March 2008: Health Briefs from Baylor Health Care System

Things to Consider Before Ditching Antidepressants

Could many of the millions of people taking antidepressants be treated just as effectively with a sugar pill? According to a recent study, four of the most commonly prescribed antidepressant medications did not have a significant impact on depression as compared to placebo pills in patients considered to be moderately depressed. The study concluded that these medications only had significant benefits to those considered severely depressed.

"There's no doubt that antidepressants are probably over-used," says Gary Malone, M.D., psychiatrist on the medical staff at Baylor All Saints Medical Center at Fort Worth. "Many people suffer from symptoms of depression due to factors such as current stress, unresolved issues, etc. and may not be suffering from a major depressive disorder which usually requires medication. The fact is that every patient is different so antidepressants may not be appropriate for everyone."

Dr. Malone adds that patients experiencing symptoms of depression should consult with a physician for a thorough evaluation to determine the best treatment plan—often times that includes a combination of psychotherapy in addition to medication.

However, psychiatrists worry that some people may misinterpret the study and decide on their own to stop taking their medication. Or in some cases, may not seek treatment for their depression at all for fear that medication will not help.

"Abruptly ceasing antidepressants can cause withdrawal-like side effects such as anxiety or sadness as well as physical symptoms like headaches, nausea and fatigue," explains Dr. Malone. "Patients taking antidepressants should always consult with their physician first before stopping their medication and should never do it cold turkey."

Dr. Malone adds that the placebo effect for the treatment of depression is nothing new—the approach has long been considered effective on a short term basis for some patients. But Dr. Malone says that if you are currently taking an antidepressant and it has been effective in treating your depression, there is no reason to stop.

"Depression is a serious psychiatric condition that can be very debilitating for the millions who suffer from it so it should not be taken lightly. Careful consideration should be taken by patients and their physicians before stopping any treatment regimens—even for those considered mildly depressed."

If you think you may be experiencing symptoms of depression, consult with your physician.

For more information about Baylor All Saints Medical Center at Fort Worth.

Secrets of Skinny People

Want to eat well, but still keep your weight under control? You don't have to radically change what you're eating. Elizabeth Schaub, R.D., a registered dietitian at Baylor Regional Medical Center at Plano, says that foods high in fiber and water can help you feel full with fewer calories. Here are some easy substitutions to try.

Instead of: Steak with potatoes and corn.
Try: Steak with corn and a large green salad.
Why: A large potato can clock in at well over 200 calories, while the vegetables in a large salad easily contain fewer than 50. Just be sure to watch the dressing, which can contain lots of fat!

Instead of: White pasta with meat sauce and garlic bread.
Try: Whole-wheat pasta with tomatoes, onions, peppers and marinara sauce, plus a salad sprinkled with low-fat cheese.
Why: You'll digest the high fiber in whole-wheat pasta more slowly, so you'll feel full longer. Plus, the tomatoes and peppers contain antioxidants, which can help fight off cancer.

Instead of: Traditional tuna noodle casserole.
Try: A casserole made with whole-wheat noodles, low-fat cream soup and a touch of cheese. Plus, add lightly steamed broccoli, carrots or cauliflower.
Why: When you lower the fat content and add vegetables, you can eat the same volume of food with fewer calories. Two cups of traditional casserole may contain 600 calories, while one cup of a modified version of casserole plus one cup of steamed vegetables with a teaspoon of margarine may only contain 350 calories. This cuts your calories almost in half, but allows you to eat the same amount of food.

Instead of: Vending-machine chips.
Try: An apple with a wedge of low-fat cheese, or a cup of strawberries with a little bit of low-fat yogurt.
Why: The fruit will fill you up and the protein in the low-fat dairy will help keep you feeling full.

For more information about Baylor Regional Medical Center at Plano.

Feeling Sick? When to Go to Work and When to Stay Home

You may think that going to work sick is a good idea—you'll save a vacation day, won't fall behind on your work and maybe even score a few points with the boss by showing how dedicated you are. But the fact is that germs can spread faster than office gossip. So just by using the fax machine or not washing your hands after you cough or sneeze, you can infect your co-workers creating a vicious cycle of illness.

"In most work environments, office supplies and equipment are usually shared and since viruses can live on surfaces for a few days, common areas such as the copy machine and water cooler can become a place where germs are easily transferred especially during cold and flu season," says Patti Powell, M.D., internal medicine physician on the medical staff at Baylor Medical Center at Waxahachie.

According to a 2006 study by the National Foundation for Infectious Diseases, 35 percent of American workers reported feeling pressure to go to work when sick. The top two reasons were out of guilt and a fear of not getting their work done. However, more than 40 percent said they resented their co-workers for coming to work sick.

"It's really a courtesy issue. If you knew someone felt as bad as you did, would you want them coming to work?" says Dr. Powell. "It's not necessarily black and white so it's best to use common sense."

So how do you know when you're too sick to come to work?

Dr. Powell says that any time you have a fever, you should probably stay home.

"A fever is a sign of infection which most likely means that you are contagious," says Dr. Powell. "Typically the first 24 hours after you develop a fever is usually when you are most infectious. A temperature above 100.4 degrees is considered a fever."

With our lives getting busier and busier, it's no wonder that we're reluctant to take a day off, but Dr. Powell says that by not slowing down to take care of your self you won't do anyone any favors—you'll only spread the illness and prolong your suffering.

But keep in mind that when it comes to most common viruses, antibiotics won't do any good—only the symptoms can be treated.

"The vast majority of colds and coughs are viral and viruses typically go away on their own after about a week," explains Dr. Powell. "There is no cure for a virus so the only defense is your immune system—that's why getting plenty of rest is so important when you're sick."

When antibiotics aren't recommended, Dr. Powell offers the following advice:

• take ibuprofen or acetaminophen for body aches and fever,
• an over-the-counter mucolytic for congestion,
• and an over-the-counter cough suppressant for a cough.

However, if you suspect you might have the flu, see a doctor immediately as antivirals can be administered within the first 48 hours. But Dr. Powell says your best defense against the flu is to get a flu vaccine. If you feel progressively worse, consult with your physician.

"The bottom line is if you're really sick, you should probably stay home because you won't be very productive," adds Dr. Powell. "Don't push yourself. Your body—and your co-workers—will thank you for it."

For more information about Baylor Medical Center at Waxahachie.

How to Avoid Back Pain on the Job

Lifting heavy objects on the job can make you more prone to back injury. But sitting for long hours at a desk or in a car can be risky too. Meredith Adams, D.O., medical director of the Baylor Spine Center and a physician on the medical staff at Baylor Regional Medical Center at Grapevine, offers this advice to keep your back strong and healthy on the job and off.

1. Keep your abs strong. Cardiovascular fitness and weight lifting are good, but core strengthening is essential. That means working the muscles in the torso—the abdomen, back and pelvis—to keep them strong and flexible, which supports the spine and keeps the body in alignment. Pilates and yoga are good for this, but check with your doctor first if you've had a previous back injury. Dr. Adams recommends working with a personal trainer who can help you learn to perform the exercises correctly.


2. Your mother was right about your posture. Slouching or sitting hunched over, particularly for prolonged periods, can put extra stress on the lower back. Get up and stretch once in a while. And sit up straight with your shoulders back. Try using a cylindrical roll across the lower back as lumbar support. If you're in the car, sit at a comfortable distance from the steering wheel, so there is not too much forward reach, which can exaggerate bad posture.


3. Lift properly. Back braces have not been shown to help prevent injury. But heavy lifting can be safe if done properly. Keep the back straight and the object you're lifting close to your body. Squat and use your legs, not your back muscles, to power the lift. The same principles apply for pushing or pulling. Get help if the object is too heavy, large or awkward.


4. Ergonomics 101. Make sure your workstation fits your body. Adjust the chair so your feet are flat on the floor; use a footrest if necessary. Keep your arms relaxed with your elbows at your side and avoid raising your shoulders or leaning forward to reach the keyboard. Computer monitors should be at or just below eye level. If you're on the phone frequently, use a headset.

Source: U.S. Centers for Disease Control

For more information about Baylor Regional Medical Center at Grapevine.

Start Small to Improve Your Health

You don't have to make drastic changes to improve your health. Start small, and once you've built a habit add another step.

Eat more fruits and vegetables.
The U.S. Department of Agriculture recommends two cups of fruit and two and a half cups of vegetables daily, though most people fall far short.

Good: Add a fruit or vegetable serving every day.

Better: Have a fruit with breakfast and two vegetable servings with both lunch and dinner.

Best: Add fruits and vegetables as snacks until you get to four fruit and five veggie servings daily.

Watch for trouble spots.
Many diseases and conditions are most treatable if they're caught early.

Good: See your doctor yearly for a physical.

Better: Perform monthly breast or testicular and skin checks to watch for problems.

Best: Make sure your doctor knows your family history, so he or she can recommend the appropriate tests. Review your test results with your doctor and take steps to address any areas of concern.

Get moving.
With 30 percent of Americans getting little or no regular exercise, many of us could use some help getting going. Cathy Thut, director of the department of physical medicine and rehab and the Howard Center at Baylor Medical Center at Irving, offers these suggestions:

Good: Start with some basic strength training 20 minutes twice a week, focusing on your trunk muscles.

Better: Add slow, sustained stretching for 15 or 20 minutes twice a week.

Best: Work in aerobic exercise until you are up to 150 minutes of exercise weekly.

Take a rest.
Most people need eight hours of sleep a night. If you're having trouble waking up or are tired during the day, you might need more sleep.

Good: Back up your bedtime 15 minutes and see how you feel.

Better: Keep the same sleep schedule on weekends and weekdays.

Best: Sleep enough so you don't need an alarm clock to wake you.

For more information about Baylor Medical Center at Irving.