Category Archives: Dr. Croft’s Blog

What’s the Buzz?

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Many folks start their day with a cup of coffee.  In fact, according to the Food and Drug Administration, about 80% of us consume caffeine on a daily basis.  Most people are aware of the stimulating effects of caffeine, but a lot of us do not know the other impacts of caffeinated beverages.

Caffeine is the most commonly used psychoactive drug worldwide.  Coffee, tea and sodas are typical sources of the caffeine we ingest, for many of us regularly.  But foods, nutritional supplements and medications may also be sources.  For healthy adults, a moderate intake of up to 300mg per daily intake is considered “generally safe” by the FDA.  The Dietary Guidelines of America recommends, however, women who are pregnant and those breast feeding consult their health care providers for advice on caffeine consumption.  For children and adolescents, the American Academy of Pediatrics takes the stance that there is “no place for stimulant-containing energy drinks” for this population.

Federal guidelines require that the presence of caffeine in beverages or foods be listed as an ingredient.  However, the amount of caffeine does not.  To give you an idea as to how much caffeine is present, here are some common listings from www.medicinenet.com based on an eight ounce serving:

Brewed coffee                   102-200mg.            Brewed decaf                    3-12mg.

Expresso (1 oz.)                  30-90mg.              Brewed black tea              40-70mg.

Brewed green tea              40-120mg.              Cold brew coffee            110-200mg.

The following sodas contain the following based on a twelve ounce serving:

Pepsi One                              57mg.                        Pepsi                                     39mg.

Diet Pepsi                              37mg.                        Coke Zero                             36mg.

Coca-Cola                              34mg.                        Diet Coke                              46mg.

Mountain Dew                     54mg.                           Dr. Pepper                           41mg.

IBC Root Beer                         0mg                          Orange Crush                        0mg.

A Monster Energy Drink contains 80mg caffeine in an eight ounce serving and has 27gm of sugar.

Many non-prescription medications that treat drowsiness, headaches and migraines will commonly have caffeine, from 60 to 200mg per dose.

 

The most commonly anticipated effect of caffeine is to stimulate the brain.  Within minutes, there is increased alertness, and there may be a buffering of drowsiness and fatigue – our morning “wake-up”.  Other positives include a decreased suicide risk as well as developing Alzheimer’s and dementia for those who consume caffeine on a regular basis. In addition is a reported decreased risk of oral and throat cancer.

 

According to the Mayo Clinic, there may be some negative effects may occur after 400mg of caffeine is consumed routinely (about four cups of coffee).  If the brain is over-stimulated, there may be side effects of restlessness, anxiety, headaches or insomnia.  Urine output is increased, producing a diuretic effect.  There may be an increase of symptoms from those already suffering from bladder problems.  Gastrointestinal stimulation may produce heartburn and diarrhea, with nausea and vomiting developing at higher doses of ingestion.  Calcium absorption into the bones is decreased, increasing the risk of developing osteoporosis and fracture.  The cardiac effects of caffeine increase heart rate, blood pressure and contribute to skipping beats.

 

Over time, your body becomes more tolerant to your daily dose.  Should you develop adverse effects from your caffeine consumption or just be concerned to the long term effects as listed, you should taper down gradually.  Headaches are the most common presentation of caffeine withdrawal.  There are websites available providing information about caffeine from the FDA and Mayo Clinic, among others.  How much caffeine are you consuming?

 

Bradford Croft, DO

East Flagstaff Family Medicine

“Cheers” May Not Be Cheerful

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Alcohol is absorbed through the stomach into the bloodstream.  Within minutes, it is distributed throughout the body in the muscles, organs and brain, and peaks over the next 45 to 90 minutes.  During that time, the body will metabolize alcohol by breaking it down in the liver with an enzyme called alcohol dehydrogenase.  From there, its byproducts can be excreted from the body.  This finite rate of removal may vary to some degree from person to person, but as the alcohol is broken down into acetaldehyde and other byproducts, the effects of the alcohol diminish.  If the amount of alcohol ingested is greater than can be removed from the body, blood alcohol levels increase along with its effects.  For some, these effects may initially be pleasant due to relaxation and reduced inhibitions.  But as alcohol levels continue to rise, other functional changes in the brain produce lowered concentration, slurred speech, lessened reflexes and response time as well as poor judgement, coordination and concentration.

Blood alcohol levels can be measured by lab testing.  The legal definition of DUI intoxication in Arizona is a blood alcohol concentration of 0.08 percent or more.  Personal diversity allows for some people to be more influenced by the effects of alcohol, others less.  But ability to perform is not an indication of intoxication, as “it is unlawful for any person who is under the influence of intoxicating liquor or any drugs to drive or be in actual physical control of any vehicle” per ADOT definition.

So how much drinking is too much?  There are individuals who may deem themselves as “responsible drinkers”.   This means assigning a designated driver, limiting the amount of drinks consumed at an event, not allowing personal compromise from alcohol intake, and not allowing alcohol to control life or relationships. The National Institute on Alcohol Abuse and Alcoholism defines moderate alcohol consumption as up to one drink per day for women and up to 2 drinks per day for men.

Binge drinking is defined at 4 drinks for women and 5 drinks for men on the same occasion over about 2 hours.  Binge drinkers are at a high risk of experiencing personal injuries and are 14 more times more likely to drive impaired.   They are also more likely to experience sexual compromises, including unintended pregnancy and STDs.  And with large quantities consumed in a short time, alcohol poisoning can be a real and fatal consequence.

“Alcohol use disorder” is a medical diagnosis of chronic compulsive alcohol use, loss of control over intake and a negative emotional state when not under the influence.  This problem can be seen with people who continue to drink on a daily basis despite the negative impacts of physical or social problems. This pattern of repeated abuse is also associated with chronic disease development.  Heart associated diseases include arrhythmias (irregular heartbeats), cardiomyopathy (weakening of the heart muscle), stroke and high blood pressure.  Liver diseases include hepatitis, fatty liver and cirrhosis.  Alcoholic pancreatitis is an extremely painful inflammation of the pancreas.  There is increased risk of cancer of the mouth, esophagus, throat, liver and breast.  Alcoholic dementia is the deterioration of memory and destruction of the brain from chronic alcohol exposure.

As April is Alcohol Awareness month, this article is to encourage you reflect upon your drinking habits.  Not everyone who abuses alcohol is an alcoholic.  In fact, only about one out of ten are.  Most individuals at risk from their habits are unaware or in denial.  Most alcohol abuse is brought forward by spouse, family or friends.  The AUDIT-C is an alcohol screen that can help identify hazardous drinkers or those who have an active disorder.  It can be found online at https://www.integration.samhsa.gov/images/res/tool_auditc.pdf.  A very quick screening test is the CAGE test: Have you ever felt you should Cut down on your drinking: Have people Annoyed you by criticizing your drinking?  Have you ever felt bad or Guilty about your drinking?  Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye opener)?   An answer of “yes” to two or more is clinically significant.  If you think you may have a problem with your drinking, please talk to your Primary Care Provider.

 

Bradford Croft, DO

East Flagstaff Family Medicine

Colon Cancer- Who is at Risk?

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Colorectal cancer (cancer of the colon and rectum) continues to be the second leading cancer causing death of both men and women in the U.S.  It is, however, the third most common cancer diagnosed in our country.  The only more common cancers in men are that of prostate and lung, and women are breast and lung.   According to the CDC, 139,992 people were diagnosed with colorectal cancer in 2014, including 73,396 men and 66,596 women. Of those diagnosed, there were 51,652 who died, counting 27,134 men and 24,517 women.

Colorectal cancer begins in early stages as growths or polyps that develop in the large bowel.  The most common polyps are adenomatous.  These are not initially cancer by nature but are likely to turn into a cancer over time.  There are also inflammatory, hyperplastic and villous polyps ranging from minimal to significant risk of evolving into colon cancer.  As cancer evolves, one may eventually have complaints of blood in the bowel movement, persisting abdominal pains or cramps, or unexplained weight loss.  Although these symptoms are not exclusive to colon cancer, immediate medical help should be sought if these complaints are present.

Although there are no absolute reasons that individuals develop colon cancer, there are some risk factors to consider.  As we age, our probabilities increase.  According to the CDC, more than 90% of cancers occur in those over fifty.  As such, the general recommendations are that men and women begin routine screening soon after turning fifty.  There is an increased incidence for those with underlying inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.  If you have a family history (mother, father, sister or brother) with a diagnosis of colon cancer discovered before age 50, or if you have a genetic syndrome such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer, you may have an increased risk and require screening earlier than the routine recommendation.

As March is Colorectal Cancer Awareness Month, your family physician can help you evaluate your risk and screening options, and may provide preliminary testing in office.  There are a number of simple screening tests.  Many involve the evaluation of a stool specimen, such as the guaiac-based fecal occult blood test (gFOBT) which tests for the presence of blood, the fecal immunochemical test (FIT) that measures antibodies that indicate bleeding, and the FIT-DNA test, checking for altered DNA combined with the antibody test. Although a positive screening test is not an assurance of cancer, it is a marker for timely evaluation.

Colonoscopy is a procedure that checks for cancer in the rectum and entire colon.  With the patient under sedation, a long, thin, flexible scope is used to painlessly visualize the bowel and remove polyps as well as biopsy areas of suspicion.  This is also the procedure commonly used if any of the previous screening tests return as positive.  Usually this screening test is only needed once every ten years as opposed to annually for gFOBT and FIT, and three years for FIT-DNA.

Additional techniques include capsule endoscopy (swallowing a camera in a pill) and virtual colonoscopy (a series CT radiology pictures combined to provide an image of the bowel).  As relatively new procedures, they may not be covered by insurance or available in your area.  Along with recommendations from your doctor, check with your insurance coverage to determine which tests may be choices for your screening evaluation.

Bradford Croft, DO

East Flagstaff Family Medicine, LTD

Healthy Hearts are Happy Hearts

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Healthy Hearts are Happy Hearts

Although there has been improvement over the years as to the impact of heart disease and health, cardiovascular disease is still the number one cause of death in men and women in the United States.  Every year, February is the hallmark of American Heart Month.   Thinking of Valentine’s Day is a good opportunity to do a little self-assessment and personal reflection of your heart health status and risks.

High blood pressure is one of the common contributors to heart disease and stroke.   Known as the “silent killer” there are no warning signs or symptoms to alert its presence.    It is estimated that one in three people have high blood pressure, but only about half are controlled.   A very simple screening test is to check your blood pressure.  To be aware of risks changing as time goes by, these checks should be done regularly.  If you have high blood pressure, there are steps to take to treat and control it.  Lifestyle changes and medication are commonly used to treat this problem.

Elevated cholesterol is another concern.  High lipids can contribute to atherosclerotic cardiovascular disease, or ASCVD.  This problem leads to the blocking of arteries in the heart and other parts of the body.  As this plaque builds up in arteries, the circulation lessens over time, again contributing to the risk of heart attack and stroke.  There again, lifestyle and dietary changes as well as medications are available to address these problems.  A simple blood test can check cholesterol levels.

Diabetes and prediabetes are problems with different levels of elevated blood sugar.  Again contributors to cardiovascular risk, high blood glucose over time will lead to damage to the heart, kidneys, blood vessels and nerves.  This damage leads particularly to the risk of heart attack and stroke as well as other organ failure.  Treatment again consists of medication and lifestyle changes.

The other risks on the checklist are those of lifestyle and behavior issues.  Physical inactivity, unhealthy diet, obesity, excess alcohol and smoking are all concerns that remarkably increase the impact and threat to cardiovascular health. Your annual wellness exam commonly is a covered benefit by most commercial health insurances.  This visit is an excellent starting point to address these concerns, risk factors, lifestyle changes and medications if needed in treating these problems and reducing your risk of cardiovascular disease.  Make your pledge to yourself and loved ones this month to step up to the plate and commit to have a healthy, happy heart!

 

Bradford Croft, DO

East Flagstaff Family Medicine

Baby, It’s Cold Out There

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Baby, It’s Cold Out There

A safe and healthy winter season goes hand in hand with a little preparation.  For any of us living in northern Arizona, we are aware of the rapid temperature changes.  We can see the daytime high temperature plummeting  forty degrees as the sun goes down.  We have seen low temperatures well below zero in the dead of winter.  We have seen cloudless days and blue skies replaced with storm clouds and whiteout snow in the blink of an eye.  With these life threatening weather transitions, it is best to be prepared.

As many of us prefer to stay tucked in at home, we are not guaranteed to be secure and protected.  A healthy home starts with good insulation to prevent the heat loss from wind and low temperatures.  Weather stripping windows and doorjambs, cleaning out gutters and downspouts, and insulating exterior pipes are a good start.

Professional cleaning and maintenance of furnace systems can be an excellent investment to assure a warm and cozy home.  Change filters, clean woodstoves, fireplaces and chimneys seasonally, and install and maintain smoke and carbon monoxide detectors as well.  To have an alternative heating system and available fuel or an emergency generator can be especially beneficial for the common power outages during a winter storm.

We still need to go out from time to time, so preparing your vehicle for the winter is also a wise idea.  Service and top off all fluids with low temperature fluids, and assure the tire tread is adequate.  Keep the fuel tank topped to avoid accumulation of water in the tank and lines.  Maintain an emergency road kit, including extra blankets, flashlight and batteries, jumper cables, some food and water, first aid kit and a shovel with cat litter or sand for traction if you get stuck.  Keep an eye on the weather, and avoid travel with inclement forecasts.

If you must travel during bad weather, make sure you have advised a friend or family member of your route and expected travel time.  If you get stranded, stay with your vehicle.  Use an exterior light on your car, and flag the antenna.  Run the engine no more than ten minutes an hour, keep a downwind window cracked and keep the exhaust pipe clear of snow.

Finally, if you must spend time in the elements, dressing in layers provides the best ability to stay warm.  The skin layer should be a wicking layer of merino wool, synthetics like polyester or silk to take moisture away from the skin.  The middle layer is the insulation, with good choices including wool, fleece or goose down.  The outer layer or shell should be both wind and water resistant.  There are varying degrees of waterproof vs water resistant and breathable vs non-breathable choices that have a wide variety of cost as well.  And don’t forget hats, gloves and boots to complete your weather protection.

Live well, travel well, dress well and stay well through the harsh winter weather of northern Arizona.

Bradford Croft, DO

East Flagstaff Family Medicine

Weighing In On the Holidays

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The “holiday season” is synonymous to many of us with the “eating season”.  Starting at Thanksgiving, our feeding frenzy extends relentlessly through Christmas and New Year’s, and continues to perpetuate all the way through the football playoffs into the February Super Bowl.  And every holiday deserves a feast!  Not just the holiday dinner, but also the endless numbers of parties, events and treats at the workplace as well as those at home all contribute to the caloric avalanche we experience through the winter months.   No wonder it is not a surprise that most people gain the most weight every year in the month of December.   They also commonly do not lose all of those acquired winter pounds.  Maintaining just two of those extra pounds each season makes you twenty pounds heavier in a decade.

The answer is, of course, calories.  Some fun facts are that, on average, the adult male needs 2500 calories to maintain his current weight.  The average female needs only 2000 calories per day.  It only takes an extra 500 calories each day to gain a pound every week.  Imagine that the typical holiday dinner alone packs a usual 3000 calories, and with appetizers and drinks may top 4500 calories for just that meal and up to 7000 for the day.  “Not bad”, you say.  “There are only a couple of excessive meals during that season in which I indulge”.

However, add the onslaught of holiday snacks, those extra calories may be easy to accrue.  A couple of calorie counts for example: a slice of pumpkin pie is 279, slice of pecan is 532, cherry pie is 304 and apple pie alamode is 414 calories.  Not a pie person?  How about cookies, then.  Each sugar cookie from Subway is 220 calories.  Beer is anywhere from 64 calories in the ultralight to 200 for a hearty IPA.  Wine may range anywhere from 110 to 300 calories per glass depending on sweetness and alcohol content.  If you are considering the playoff parties, a serving of beef nachos is 430 calories, a chili cheese hotdog is 340, one pork rib is 370 and a half dozen chicken wings is 616 calories (www.calorieking.com).

The point is not so much the specific calorie count, but rather the ready availability of “extracurricular” food and treats in which we mindlessly and consistently indulge.  Adding this onslaught of calories consumed throughout the “season”, one could readily pack on two, five or even ten extra pounds this year.

Your awareness of these points may make it easier not to go overboard this year.  Some tips include limiting your choices to eating only your favorite foods.  You do not have to try one of everything.  Serve yourself smaller portions, as most holiday foods are rich and should readily fill you up.  Only eat one helping at a service.  If you feel you must have more, drink a big glass of water and set your timer for twenty minutes.  It is likely by then that meal has caught up, and you will not be hungry for a second helping.  Finally, eat slowly, taste every bite and enjoy these special treats.  Celebrate the holidays and enjoy your time with family and friends.

Bradford Croft, DO
East Flagstaff Family Medicine

Commit to Fit

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It is well accepted that the keystone to good health starts with a prudent diet and regular exercise.  To promote this concept, the President’s Council on Fitness, Sports and Nutrition has earmarked the month of May as National Physical Fitness and Sports Month.  According to healthfinder.gov, all ages can benefit from physical activity.  Children and adolescents can improve muscular fitness, bone and heart health.  Adults can lower the risk of heart disease, diabetes and other diseases.  Older adults can benefit by reducing fall risk and improving brain function and judgement skills.

The guidelines differ among age groups.  Children age 6-17 are recommended to achieve 60 minutes of daily activity.  Most of that activity recommended is aerobic, at a moderate or vigorous intensity three days per week.  The balance is made up of muscle and bone strengthening.  Examples of aerobic include running, jumping rope, dancing, bicycling and swimming.  Muscle strengthening can be unstructured, such as climbing on playground equipment, or structured such as weightlifting or resistance bands.  Bone strengthening also includes running and jumping, as well as basketball, racquetball and tennis.

Adults age 18-64 will gain most of their health benefits with at least 150 cumulative minutes of aerobic activity of moderate intensity beyond baseline activity per week.  The older population of 65+ benefits from exercise similarly.   A subset of this group can additionally profit from balance training.  This program includes lower extremity strengthening along with a core or abdominal strengthening program, reducing the risk of fall injuries which may increase with age.    The same recommendations apply throughout for general muscle and bone strengthening exercise which benefits all populations.

For those who are already maintaining a level of fitness, these are some guidelines for activity.  For those who are starting a program or have chronic conditions that may limit their abilities, any level of activity is better than none.  Start slow and ramp up to goal.  The threshold for significant impact seems to come at three or more days per week of consistent effort.  If there is any question about your ability to initiate or increase a regular exercise program, or for additional information or specifics regarding exercise, please visit your primary care provider.  An additional resource from the Office of Disease Prevention and Health Promotion can be found at https://health.gov/paguidelines/guidelines.

Bradford Croft, DO