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FROM THE DOC
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THE ANTIDOTE
The antidote is a term we are familiar with from thriller movies in which someone gets poisoned and they are saved by the magic cure that is given to them. The antidote is a particular type of cure, one which is specific to a poison and which renders the poison harmless or inactive. I must say that I have cured many people through the years by different medications, but I've never thought that I was giving them 'the antidote.'
In today's environment of political stress and partisanship, I hear many patients report that the news is making them frustrated, anxious, or just plain mad....so I thought I would come up with THE ANTIDOTE for the current negative vibrations.....and that antidote is........wait for it.....DOING.
By DOING, I mean, rather than thinking about things and letting the issues of concern get to you, you stop thinking and start doing something. That something can be particular to the topic at hand.....get active in the political issue you are concerned about through the group that supports your cause or view. Participating in that group through actual activities as opposed to just talking about the topic. But alternatively, you can just DO SOMETHING ACTIVE of any sort. Play a game, engage in a hobby, do some physical activity like walking, biking, swimming, exercising. Find a sport to participate in or to watch actively, going out to the game to be there in person as opposed to watching it on TV. Getting out of your house to be an active participant in the world will take you out of your headspace and put you into the world more fully, engaging all of your capacities and sense in a richer and more vibrant way.
Kurt Vonnegut explained the meaning of life.....as follows: "We are here to help each other get through this thing, whatever it is." By DOING.....you will inoculate yourself, and others.....and that will make a difference that matters.
Yours in good health,
- Dr. Lakin
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VOL 15 / Issue: #4
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Autumn/ 2019
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SAVE THE DATE!
Powerful Converations With Dr. Raj Singh and Dr Douglas Lakin. . . . October 24th!
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WATCH FOR OUR
EMAIL INVITATION SOON!
Thursday, Oct. 24, 2019,
7 - 8:30pm
Honor Health Scottsdale Shea Medical Center
Brady Conference Center
Dr. Raj Singh, MD is a neurology specialist in Scottsdale, AZ and has been practicing for 40 years. He specializes in neurology, physical medicine & rehabilitation, regenerative therapy and a holistic wellness approach that ensures all patients are able to maintain healthy, active lifestyles.
Dr. Singh provides detailed health evaluations for patients who are motivated and committed.
As a specialist in treating medical conditions using non-surgical methods, Dr. Singh has long been an advocate of regenerative therapy.
You won't want to miss this exciting conversation!
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LISTEN TO DOCTORDOUG ON THE UPCOMING FLU
SEASON. . . . .
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The FLU SEASON almost here...and OUR FLU SHOT CLINIC is in progress.
Take a listen to my latest
PODCAST ON THE FLU. Getting ready for this season..it's time. Remember....."Failing to prepare...is preparing to fail." Let's keep the FLU at bay......take a listen
>>>>HERE<<<<
Read more about he FLU below:
This information and other health topics can be found at....
DoctorDoug.com
The Flu
This is a specific viral illness that has similar and overlapping symptoms with common cold/respiratory viruses but is unique in that it is much more virulent (symptoms are significantly worse). This infection is specifically seasonal, typically in Arizona from November until March with the peak incidence in December, January, and February.
Most Common Symptoms
They consist of the same set of symptoms as the common cold/rival respiratory syndrome, but they are worse.
- High fever (often over 102 degrees, but can range from 99's to 104+)
- Aching muscles throughout the body
- Pain in the muscles around the eyes with movement of the eyes
- Sore throat
- Sinus congestion
- Severe cough
- Excessive mucous production (sinus and chest)
- Headache
- Occasionally diarrhea
What to Do at Home
Symptomatic treatment for the most bothersome symptoms
Aches and Pains and Fever:
- Use anti-inflammatory medication. Advil (Ibuprofen 200mg), 2-3 tablets....2-3 x per day or Aleve (naproxen 220mg), 1-2 tablets...1-2 x per day, or Tylenol 650-1000mg four times per day.
- Drink good amounts of clear liquids (anything you can see through)
Sore Throat:
- Dissolve 1 teaspoon of salt in a glass of warm water.
- Gargle for 15 seconds and spit.
- Repeat during the day every 2-4 hours to relieve pain.
- Pain relief medications: Advil (Ibuprofen 200mg), 2-3 tablets....2-3 x per day or Aleve (naproxen 220mg), 1-2 tablets...1-2 x per day, or Tylenol 650-1000mg four times per day.
Sinus Congestion and Drainage:
- Use a decongestant such as Sudafed 30mg, 1-2 pills up to four times per day, or use a drying antihistamine such as Chlortrimeton 4mg, up to four times per day. Other cold medications (over the counter) can be used.
- Claritin, Zyrtec, Allegra will not work for congestion symptoms from an infection. Do Not Use.
Cough:
- Steam: Either in the form of a hot, steamy shower or using a hot pot of water and covering with a towel and put your head under the towel. Both methods will provide humid air to the irritated air passages and soothe the cough.
- Cough Syrup: Robitussin DM or Delsym cough syrup can be used to suppress cough.
- You may require a prescription cough syrup with Codeine. Contact me if that is the case.
When to Seek Medical Assistance
- If it's during flu season and you have high fever, aches and pains, and sore throat/cough....prescription treatment is reasonable to reduce symptoms and shorten the course of illness.
- Flu medication (Tamiflu..twice daily for 5 days) can shorten the course of symptoms. Earlier is better, but you can take this later in the course of the flu.
- Xofluza....single dose (2 pills) is best taken very early in the course of the flu (within 48 hours). It significantly reduces the duration and severity of symptoms in just one single dose.
Worsening symptoms/Signs of Complications:
- If fever is over 101 degrees and symptoms are worsening after 2-3 days and fever is persisting at a night level.
- If cough produces blood tinged mucous
- If confusion is associated with the above symptoms
- If you get a rash with the above symptoms
If any of the above symptoms occur.....you may want to be checked for complications of THE FLU. Come to the office to be evaluated
How Long to Recover
- The flu is a viral infection that will generally take from 3-5 days to improve and then from 7-14 days to completely resolve.
- Plan on being away from the general public for the first three days, although you may remain infectious for a week. Rest and drink fluids for the first few days then your activities are 'as tolerated.'
How to Prevent
- Avoid people who you know are significantly ill particularly during the flu season
- Consider getting the FLU SHOT. This is an immunization that is given in late summer through the winter and can markedly reduce your chances of getting the flu.
Wash your hands and use alcohol-based hand cleansers frequently.
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Can Science Explain What People See & Feel During a Near-death Experience?
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New research points to brain activity that occurs when the body isn't in any danger at all: REM sleep.
For hundreds of years, people of all ages, from all over the world, have told similar stories about moments their lives were in real peril: an intense white light, a sense of tranquility and feeling as if they were somehow floating above their body.
For neurologists, these so-called near-death experiences have a neural basis, one that may, according to new research, be similar to what goes on in the brain during certain sleep disturbances.
"I have a theory that near-death experiences may occur when the brain is still functionally and structurally intact," said Dr. Daniel Kondziella, a neurologist at the University of Copenhagen.
Kondziella is the lead author of
new research on near-death experiences that is being presented Saturday at a meeting of the European Academy of Neurology Congress. His findings, which have not yet been published in a peer-reviewed journal, suggest that the typical hallmarks of such episodes, such as bright white light and a sense of tranquility, are most likely the result of neural activity in the brain, similar to what goes on during a phenomenon called sleep paralysis.
"I do think these experiences can be triggered in situations with imminent death," Kondziella told NBC News. "But while perceiving these experiences, brain networks are working to be able to store those experiences, to be able to be resuscitated, to retrieve those memories, and to tell us about them."
"I think that before passing out, they have the near-death experience. When they are then resuscitated, the last thing that they remember is that experience," he said.
Near-death experience and sleep paralysis
Kondziella's study was based on questionnaires given anonymously to 1,034 people online. The questionnaires began with a single query: Have you ever had a near-death experience?
The definition of such an experience was broad: "Any conscious perceptual experience, including emotional, self-related, spiritual and/or mystical experiences, occurring in a person close to death or in situations of intense physical or emotional danger." And because the responses came from anonymous individuals, it was impossible for the researchers to confirm any of the responses.
Those caveats aside, the researchers found that 106 people, or about 10 percent of the respondents, reported what was considered to be a "true" near-death experience.
What's more, participants who reported near-death episodes were also more likely to have a history of extreme and vivid sleep disturbances, referred to as REM sleep intrusion (REM is rapid eye movement).
That finding, the researchers said, boosted the theory that these experiences have a neurological basis.
"REM sleep is the kind of sleep where we do most of our vivid dreaming," said Dr. Kevin Nelson, a neuromuscular neurologist affiliated with the University of Kentucky. He was not involved in the study, but published
similar research more than a decade ago.
Nelson explained that there are only three states of consciousness in which the brain can exist: awake, non-REM sleep and REM sleep.
During REM sleep, when a person is dreaming, most of the muscles in the body are paralyzed so dreams aren't acted out physically.
Usually, a switch in the brain allows people to move seamlessly from one state of consciousness to another. But sometimes, that switch doesn't work properly, allowing REM sleep and waking to blend.
"So you'll have
elements of the REM system occurring while a person is essentially awake," Nelson said. "People may wake up and they'll be paralyzed and unable to move. They may have visual or auditory hallucinations. Usually they're terrified."
This phenomenon is called sleep paralysis, and it was described by some of the respondents in the study. "Sometimes I wake at night, and I can't move," one participant wrote. "I see strange things, like spirits or demons at my door, and after a while I see them coming beside me. I can't move or talk, and they sit on my chest. It scares the hell out of me!"
A
2011 review estimated nearly 8 percent of the world's population has experienced at least one episode of sleep paralysis in their lifetime, and not all experiences are as vivid or scary.
Both Kondziella and Nelson suggest the brain mechanisms responsible for these sleep disturbances also allow people to visualize experiences when their lives are truly in danger, a hypothesis that is bolstered by the study's finding that there is overlap between those who report experiencing both phenomena.
"People whose brains are more likely to blend REM and waking consciousness - under the right circumstances - are much more likely to have a near-death experience," Nelson said.
Nelson also said the part of the brain that allows people to be aware of where they are physically - standing up, lying down, sitting on a chair - is turned off during REM sleep. This may explain in part why some people have out-of-body experiences.
Some outside experts were skeptical of the study, and in particular, the finding that one in 10 people have had a near-death experience.
"If anything, I think it's more likely that people are reporting sleep events erroneously as near-death experiences based on this study," said Dr. Donn Dexter, a fellow of the American Academy of Neurology and a neurologist with the Mayo Clinic Health System.
Kondziella was quick to defend what people experience as near-death episodes, which are often reported to be life-changing and spiritually meaningful.
"As a scientist, I think there is a biological explanation," he said. "But if there is a deeper meaning for them, that is a question for philosophers and religious leaders."
All of the neurologists agreed that there is room for both science and faith in the same conversation about near-death experiences.
"You can be a scientist and still have strong faith," Dexter said. "With science, you have to have a theory, a hypothesis that you can prove false. You can't prove somebody's faith false."
"There will always be mysteries that can't be solved," Nelson added. "But it does no harm to the mystery to know a little bit more about it."
- By Erika Edwards MSNBC, Health
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Dr Lakin's New Book:
The New Guide
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Dear Patients,
This guide is one of a series of books meant to provide simple answers for day-to-day health questions. It is my effort to pass on 55 years of wisdom accrued as a child of a physician and as a Johns Hopkins-trained internist with over 30 years in practice. I hope this advice is helpful to you and your family. It's actually meant for my own.
DoctorDoug
Paper copy available in our office or you can read it online....
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Would You Like to be 'Paged' for Your Appointment?
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We have brought back the option to wait outside the office for your appointment and be 'paged' when it is your time.
Yes, now you have the option to wait outside the office; in the main lobby or even in your car!
When it is time for your appointment, we will page you so you can avoid close contact with any possible environmental infections.
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Sarah & Her Little Helper
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Simply check in at our front desk, then we will give you a pager to keep in touch. It is that easy!
Stay healthy my friends!
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It's important to safeguard both your Medicare Number and Medicare card. Con artists may try to get your Medicare Number or personal information, so they can steal your identity and commit Medicare fraud.
Here's what can you do to protect yourself: guard your Medicare card like a credit card, and only give your Medicare Number to people who should have it (like doctors and pharmacists).
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GET ON BOARD
THE Q STRESS SYSTEM!
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'After 30 years our old treadmill machine finally gave up the ghost and conked out. State of the art in 1990, it was a workhorse and provided rather impressive results for heart screening in our patients .
As a result, we have now purchased the 2019 state-of-the-art treadmill to carry on with cardiac screening for patients at risk for heart disease.
The new equipment has cutting edge computer technology and systems that make it a pleasure to use and a pleasure to run on.
If you have concerns about your heart, we can consider doing a treadmill test to allay concerns about potential troubles.
Let's discuss this at your next physical exam. I'm excited to be able to carry on our high level of cardiac screening for out patients!'
Dr. Lakin
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Genetic Testing By Myriad, Available In Our Office Now. . . . .
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The Myriad Hereditary Cancer test is a 28-gene panel that identifies an elevated risk for eight hereditary cancers:
Genetic screening is now a practical tool that we can use to help in the management of your health and the health of your family. It is recommended by the USPTF (United States Preventive Services Task Force.) This has implications for you, but also for your family, and I think it is worthwhile to consider.
We are at the beginning stages of applying this science in the clinical setting, so it is of limited scope of application. I want to help determine if it can be applied to your particular family history. This questionnaire is meant to do just that.
- Determine if you are at risk for cancers that run in the family
- Determine if genetic testing, at it's current state of development, is applicable to your situation
- Have the testing done to determine the best monitoring strategy, as well as helping guide you and your family in future testing and monitoring.
You will notice that this questionnaire has a specific focus on certain cancers, as that is the state of practical application of current genetic testing.
We are using a 24-gene panel from Myriad labs, the inventors of the BRCA test, which was the first large-scale genetic test validated for breast cancer family history.
For now, only a select group of patients can benefit. In the future, genetic testing will become commonplace and perhaps done routinely for everyone.
Answer the following questions and we will determine if you can benefit from this testing right now.
As for the cost, insurance coverage, and privacy issues related to such testing, this will be answered prior to running the test, so feel free to provide this information to initially see if you can benefit.
The process:
Complete this questionnaire
Submit a specimen of saliva (spit test).....this will be the material that is genetically tested.
Myriad labs will contact you to review cost, insurance, and privacy issues before any testing is performed.
Once completed, you will receive a detailed report and we can review it together to determine the best strategy for monitoring your health on an ongoing basis, as well as having specific advice for monitoring of your family members.
In the future, should additional testing become available that is valid to do, your current information will be used in such an analysis.
** Click HERE for more information and to take the Myriad Genetic test
to see if you are at risk.
If you think you are at risk and would like more information, please contact our office to schedule an appointment with Dr Lakin.
'Knowledge is Power!'
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Which Drink Is Best For Hydration?
Hint: It Isn't Water.....
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 When you're thirsty and in need of a drink, which beverages are best at keeping you hydrated?
The researchers found that while water --
both still and sparkling --does a pretty good job of quickly hydrating the body, beverages with a little bit of sugar, fat or protein do an even better job of keeping us hydrated for longer.
The reason has to do with how our bodies respond to beverages, according to Ronald Maughan, a professor at St. Andrews' School of Medicine and the study's author. One factor is the volume of a given drink: The more you drink, the faster the drink empties from your stomach and gets absorbed into the bloodstream, where it can dilute the body's fluids and hydrate you.
The other factor affecting how well a beverage hydrates relates to a drink's nutrient composition. For example, milk was found to be even more hydrating than plain water because it contains the sugar lactose, some protein and some fat, all of which help to slow the emptying of fluid from the stomach and keep hydration happening over a longer period of time.
Milk also has sodium, which acts like a sponge and holds onto water in the body and results in less urine produced.
"This study tells us much of what we already knew: Electrolytes -- like sodium and potassium -- contribute to better hydration, while calories in beverages result in slower gastric emptying and therefore slower release of urination," said Melissa Majumdar, a registered dietitian, personal trainer and spokeswoman for the Academy of Nutrition and Dietetics who was not involved in the study.
Sugar in moderation
But here's where it gets tricky: Beverages with more concentrated sugars, such as fruit juices or colas, are not necessarily as hydrating as their lower-sugar cousins. They may spend a little more time in the stomach and empty more slowly compared to plain water, but once these beverages enter the small intestine their high concentration of sugars gets diluted during a physiological process called osmosis. This process in effect "pulls" water from the body into the small intestine to dilute the sugars these beverages contain. And technically, anything inside the intestine is outside your body.
Juice and soda are not only less hydrating, but offer extra sugars and calories that won't fill us up as much as solid foods, explained Majumdar. If the choice is between soda and water for hydration, go with water every time. After all, our kidneys and liver depend on water to get rid of toxins in our bodies, and water also plays a key role in maintaining skin's elasticity and suppleness. It's the cheapest moisturizer you'll find.
While staying hydrated is important -- doing so keeps our joints lubricated, helps prevent infections, and carries nutrients to our cells -- in most situations people don't need to worry too much about how hydrating their beverages are.
"If you're thirsty, your body will tell you to drink more," Maughan said. But for athletes training seriously in warm conditions with high sweat losses, or for someone whose cognitive function may be negatively impacted by working long hours without beverage breaks, hydration becomes a critical issue.
Can beer and lattes keep me hydrated?
Alcohol acts as a diuretic, which causes you to pass more urine, so when it comes to alcoholic beverages hydration will depend on a beverage's total volume. "Beer would result in less water loss than whiskey, because you are ingesting more fluid with beer," Maughan said. "Strong alcoholic drinks will dehydrate, dilute alcoholic drinks will not."
When it comes to coffee, how well your java hydrates you will depend on the amount of caffeine you consume. A regular coffee with about 80 milligrams of caffeine --
roughly what you would find in 12 oz. of Folgers' house blend -- would be pretty much as hydrating as water, according to Maughan's research.
Consuming more than 300mg of caffeine,
or about 2-4 cups of coffee, could cause you to lose excess fluid as the caffeine causes a mild, short-term diuretic effect. This is more likely to happen with someone who doesn't typically consume caffeine, and it could be offset by adding a tablespoon or two of milk to your cup of joe.
The most hydrating beverages, ranked
The research team at St. Andrews University tested 13 common beverages to see how they impact hydration. Here's what they found, ranked from most hydrating over a four-hour period to least.
- Skim milk
- Oral rehydration solutions (like Pedialyte or Liquid I.V.)
- Full fat milk
- Orange juice
- Cola
- Diet Cola
- Cold tea
- Tea
- Sports drink
- Still water
- Sparkling water
- Lager
- Coffee
- by Sandee LaMotte, CNN
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Ascenda Introduces New Molecular Stool Test That Detects C. Difficile Toxin A and B
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Testing available in our office now!
Ascenda BioSciences is proud to introduce a NEW molecular stool test that detects C. diff toxin A and B (2 separate results). This test is intended for all types of patients with diarrhea, especially those who live in assisted living facilities
Gastrointestinal infections in both pediatric and adult patients account for significant morbidity and mortality worldwide (Schlenker and Surawicz 2009). In developing countries, an estimated two to four billion episodes of infectious diarrhea occur annually (Navaneethan and Giannella 2008). In addition, immunocompromised hosts, including HIV patients, solid-organ transplant recipients or patients requiring therapy for chronic inflammatory diseases are susceptible to gastrointestinal infections (Thom and Forrest 2006). Mild diarrhea can lead to absenteeism from school or work and may require treatment by a health care provider. Patients with severe diarrhea may be hospitalized and some may develop more serious sequelae such as Guillain Barré syndrome and hemolytic uremic syndrome (HUS), and in some cases death (Fischer Walker, Sack et al. 2010). Nearly three percent of neonatal mortality and 17 percent of under-five child mortality is attributable to diarrhea (Patel, Mamtani et al. 2010).
Clostridium difficile is the most common cause of nosocomial infectious diarrhea in developed countries and is the major cause of antibiotic-associated pseudomembranous colitis (Yoo and Lightner 2010; Navaneethan and Giannella 2008).
C. difficile is a Gram-positive anaerobic rod-shaped bacterium belonging to the Clostridiaceae family that causes diarrhea following the production of two toxins, enterotoxin A (the product of the tcdA gene) and cytotoxin B (the product of the tcdB gene) (Yoo and Lightner 2010; Schlenker and Surawicz 2009; Persson, Torpdahl et al. 2008). In the US, the number of hospitalized patients discharged with "intestinal infection due to C. difficile" (as the discharge diagnosis) more than doubled between 2000 and 2009 from approximately 139,000 to 336,000 (CDC, 2012).
Contact us today for more information about how to order the test at our office.
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Halitosis/Bad Breath
Symptoms - Causes - Treatment
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Dr Marie Jacobs
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Bad breath, also known as halitosis, is estimated to affect one in four people globally. It can cause significant worry, embarrassment, and in some cases may even cause anxiety. While there are many products available designed to fight bad breath, because they do not address the cause of the problem, they are only temporary measures.
SYMPTOMS
Bad breath odors can vary, depending on the cause or underlying source. Some Individuals have serious concern about their breath even if they have little or no mouth odor, while others who have bad breath are not even aware of it. If there is a concern, since it is difficult to assess one's own breath smells, a close friend or relative can help to confirm your bad-breath questions.
CAUSES
The most common reason for bad breath is related to oral hygiene, but other situations can also be contributing factors.
Food -
The breakdown of food particles in and around teeth can increase bacteria and cause a foul odor. Eating certain foods that can cause bad breath are absorbed into the blood stream and move to the lungs which affect exhaled air. Brushing can mask it, but halitosis lasts until the culprit is no longer in the body.
Common odor-producing foods include onions, garlic, cheese, pastrami, certain spices, orange juice or soda, and alcohol. Also at risk for bad breath are dieters who eat too infrequently, or who are fasting, or persons following low-carbohydrate eating programs. This is due to the breakdown of fats, producing chemicals called ketones which have a strong aroma.
Tobacco Products -
Tobacco products cause their own types of mouth odor. Additionally, users have an increased chance of gum disease, another source of bad breath.
Poor Oral Hygiene -
Brushing and flossing ensure the removal of small particles of food that can build up and then slowly break down, producing odor. A film of bacteria called plaque builds up if brushing is not regular and thorough. This plaque can irritate the gum tissue and cause inflammation between the teeth and gums called periodontitis. Dentures that are not cleaned regularly or properly can also harbor bacteria that cause halitosis.
Dry Mouth -
Saliva helps cleanse the mouth, removing particles that cause bad odors. A condition called dry mouth or xerostomia can contribute to bad breath because production of saliva is decreased. Dry mouth naturally occurs during sleep, leading to "'morning breath", and it worsens if you sleep with your mouth open. Chronic dry mouth can be caused by a salivary gland problem, medications, medical conditions, alcohol use, tobacco and excessive caffeine.
Medications -
Certain medications can reduce saliva and, therefore, increase odors. Others can produce odors as they breakdown and release chemicals in the breath. Examples include nitrates used to treat angina, some chemotherapy chemicals, and some tranquilizers, such as phenothiazines. Individuals who take vitamin supplements in large doses can also be prone to bad breath.
Intraoral Infections -
Bad breath is possible following oral surgery procedures, tooth removal, or as a result of tooth decay, gum disease, or mouth sores.
Other Mouth, Nose, and Throat Conditions -
Bad breath can sometimes stem from small, bacteria-covered stones that can form on the tonsils at the back of the throat. Also, infections or chronic inflammation in the nose, throat, or sinuses, which contribute to postnasal drip, can cause oral odor. A foreign body lodged in the nasal cavity should be suspected, especially in children, as a contributor to bad breath.
Diseases -
Some cancers, chronic lung disease, liver failure, kidney disease, diabetes, and other metabolic diseases can cause or contribute to halitosis - some causing a distinctive breath odor due to the specific mixes of chemicals that they produce. Chronic gastroesophageal reflux disease (GERD) can be associated with bad breath due to the regular reflux of stomach acids.
DIAGNOSIS
Often, a dentist will likely smell the breath from the mouth and from the nose of a patient with suspected halitosis and rate the odor on a six-point intensity scale. The dentist may also scrape the back of the tongue, as it is often the source of the odor, and smell the scrapings and rate its intensity.
There are a variety of sophisticated detectors that can rate odor more precisely; however, these are not always readily available.
TREATMENT
Depending on the cause, further treatment for bad breath can vary. If your halitosis is thought to be caused by an underlying health condition, your dentist will likely refer you to your primary care provider.
To resolve causes related to oral health, your dentist will work with you to guide you to better control that condition.
Dental measures may include the following: If your bad breath is due to a buildup of bacteria (plaque) on your teeth, the dentist may recommend a mouth rinse that kills the bacteria. Also, a toothpaste that contains an antibacterial agent to kill the bacteria causing plaque buildup may be recommended.
If you have gum disease, you may be referred to a specialist (periodontist) because it can cause gums to pull away from the teeth, leaving deep pockets that can fill with odor-causing bacteria. Usually, only professional cleaning removes this source of bacteria. The dentist may also recommend replacing faulty tooth restorations, which can provide a breeding ground for bacteria.
LIFESTYLE AND HOME CARE
To reduce or prevent bad breath:
Brush teeth after eating. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice daily, especially after meals. Changing your toothbrush every two to three months is also important to prevent bacteria buildup - and choose a soft bristle toothbrush.
Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth. Brushing only cleans approximately 60 percent of the surface of the tooth.
Brush your tongue. Your tongue harbors bacteria, so carefully brushing it may reduce odors. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth, for example) may benefit from using a tongue scraper or use a toothbrush that has a built-in tongue cleaner.
Clean dentures and dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once daily as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product.
Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water - not coffee, soft drinks, or alcohol, which can lead to a drier mouth. Chew gum or suck on candy (preferably sugarless) to stimulate saliva. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
Adjust your diet. Avoid onions, garlic, and spicy food. Sugary foods are also linked to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue. Eat more vegetables and fruits and less meat.
If breath odor persists despite following appropriate home care, a visit to your primary care physician is recommended for further tests to rule out other contributing conditions.
With guidance and persistence, solutions are available for you to address and manage the very difficult problem of bad breath.
Here's to your good health.
Marie C. Jacobs, D.D.S.
Professor Emerita Loyola University Chicago
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DR. LAKIN'S NEW SECURE PATIENT PORTAL
'MyHealthRecord.com'
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Dr. Lakin and staff are very excited to announce we have upgraded our secure patient portal!
We changed vendors, and our new secure portal,
MyHealthRecord.com, is easier to use and easier for us to respond to your requests.
At your convenience
- View your health record from any Internet-enabled device
- Exchange secure messages with Dr. Lakin or our staff
- Request and manage appointments
Anytime access
- Lab orders
- Test results
- Upcoming appointments
- New Document and articles from Dr Lakin
To access our new patient portal, MyHealthRecord.com, you are required to complete a short questionnaire. This is a very simple process.... quick and easy. If you need assistance, we are always here to help.
Call us for your invitation email!
It will give you all the information you need to use our secure portal, MyHealthRecord.com, for your medical care!
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TOM'S TRAVELS:
The Peruvian Passage. . . .
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Although we have traveled independently in Europe for a total of two years we had never taken a group tour, but we found one to South America beginning in Peru that tempted us. Starting in the capitol Lima we were greeted with a welcome drink of pisco sour (think margarita) here and at almost every hotel stop. Lima has beautiful Spanish colonial architecture on its main plaza and although a coastal city there is no beach life due to the steep cliffs leading to the Pacific Ocean. 
Over 11,000 feet in elevation Cuzco is more interesting for tourism and the Inca influence in architecture is to be marveled at for its precision. To avoid the dreaded altitude sickness I took the pills recommended by Dr. Lakin and had no problem. I also drank a little coca tea promoted in the hotel lobby. Day trips outside the city offered plenty of photo ops of women and children in traditional dress with their animals. 
Our tour provided a ceremony witnessing a Peruvian shaman making an offering of many things in nature but first wrapping it up and blessing our heads with it before putting it in a fire. A home visit arranged by Grand Circle Tours took us to a modest home and meal of roasted guinea pig prepared by our gracious hostess. Fortunately potato pancakes and vegetables came with the meat.
Of course the highlight of Peru are the ruins of Machu Pichu also at a high elevation. At the base town we arrived in a pouring rain donning our recommended ponchos and single filing to the hotel. Our spirits were lifted as we awoke in the morning to clear skies followed by a bus ride to the entrance. Fortunately our health allowed us to climb all over the terraces for photo ops of this world treasure created by ancient Peruvians. And I still search for the treasured pisco sour when I travel in South America.
I would be happy to share travel info with you at my email:
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Rx Prior Auth News From Jeff
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Everything Old Might Not Be Renewed Again
Rx's: Refills, Renewals and Prior Authorization:
 When it comes to prescription medicines what is true today may not be so tomorrow. Or next year. When it's time for your prescription re-fill or renewal, this fact may kick you in the pocketbook if your drug(s) have become "non-formulary" when you weren't paying attention.
A recent Kiplinger study reported that drug prices outpace overall inflation every year. 2019 was no exception. Drug prices jumped 10.5 percent over the past six months. They rose four times faster than inflation, despite pleas/pressure on drugmakers and Prescription Benefit Managers (PBMs) from healthcare advocates, consumer groups, the Trump administration and Congress.
Higher drug prices also impact availability. Insurers and PBMs add or delete selective drugs from their formulary annually based on pricing arrangements they make behind-the scenes with manufacturers, distributors and others. In 2019, Express Scripts and CVS Caremark, two of the largest well-known pharmacy benefit managers (PBMs) that provide drug coverage for many health plans, dropped about 90 drugs from their formularies (the list of drugs they cover). For 2020, expect more of the same.
The growing concern over opioids is another renewal concern. All prescribed opioids are facing stiffer approval headwinds resulting in severe quantity limits and increased addiction awareness and scrutiny. This is making our PA process even more challenging by requiring more details, data and time and more controlled-medication denials than approvals.
Annually, we remind our patients to research, question and pay attention to your current health insurance and drug plan BEFORE renewing with them for the new year. We encourage our patients' to be their own "activists" - starting by reviewing your healthcare and insurance options yearly. Do not assume "business as usual" because you didn't make any changes. Health plans alter their terms and coverage annually, they can change their preferred drug formulary at will and they usually will!
Plans send an annual summary of changes to subscribers, but many do not read these notices. Bottom line: Pricey drugs are increasingly not covered by drug plans or else patients/subscribers may incur higher out-of-pocket co-pays or co-insurance if a non-formulary drug(s) is "approved" for them.
If your prescription drug is denied, you may request a prior authorization (PA) to have your insurance re-consider their denial. It may then be approved, or it may be denied again. You can opt to pay cash for a medication. At times, paying cash may be a better choice especially for drugs that are low-priced and affordable for you. You can also select a suitable alternative drug that your insurance plan favors. Make certain your doctor agrees that an alternative drug choice is beneficial therapeutically for you.
It's all in the cards, what's allowed is dictated by the health insurance card that you carry in your wallet. Hope that the drug(s) you take remains in your Plan's formulary and that it stays on a lower "tier" or price level. If this is no longer the case, do your homework and find a replacement for your prescribed drug(s) or shop other drug coverage programs if they offer you better coverage, prices and options.
 Everything old might never be the same or new again. Just because you had a medication approved in the past do not expect it to hold true in the future. As always, our office will strive to have a prescription "approved" for our patients by initiating a prior authorization if justified.
Be smart to your Plan's changes. Call and discuss pending changes with your current carrier. If necessary, be willing to move to another healthcare plan when you make your selections for the new year. It is better and less stressful to know where you stand before the need arises than to take on your insurer and fight a drug denial after the fact.
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Note From Our Biller:
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Original Medicare includes Medicare Part A and B. Medicare Part A is free and covers hospital costs. Medicare Part B covers doctors' fees and outpatient services and has a monthly premium. The basic Part B premium is expected to be approximately $144.00 per month in 2020 though higher income retirees will likely pay more. The 2020 Medicare deductible will be officially published by October 15th but is currently expected to be $197.00.
During open enrollment Medicare beneficiaries have the opportunity to make changes to their health insurance plan during the annual open enrollment season which begins on Oct. 15, 2019 and goes through Dec. 7, 2019. Any coverage changes made during this time period will take effect on Jan. 1, 2020. While you may be content with your current plan it is important to know insurance companies can make changes to your plan from year to year. Any changes made by your plan can affect out-of-pocket costs for monthly premiums, deductibles, drug costs, health care provider networks and pharmacies. Even if you plan to stay with your current plan it is generally best to review your insurance documents or call member services to be sure no significant changes are set to take place in the new year.
The federal government has redesigned the online plan finder tool to help beneficiaries research coverage options. The tool finder can be located at www.medicare.gov under the Sign Up / Change Plans tab. The Medicare Plan Finder allows users to shop and compare pricing between original Medicare, Medicare prescription drug plans, Medicare Advantage and Medicare supplemental insurance policies.
When utilizing the Medicare Plan Finder tool please be aware Dr. Lakin does not accept Medicare Advantage Plans (also known as Medicare Part C). For patients who decide Medicare Advantage is a more favorable option please know it will most likely become necessary to locate another primary care provider since Dr. Lakin chooses to support only Original Medicare. While Medicare Advantage Plans can be less expensive than original Medicare, most Medicare Advantage plans restrict access to in-network health care providers, so it can be a cumbersome option for snowbirds or people who travel extensively and need non-emergent services.
For most of us, researching and understanding insurance coverage is a time consuming and confusing process. Though it can be tedious, you will often gain knowledge and feel more informed about your coverage should the need to use it. Doing the research in pieces over the next few weeks is often less frustrating than trying to accomplish it all in one session. It is certainly best to be informed and prepared before an injury or illness occurs. As always I am happy to talk with anyone who may need some direction.
If you need more information on Medicare plans, please contact Veronica.
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Doctor's Visits:
Why Checkups Are Vital. . . . . .
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Annual Physicals 101:
When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you've grown older, you may have gotten out of this habit.
Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor's visit will help you live a long and
healthy life.
It is also very important for you to play an active role to get the most out of your doctor's visit. Before your exam, review and update your family health history, be prepared to ask if you're due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.
During your actual doctor's visit, don't be shy about getting your questions answered. Also, if the doctor gives you advice about specific health issues, don't hesitate to take notes. Time is often limited during these exams, but by coming prepared you're sure to get the most out of your checkup.
Have you scheduled your physical for 2019 yet?
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Slow Cooker Curried
Butternut Squash Stew
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1
15-ounce can light coconut milk
1 1/2 tbsp.
vegetable bouillon base (we used Better Than Bouillon)
1 tbsp.
curry powder
1 tbsp.
turmeric
1/2 tsp.
cardamom
3 tbsp.
grated fresh ginger
kosher salt
1 1/2 c.
yellow split peas, rinsed
1
15-ounce can diced tomatoes
2 lb.
butternut squash, peeled and cut into 1/2-inch pieces (about 4 cups)
1
medium onion, chopped
1/4 c.
olive oil
2 tbsp.
lemon juice plus 1 teaspoon zest (from 1 lemon)
2
large scallions, thinly sliced
Rice and plain yogurt, for serving
- In bowl of a 6-quart slow cooker, whisk together coconut milk, vegetable bouillon base, curry powder, turmeric, cardamom, 1 tablespoon grated ginger, 4 cups water, and 1 teaspoon salt.
- Add split peas, tomatoes (and their juices), butternut squash, and onion and mix to combine. Cook, covered, until most of the liquid has been absorbed and lentils are tender, 6 to 7 hours on low or 4 to 5 hours on high.
- Make lemon-scallion drizzle: In a small bowl, whisk together olive oil, lemon juice and zest, scallions, remaining 2 tablespoon grated ginger, and 1/4 teaspoon salt.
- Serve the stew with rice and a dollop of yogurt, if desired. Drizzle with lemon-scallion drizzle.
- By Woman's Day Kitchens
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Insights By Steve: Check it Out!
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Insight By Steve (Author)
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"Five Foods That Fight Sunburn"
.... and more news you can use!
Back To Top
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We Need Your Help!
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 Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
Tips:
1. If you need a refill, be sure to call your pharmacy FIRST, not our office. They will know if you have more refills, and if not, they will call/fax/electronically message us with your request. Then we will contact you if there is a question or concern.
2. Remember to call your pharmacy in plenty of time so you do not run out of your medications. Sometimes we need up to 48 hours to complete a request and we do not want this to be a hardship for you.
3. Register and use our SECURE PATIENT PORTAL for refill requests. We monitor this continually and again will contact you if there is a problem.
4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office. We cannot mail or any medications outside our office. Please plan ahead and make arrangements!
We are always here to help you and appreciate the opportunity to care for your healthcare needs!
Yours in good health,
Dr. Lakin & Staff
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Meet Laya,
Our New Sonora Quest Phlebotomist
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Laya is Persian and as fate would have it, has lived in the United Sates for 7 years.
Laya received her training in Los Angles in 2017 and worked as a volunteer at UCLA before joining Sonora Quest in Phoenix.
Her hobbies are swimming, reading, and going to movies.
Please join us in welcoming Laya to our office!
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Have a Safe & Healthy
Autumn!
Dr. Douglas Lakin & Staff
Paradise Valley Medical Clinic PC
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