleep
  • respiration and heart rate slow down as muscles relax further
  • body temperature goes down, blood pressure drops

Stage 4(REM)

  • comprises about 20-25% of sleep
  • lasts 10 to 60 minutes
  • arrives about an hour to hour and a half after you go to sleep
  • first REM period lasts about 10 minutes.
  • each REM stage that follows gets longer and longer
  • eyes move rapidly
  • body becomes relaxed and voluntary muscles become immobilized
  • brain activity increases again, sleep spindles are seen
  • dreams occur

Deep sleep:

  • Is felt to be help consolidate and solidify the information you have learned in the daytime
  • Helps with creativity and insightful thinking
  • Sleep spindles and powerful brain activity help to transition short term memory to long term storage(helps capture memories)
  • Improves immune system, increases amount of immune factors and also sensitivity to those immune factors
  • Cells repair and rebuild to promote bone and muscle growth

Ways to Boost Your Immunity and Fight Off Infections

Photo by Luke Michael

It’s the season of viruses…we have a “tripledemic” going on with influenza, respiratory syncytial virus, and COVID-19 surging throughout the country. Hospitals are getting overwhelmed while staffing shortage continues and cold medications are becoming harder to find on shelves. We all have to do our parts to keep ourselves and our loved ones safe.

Steps to avoid infection

  • Get vaccinated-take flu and covid-19 vaccines
  • Keep up with hand hygiene
  • Wipe down counters/phones/keys with sanitation wipes(viruses can live on surfaces)
  • If someone is infected with a virus, stay away from others, especially young children and elderly(it is spread via respiratory droplets(coughing, sneezing, etc.). Don’t shy away from wearing that mask.

Boost immunity

  • Exercise regularly
  • Get your beauty sleep-don’t skimp on sleep(adults should be getting about 7 to 9 hours a sleep each night)
  • Maintain healthy weight
  • Try to minimize stress
  • Eat lots of fruits and vegetables

Foods that help with immunity

Of course, drinking plenty of water and getting those antioxidants in you is important. Here are some examples of foods you should be eating to up your natural immunity.

  • Vitamin C rich foods-citrus fruits such as oranges, broccoli, spinach, cauliflower, kale, kiwi, red bell pepper, strawberries
  • Zinc rich foods-lentils, nuts(almonds, peanuts, cashews), seeds(sunflower seeds)
  • Herbs/spices-garlic, ginger, turmeric, cinnamon, local honey
  • Probiotic-yogurt(also rich in vitamins including vitamin D
  • Flavonoids-blueberries, green tea

Antioxidants and Oxidative Stress

Photo by Brooke Lark

Cells produce free radicals during normal metabolic processes that are necessary for the body to function and also produce antioxidants to neutralize these free radicals.

Oxidative stress occurs when there is an imbalance between free radicals and the ability of the body to clear them(the antioxidant defense of the body) leading to cell and tissue breakdown which may cause DNA damage.

Ongoing oxidative stress can lead to chronic inflammation along with chronic medical conditions such as diabetes, chronic fatigue syndrome, Alzheimer’s disease, Parkinson’s disease, hypertension, atherosclerosis, stroke, etc.

Some of the risk factors for oxidative stress are obesity, smoking, alcohol use, intake of processed foods, diets high in fats and sugar, exposure to pollution, and UV radiation exposure.

Prevention is key and includes eating a diet rich in fruits and vegetables(that will provide antioxidants to the body), limiting processed foods, avoiding foods high in sugar and fats, regularly exercising, and maintaining normal body weight.


Although our cells naturally produce antioxidants, diet is also an important source. Eating foods with vitamins and minerals which also serve as antioxidants is important. Here are some examples of foods to eat more of whenever you get the chance:

  • Vitamin C-broccoli, brussels sprouts, berries, cauliflower, kale, kiwi, lemon, orange, papaya, bell peppers, tomatoes, sweet potato
  • Vitamin E-leafy greens, spinach, avocado, almonds, red peppers, almonds, peanuts, sunflower seeds
  • Zinc-chickpeas, cashews, lentils, fortified cereals
  • Beta-carotene and lycopene-beets, broccoli, carrots, kale, bell peppers, mango, oranges, peaches, spinach, sweet potato, tomatoes, tangerines
  • Selenium-Brazil nuts, seafood
  • Catechins-tea, cocoa, berries
  • Flavonoids-tea, citrus fruits, red wine, apples, pomegranate
  • Quercetin-apples, onions, red wine
  • Coumaric acid-spices(cloves, cinnamon, tumeric), berries
  • Anthocyanins-blueberries, strawberries, eggplant
  • Polyphenols-herbs, coffee

In general, the best antioxidant benefits are when foods are eaten raw or lightly steamed. Don’t overcook them! Next time you go grocery shopping, make sure you pick out as many antioxidant containing foods as possible. You will feel good about it and will be doing your body a huge favor.

The Pfizer COVID Vaccine Price Hike

Per Annalisa Merilli published October 22, 2022 in Quartz:

“For over two years now, the US government has purchased all of the covid vaccines administered in the country, in what has become the largest public vaccination campaign in American history. Those purchases have included more than 500 million doses from Pfizer. The first 100 million cost around $20 a dose, thanks to an earlier agreement in which the US government invested $1.95 billion in vaccine production. The remaining doses were bought for around $30 each. But once the US government supplies run out (likely in the first quarter of 2023) and covid vaccines and therapeutics are moved onto commercial health platforms, Pfizer is able to hike up the price of its shots. The company announced on Oct. 20 that it intends to sell the covid vaccine, marketed under the brand name Comirnaty, for $110 to $130 per dose. This is about four times the current selling price—and 100 times the estimated cost of manufacturing the vaccine. According to The People’s Vaccine Alliance, a coalition of over 100 organizations working to end vaccine inequity, Pfizer spends less than $1.20 to produce each dose of vaccine”

A 10,000% price hike of the COVID vaccine which has the power to save lives is hard to digest. Pfizer can talk about packaging and distributing costs but really cannot justify a mark up like this. The flu shot costs about $18 to $28, and the COVID vaccine cost will be about $110 to $130. It just goes to show, nothing changes, not even after a pandemic, the number one priority of pharmaceutical companies will be to make money and pad their bonuses.

Screen Time Can Affect Your Health

Photo by Jordan

It’s almost impossible to get away from the screen these days! We have work, computers, video games, social media, televisions, and let’s not forget our smart phones! Screen time is the amount of time spent using a device with a screen. Over the years, that time has increased dramatically, especially since the pandemic.

Adverse health risks associated with increased screen time:

  • Obesity-because of sedentary behavior while using the electronic devices, and this in turn can lead to other chronic illnesses
  • Chronic neck and back pain, poor posture
  • Depression and anxiety
  • Poor sleep-blue light emitted from digital screens interferes with the production of the sleep hormone melatonin in the body.
  • Physical strain to eyes. Remember, Take a screen break every 20 minutes for 20 seconds looking at something 20 feet away(20-20-20 rule) to prevent eye strain
  • Impaired socializing skills

How much screen time is too much?

  • No screen time for kids younger than 18-24 months
  • Children ages 2 to 5 years-American Academy of Pediatrics recommends about 1 hour a day of high quality programming(such as Sesame Street) A study that began in 2018 by National Institutes of Health (NIH) found that children who spent more than two hours a day on screen-time activities scored lower on language and thinking tests, those that spent more than seven hours a day of screen time had thinning of the brain’s cortex that may impact critical thinking and reasoning.
  • Adults-less than 2 hours a day outside of work use

Tips to reduce screen time:

  • Engage in more physical activity-walks, work-outs
  • Play board games with the family, read books, build puzzles, legos, listen to music, cook
  • Set aside times to “un-plug” from electrical devices as a family
  • Keep some rooms screen-free

After Exercise Care

Photo by Karsten Winegeart

We have all had those really great work-outs where we feel amazing afterwards…until the next day…then those muscle aches and soreness sets in.

This is called delayed onset muscle soreness(DOMS) and is normal after a new exercise or taking a familiar exercise up a notch. DOMS occurs about 12-24 hours following a work-out due to small microtears of the muscles. The muscle fibers due build back following these tears and recover and become stronger.

With time(few days to about a week), the muscle pain and soreness will go away. In the meantime, there are some things you can do:

  • Drink plenty of water
  • Continue with light activity-yes, you are sore but don’t just sit on the sofa, you need blood flow to your muscles to help in healing. Do light activity such as walking and stretching exercises
  • Make sure you eat protein-protein is needed to build back your muscle
  • Local pain relief such as heat therapy or cold therapy-for example, a warm shower
  • Massaging tender areas with your hands, foam roller, or massage gun
  • OTC anti-infammatory medication if you are really sore, but be cautious with this. Get yourself checked out with a doctor if you have to take OTC medications for more than a couple of days to make sure you don’t have a bigger injury.

It is sometimes hard to prevent DOMS from occurring but some things that may help or reduce the risk:

  • Don’t forget that 10 minute warm-up before your work-out and 10 minute cool down
  • Go slow with a new exercise routine and build up to the intensity you would like gradually
  • Hydrate yourself with plenty of water
  • Have recovery days where you do light activity such as walking, hiking, yoga, etc

Remember, the most important thing is you keep working on physical fitness and make it a part of your lifestyle.

Exercise and Electrolytes

Photo by Towfiqu barbhuiya

Water is by far the best drink for our bodies. But what about those times when you are are working out vigorously in the gym, playing a basketball game, or going for a long hike? At those times, it may be a good idea to think about the elctrolytes you may need to replenish. When we perspire, we lose electrolytes with that salty sweat. The main electrolytes lost are sodium, potassium, and magnesium. Later on, symptoms such as feeling thirsty, muscle cramps, salt craving, and sometimes muscle twitching can occur.

Prevent electrolyte issues

  • Hydrate early and start with water, let your thirst guide you
  • If you are doing a high intensity work-out, it’s hot outside, or you are sweating alot, then look to either have electrolyte drinks or water with a salty snack and/or banana. The main electrolytes in a sports drink is sodium and potassium which you can get in your snack when paired with water.
  • Beware of the sugar and carbohydrate content of sports drinks which have elctrolytes.

Some altertnatives to electrolyte water

  • Coconut water(unsweetened) is an alternative to sports drinks as you can avoid the sugar but it also contains less sodium than sports drinks do
  • Smoothies
  • Milk
  • Orange juice

The big question to drink electrolyte drinks or not should depend on your work-out, how intense your session is, and how much you sweat. On an average, if you have an hour long high intensity work out, you need to have water with a snack(that will replenish electrolytes such as sodium, potassium, and magnesium) or an elctrolyte/sports drink.

Mechanics of the Proper Walk

Photo by Sincerely Media

Just about all doctors, every chance they get, will tell their patients to take walks as often and as much as they can. Walking is one of the best exercises we can do for ourselves and has many health benefits. It is worthwhile to look at the mechanics of walking to make sure our walks are as effective as they should be.

Proper walking tips

  • Good posture-stand up tall with back straight, don’t slouch, slightly tighten your stomach muscles to engage your core, hold your head up straight, shrug your shoulders and let them relax

  • Let your arms swing naturally with slight elbow bend-opposite arm swing helps to maintain balance

  • Walk from heel-to-toe. Strike the ground with your heel and roll through to the toes

  • Wear proper shoes which are comfortable and tie your laces properly

  • Don’t overstride. Taking a longer step to increase your speed can cause mechanical stress to ankle, knees, and hip joints. You can increase your speed but keep the same walk stride.

  • Choose the right location, it could be your own neighborhood or nearby park-somewhere convenient so you don’t have to go out of your way and will give your more walk time

  • Challenge yourself-walking on a flat surface is nice, but going up and down hills will increase cardiovascular benefits

  • Balance the weight-often, walking to work entails carrying a purse or bag which we often place on one shoulder preferentially. Try to keep things balanced, if you carry the weight of your laptop bag on your right shoulder for 15 minutes, make that conscious attempt to change it to your left shoulder for the next 15 minutes.

Coffee Is Good for the Heart

Photo by Jessica Lewis

International Coffee day is celebrated October 1st and a new study was just published in European Journal of Preventive Cardiology that backs up that coffee is actually good for the heart.

In the study, about 450,000 adults from UK Biobank were followed for a period of 12.5 years and results showed that all types of coffee intake were associated with reduction in death from any cause. Drinking two to three cups of coffee a day was linked to the largest benefit.

In this large prospective cohort study, associations between habitual coffee intake, impact of all coffee subtypes, including decaffeinated coffee, and major cardiovascular endpoints were studied. The main findings from the study are:

  • Ground, instant, and decaffeinated coffee were associated with equivalent reductions in the incidence of cardiovascular disease and all-cause mortality.
  • Two to three cups/day of all coffee subtypes was consistently associated with the largest risk reduction of heart diseasse and all-cause mortality.
  • Ground and instant coffee but not decaffeinated were associated with a reduction in heart rhythm abnormalities.

So, it turns out coffee is actually good for you. Among other countless benefits of coffee, drinking two to three cups of coffee, caffeinated or decaffeinated, will improve longevity and heart disease. So grab that cup of coffee…or two….or three….and enjoy!