Going the Distance

Last weekend I ran the Richmond Suntrust Marathon. I was standing back with the 3:40 pace team when the marathon started.

I stayed with the 3:40 pace team running an 8:30 mile for 13 miles...

Then I hit the wall...

I was still able to walk, then jog, then walk, then run until I finished the 26.2 miles with a time of 4 hours 36 minutes or a (10:35 per mile pace).

Running the marathon was probably the hardest thing I have ever done, I ran 745 miles in training and although I did not get a sub 4 hour time like I wanted, I was happy that I was able to finish. Out of the nearly 4,000 runners who signed up about 3,000 finished and I finished in 1,686th place.

Exercise, its good for you!

Due to the fact that I don't have nearly as much homework now as a 4th year dental student, I have had a little extra time to dedicate to training for the Richmond Suntrust Marathon coming up in November. Here is my training schedule:I have never run a marathon before so my goal is to just finish it and hopefully do it in under 4 hours. I have spent my Saturday mornings doing long jogs. Last Saturday I was able to beat my previous personal distance record of 16 miles by running a full 17 miles.

This episode of NOVA on PBS inspired me because there were people with some serious health problems who were able to finish the Boston marathon so I figured if they could do it so could I. I watched this episode for the second time about six months ago around the time when I started to seriously train for the marathon. I began my training around May as you can see on my training schedule the numbers highlighted in yellow are the runs I have completed. Thus far I have been doing intensive training for nearly 4 months and have run a total of nearly 500 miles.

Running and exercise in general is much easier to do with a friend. My buddy Jonathan has helped out quite a bit because he has gone with me on nearly every one of my training runs. He has run in a few marathons already so he has some experience I can learn from. There are actually a lot of very talented runners at my dental school. One of the 2nd year dental students finished 7th at the last Boston marathon and another friend of mine, Jake ran in college and has gone on some of the longer runs with Jonathan and I.

One tip we have learned for anyone who is an endurance athlete is that low fat chocolate milk is an excellent recovery drink after doing a long run because it has the correct protein: carbohydrate ratio and it just tastes good.

Another tip I have for runners is to buy shoes frequently and if you can afford it get them from a running store where they can match your running style to your shoe. I broke both my feet with stress fractures in high school running cross country due to over training and not replacing my shoes frequently enough. I went through months of recovery and physical therapy and after all of it was over I had some custom orthotics made by my podiatrist which I still wear all day every day some 10 years later. Once I get a job I think I will have a podiatrist make me a new set of orthotics.

Other lessons learned from breaking my feet: eat a good diet with calcium and vitamin D. (I eat a good diet and I take a multivitamin daily). AND build up your endurance and fitness slowly! Your bones need time to get stronger, your muscles and tendons need time to rebuild and re-tool themselves to be able to withstand the intense pounding of a long run.

While intense exercise like marathon training is rewarding and challenging, exercise in general is essential to good health. We were not built to sit around. Diet is more important for weight loss than exercise (probably because as you exercise a lot you need to eat more). However, exercise is very beneficial for maintaining a healthy weight along with prevention of cardiovascular disease which is the leading cause of death in the USA.

Check out this Wikipedia article on exercise and this article on MayoClinic.com and finally this concise list of the benefits of exercise from Georgia State University.

Exercise will improve your ability to learn, prevent disease, and improve your mood. Just Do It!

Second Hand Smoke Causes Asthma

On Friday afternoon I got home from school and my wife told me that our son had been diagnosed with asthma. (If you scroll down you will notice my article on second hand smoke—is there a correlation? OF COURSE!!!) Our son had been throwing up almost every night starting about a month ago (shortly after our new smoking neighbors moved in) but when we visited family out of state for two weeks he had relatively no problems at all. We thought at first that the problem was acid reflux. The doctor listened to his lungs and checked his Oxygen saturation and diagnosed him with infantile asthma. My initial reaction was anger at the fact that I knew something like this was coming. I have been spending every free moment trying to seal our apartment to keep the smoke out. We were given a nebulizer to give him some medication but he screams and screams until he throws up making the whole medication idea pointless. So now we just have to focus on creating a healthy environment.

Here is what we have done so far:

1. Purchased a new vacuum with a true HEPA filter for $140
   
2. Purchased 2 Honeywell True HEPA air filters from Wal-Mart and left them running on full power while we cleaned the house the larger air filter/purifier was about $130 and the smaller one was $85. In addition to the HEPA filter they have an activated carbon pre-filter to help with the smoke. These filters have made a significant difference in the smoke smell in our home. There are better air filters/purifiers on the market which implement the same basic technology of a true HEPA filter with an activated carbon pre-filter but they cost nearly $600 and are not found in your basic Home Depot or Walmart. See the photo below...
3. Vacuumed the entire house with the new vacuum including the sofas
4. Removed most of the dust in the house
5. Washed all the sheets, blankets, washable pillows, drapes, and rugs in HOT water and dried them In the dryer on HOT to kill/remove any dust mite colonies
6. Sealed off some suspected remaining entry points of smoke into the house
7. Placed a top of the line furnace air filter with an activated carbon layer to absorb smoke and chemicals.

What I plan on doing:

1. Finish Cleaning: I still have to clean the kitchen floor and do more dusting.
2. Purchasing a Dehumidifier: Humidity should be low to reduce the incidence of dust mites which are a very significant allergen and contributor to asthma; chances are you have dust mites in your pillows, sofas, mattresses, and elsewhere. I take back my comment on the last post where I say you should open your windows. It is good to open your windows assuming it is not too humid outside and the air quality outside is good. Centralized air conditioning is good in that it reduces humidity.
3. Purchasing dust mite proof encasings for our mattresses and pillows.
4. Eventually I will purchase leather sofas to prevent dust mite infiltration
5. Someday I will find that last little spot where the smoke is getting in... you would not believe how many hours I have spent on sealing little air leaks probably near 40 hours so far at least. (in addition to being a full time dental student, dad, etc) This little area above the furnace closet was a highway of air coming from our neighbors apartment, whenever our AC would run it would suck the smoky air from their apartment into ours. Solution: stuff it with insulation and cover with plastic and duct tape, in addition to keeping the furnace closet door open to prevent the "suction effect":
   

My theory is that my son developed asthma when the cigarette smoke in combination with the dust mites and other irritants overwhelmed his lungs. It probably does not help that we have smokers next door, live in 30-40 year old apartments, and live in a very humid part of the country.

For information on second hand smoke see my last post.

For more information on dust mites see the following:

http://healthandenergy.com/dust_mites.htm

http://www.ehso.com/ehshome/dustmites.php

http://www.mayoclinic.com/health/dust-mites/DS00842\

One recent systematic review in the Cochrane Database suggests that efforts to reduce dust mites do not have any clinical affects at reducing asthma: I still think it is worth trying to reduce dust mites in combination with avoidance of cigarette smoke and other potential triggers.

http://health.usnews.com/articles/health/2008/04/18/got-dust-mites-just-live-with-them.html

However this study shows that overall reduction in multiple allergens can help reduce symptoms of asthma.

http://www.nih.gov/news/health/feb2008/niehs-29.htm

I figure it is still worth the effort of trying to prevent and control the problem rather than medicate it. It just breaks my heart that my poor son has to suffer due to the inability of his parents to afford a nicer place to live and the poor choice of our neighbors nicotine addiction. At least all this effort makes me not feel so guilty so I can sleep at night knowing I have done everything possible to prevent/treat his condition. Good news is that we will be moving in less than a year following my graduation from dental school and hopefully be able to afford a clean place to live in the future.

All I need is the air that I breathe: The importance of good indoor air quality

Last weekend on Saturday a new family moved in the apartment next door. Unfortunately our neighbors are heavy smokers and the smoke started pouring into our apartment through the poorly sealed adjoining walls. Tobacco smoke can cause/aggravate: cancer, heart disease, bronchitis, asthma, emphysema, periodontal disease (loose your teeth), to name a few. I have a one and a half year old son not to mention my wife and I to protect from breathing in the cancer causing chemicals every day and night. This would be a big deal to almost any non-smoker but especially for me because I am obsessive compulsive about clean air anyway. I have spent a long time doing research on how to maintain clean air. There is some good information on the air quality tips blog and the EPA website dedicated to indoor air quality.

We found that most of the smoke smell was coming from our downstairs bathroom. I decided to try to seal off the source of the airflow between the two apartments. I used cardboard, tinfoil, duct-tape, and plastic to secure our bathroom fan which we can no longer use. I bought caulking and sealed any open cracks between the walls, light fixtures, electrical outlets, pipes, etc. I found a major source of airflow was underneath the bathroom cabinets there was smoky air coming in and where the pipes came out of the wall. I used caulking where I could to seal it off. Over the next few days the smoke smell greatly diminished. I learned a few tips for any of you who may be facing this problem.

Tips on sealing off an apartment from smokers:

• Use your nose to find where the smoke is coming from
• Use non-odor acrylic based caulk; don’t just replace one toxic odor with another: the 100% silicone has a strong odor which can’t be healthy.
• Do not rely on candles or any other form of air freshener to “hide” or “cover-up” the smoke smell. God gave us a nose for a reason: to enjoy good smells and to know when to get away from bad smells. Eliminate the source of the bad smell don’t just cover it up. Candles and air fresheners also have risks of toxicity; not only does the smoke from a candle flame produce carbon-monoxide and carbon dioxide but it also can have lead in the wicks which is carried into the air when a candle burns.
• Be careful when applying caulking or the foam stuff. It sticks to your arm hair and hurts to remove so wear an old long sleeve shirt, gloves (I prefer disposables), N95 respirator, and eye protection. Also the foam sealer is flammable, sticky, and does not defy gravity.

General tips on improving indoor air quality:

• Check online if the air quality is good/moderate outside and the weather is nice then open your windows! This is the best way to quickly and effectively improve indoor air quality.
• Purchase a good air filter for your furnace/ Air conditioner and change it regularly: The filters rated MERV 12 are the best currently on the market; make sure you get a good tight fit to avoid air leaking around the filter.
• They do have good indoor air purifiers with HEPA filters that supposedly work well but they are a very expensive proposition. I think as long as you are not sensitive to minor air impurities then you can get along just fine with less expensive methods.
• Ventilate your house well when painting or using any type of cleaner with volatile substances
• Have your home tested for Radon: the 2^nd leading cause of lung cancer in the USA after smoking.
• Some houseplants are good at removing toxins but one study showed that the soil that the plant is in and the microorganisms in the soil that live with certain species of plants are also beneficial. The study also mentions having activated carbon mixed in the soil to absorb toxic chemicals. While the benefit of houseplants is controversial because the benefit may be negligible or very slight; it still may be a good idea if done properly especially when outdoor air quality is bad making it unwise to ventilate with the outside world or it is too hot or cold to open a window.

This is what I would use as a recipe for a houseplant “air purifier”:

• Use the Janet Craig Dracaena plant for its various qualities: good at removing toxins, low maintenance, low light needed, non-toxic (or less toxic than other houseplants for pets & kids)
• Add carbon, Perlite, and Shultz’s Soil Conditioner to the soil
• Trim the lower branches to avoid covering the soil
• Use a pond basket, or strainer type of pot to allow a lot of air flow to the soil and roots
• Use a tray to catch the excess water
• Place several of these plants throughout the house; the more the better.
• Make sure to not over-water the plant to avoid mold
• Place a fan behind or near the plants and blow air on them to facilitate faster air exchange.\

This weekend when I posted this article the strong smoke smell came back again and we realized that our neighbors probably smoke more at home during the weekends. So I started looking for air leaks and found a major one in the kitchen where the wires and pipes come through the wall. I just have to move the dishwasher to get to it. For additional air quality tips take a look at the air quality tips blog: http://www.airqualitytips.com/97/9-ways-to-keep-your-indoor-air-healthy/

Health care workers are at high risk for developing irritation contact dermatitis

As I said in a previous blog post, I have had an annoying, painful, red, and itchy rash on my right hand for over a year since I started doing full time clinical dentistry. I ruled out latex allergy, poison ivy, and 3^rd year dental student syndrome. I finally got an appointment with my dermatologist who called the problem hand eczema. I have made some important changes by being much more selective about the products I buy that come in contact with my skin but the problem still has not gone away. Yesterday I realized why...

I was studying the Dental Decks for part II of the National Board Dental Exam, when I read a card that hit me like a Mack Truck on its way to a NASCAR race:

“The most common form of an adverse epithelial reaction noted for health-care professionals is: Irritation dermatitis. A number of published reports have cited data suggesting that between 20-30% of health care workers suffer from occasional or chronic dermatitis on their hands. The most common manifestation of the condition is irritation dermatitis, a non-specific immune reaction often caused by contact with a substance that physically or chemically damages the skin. The condition can be aggravated by frequent hand washing, residual glove powder left on hands, and the harshness of repeated use of some antiseptic hand wash agents. Health care workers located in colder climates may also experience chapping during the winter months.”

Wow! Finally after a year of searching, something tells me what the specific name of my problem is! I have had this problem for more than a year! All my dermatologist did was prescribe a topical steroid, say it was eczema, and throw a pamphlet about “Hand Eczema” at me as I was kicked out the door. “That will be $80 please.”

Irritant contact dermatitis is a form of eczema that occurs from frequent irritation by harsh chemicals, water, dry air, or chronic physical trauma. I googled “Irritation Contact Dermatitis and Health Care” and found the following article on the American Academy of Dermatology Website.

I don’t know but Dr. Nedorost may be getting some of her information from this article on Pub Med:

Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review.

Dr. Nedorost explained that irritant contact dermatitis is more highly associated with the number of times you wash your hands every day than any other factor; the best way to prevent it is to reduce the amount of times you wash your hands. Does this mean that we should stop washing our hands? Absolutely Not! Clean hands are essential for preventing the spread of infection from patient to patient and to you and your family. However, we can take the following precautions while still maintaining very clean hands as health care providers:

• Use a good alcohol hand sanitizer rather than soap and water whenever possible. (If you have visibly soiled hands then soap and water is necessary.) A great hand sanitizer that is fragrance free and includes moisturizers is Nexcare 3M Moisturizing Hand Sanitizer or the EO brand hand sanitizers.Don’t use the cheap stuff from the Dollar store or Wal-Mart!
• Use good quality, fragrance free moisturizers/emollients right after hand-washing
• Irritant contact dermatitis is a form of eczema that occurs from frequent irritation by harsh chemicals, water, dry air, or chronic physical trauma.
• Topical steroids may provide temporary relief of the symptoms but will not likely solve the problem. Long term use of topical steroids may actually weaken the skin making it more susceptible to further damage.
• Use cotton under gloves if possible; this may not be feasible in dentistry due to the fine amount of tactile sense required but if you have a bad case it may be helpful.
• Look up your hand soaps, moisturizers, and other cosmetic products that come in contact with your skin on http://www.cosmeticsdatabase.com and try to choose those products that have less harsh chemicals for your skin

I encourage anyone who has to wash their hands frequently to be aware of the damage it can cause to your hands. Even if you use the best hypoallergenic, mild soaps available, the water and drying effect on your hands can cause dermatitis. Especially those of us who work in health care, we need to use a good hand sanitizer as the rule not the exception. When your hands are visibly dirty then wash with soap and water, if not then use the hand sanitizer. Our dental school needs to improve by having hand sanitizer available to our students and to educate them on this topic; for now, I am going to bring my own Nexcare hand sanitizer from home.

Public Service Announcement #2: Replace Your Worn Out Tires!

This sounds obvious but I have friends whose family members were killed because they had tires that exploded. We recently replaced our tires on our one car that had very worn out tire treads. I watched this video on the Tirerack.com website that scared me quite a bit because I have almost crashed a few times on wet roads. Watch this video on the testing they did as to how long it takes you to stop with worn tires on a wet road you will be amazed! http://www.tirerack.com/videos/index.jsp?video=5

I know its biased propaganda from a tire company trying to scare you into buying new tires but why take the risk? The old rule: “replace your tires when the tread does not pass Lincoln's head on a penny” is just not safe at all. Even tires which only have tread as deep as Washington’s head on a quarter are not as safe. Rule: If the tire tread does not pass Washington’s head on a quarter you need new tires yesterday!

Even new tires vary as to their stopping ability. Some tires stop faster than others which may be the difference between life and death or an expensive crash and a close call. The Tirerack.com website has excellent reviews and ratings and fairly good prices. I ended up buying my tires from a local tire company but you can order through tirerack.com and they will send the tires to the auto shop where they install your tires.

Another good resource for information on tires in consumersearch.com which gives you a good review of the reviews and details on why performance tires are good for heat dissipation and handling which may be good when you are in a potentially scary situation on the highway. http://www.consumersearch.com/www/automotive/tires/

Again having a baby inspired me to do all this research too. I come from a long line of people who worry about things, just ask my mom.

Today's Public Service Announcement: Eat More Fruit

I was very long winded on the last post so this will be short and sweet. Fruit helps prevent various types of cancer including oral cancer and provides essential nutrients. I took this photo of a strawberry I picked from a local farm where they let you pick (and pay for) your own fresh, organic strawberries. Fruit is good for you and tastes good too!

Even if it's not organic fruit is still good, and we should all eat more of it. A multivitamin can never take the place of a healthy diet. While studies show that fruit helps prevent cancer, studies also show that you do not get the same benefit from taking a multivitamin. That's all I have to say; just eat more fruit!