Why Eating Breakfast Boosts Your Health!

By Mike Polich NP


Looking at the year ahead, do you want to make 2018 the year you focus on your health? Wellness goals are admirable throughout the year, but too often well-meaning people make a common mistake that sabotages their efforts: they skip breakfast.

It's a daily choice that millions of people shrug off as "no big deal", but research proves breakfast is an important component in how you feel throughout the day. Fueling up solely on java or energy drinks may perk you up momentarily, but it doesn't do the trick long-term.

Consider these five reasons why breakfast boosts your health and should not be ignored. Breakfast:

1. Awakens your metabolism
When you eat breakfast, you "break the fast" from your sleep periods and give your metabolism a wake-up call. When you sleep, your metabolism slows and you burn fewer calories while you rest. By eating a nutritious breakfast, you are sparking your internal engine so it burns calories and gives you more energy throughout the day.

2. Helps you focus
Hunger can make people irritable and it's hard to focus on work when your stomach is grumbling. By eating a balanced breakfast of fat, protein and fiber, the food is processed into energy, allowing you to feel fuller longer.

3. Steadies the burn
When you skip breakfast, the body panics for nutrition, so come lunch time, you tend to overeat. This in turn overwhelms the metabolism and you end up with peaks and pits of energy throughout the day. For steady energy and efficient calorie-burning, eat a nutritious breakfast and other meals on schedule.

4. Encourages healthy choices
People who eat breakfast tend to make healthier choices throughout the day. According to MayoClinic.org, "People who eat breakfast tend to eat a healthier overall diet, one that is more nutritious and lower in fat. In contrast, people who skip breakfast are more likely to skip fruits and vegetables the rest of the day, too." Try starting the day with 100-calorie multi-grain English Muffins.

5. Sets a good example
When you eat breakfast, it sets a good example for your family. Plus, sitting down to a nutritious meal is a positive way to start the day together. You're helping your kids form healthy habits that will benefit them with increased focus and energy at school, ensuring they can do their best academically.

So don't skip the most important meal of the day! Furthermore, studies of children and adolescents have shown that those who skip breakfast are apt to be overweight.  Questions about what and when to eat?  Talk to your doctor or one of the providers at Ns1ghter!

Getting Better Sleep

By William Jantsch MD

Sleep is a remarkable phenomenon that is not well understood, but definitely necessary for proper mental and physical function. Most adults need between 7.5 and 8.5 hours of sleep every day. The consequences of not getting sufficient good-quality sleep are severe, and can include depression, chronic fatigue, headaches, high blood pressure, muscle aches, and an increase in risk of heart disease and stroke. 

Many people have no trouble sleeping; such people fall asleep easily, go through multiple cycles of REM sleep (or “rapid eye movement” sleep, when dreams occur), and wake up feeling refreshed and invigorated. Unfortunately, many others will have trouble falling asleep, staying asleep, or will not sleep efficiently, and will roll out of bed in the morning just as tired as when they went to bed.

People with poor sleep quality would be well served to consult a physician, who may be able to determine whether there is physical or psychological reason for poor sleep. One of the most common conditions leading to poor sleep nowadays is Obstructive Sleep Apnea, a consequence of severe snoring which causes a person to choke during the night, temporarily interrupting breathing.

Prior to or in conjunction with a physician’s evaluation, there are steps a person can take in order to have a better chance of good sleep. These measures as a whole are referred to as “sleep hygiene”, and recommendations follow:
a. Have a regular routine: Go to bed at the same time every night, and try to get up at the same time every morning; Try taking a warm bath or shower prior to going to bed. Meditation or other quiet activity right before bedtime may help you be relaxed and calm.
b. Avoid naps: Napping can lead to fragmentation of sleep patterns at night.
c. Foods, beverages, and medications to avoid: Alcohol is the worst offender- a few drinks may help you get to sleep, but the process of metabolizing the alcohol will cause you to be awakened in the middle of the night. Also, avoid decongestants and other cold medications. Coffee and tea should be enjoyed only in the morning, not after noon.
d. Things not to do in bed:
     1. Stay awake: If you just can’t sleep, after 5 minutes get up and sit quietly in a chair in the dark. Don’t turn on the lights and start reading or going on the computer.
     2. Eat
     3. Watch tv
     4. Use a tablet or computer with a bright screen: the bright blue lights of a computer or tablet screen can fool your brain into thinking that it is still daytime.
e. Get regular exercise: Try not to exercise within 8 hours of going to sleep at night.
f. Have a quiet and comfortable sleep environment: Keep the bedroom cool and quiet; consider getting a “white noise” generator if there are extraneous sounds around you. Don’t let your pets interrupt your sleep by jumping on the bed. Make sure your mattress is comfortable.

If you have further questions, ask your primary doctor, or consider chatting with one of the doctors on Ns1ghter.

Good night, and sleep well!

How To Eat II

By Joseph Accursio NP

“Let food be thy medicine, and thy medicine be food.” Hippocrates

Continuing from a previous post, the idea behind this article is to provide a streamlined way to think about nutrition and what to eat. There are a seemingly infinite number of dietary tips and tricks and methods out there, but if we’re going to make changes and think about things differently, then we have to make it simple and useful. Without further ado, here is my personal way to view eating:

First things first, we need to get the “d-word” out of the way. Discipline. Changing your eating habits on a permanent basis is unpleasant. There is no way around this. That’s why a proper perspective and going into a change with both eyes open is crucial. You’ll have times of struggle, weakness and discomfort. But, as the old Rocky IV song goes, “it’s you against you, the paradox that drives us all.” So then, show your appetite who’s boss!
A pivotal part of discipline is planning ahead. If you try to wing it in times of stress, you will fail. Don’t stare temptation in the face - plan for it, then run from it when it comes- because it will come. The more you do on the front end, the higher likelihood of your success. 
With that groundwork laid, onto the actual food part: 

There are three sources of fuel that the body can burn in order to stay alive – carbohydrates, fats and proteins. Anything that doesn’t fall under those categories is a filler, a fiber, water, or a nutrient of some kind (like vitamins and such). 
Carbohydrates are, for all intents and purposes, sugars. From white stuff in a packet to broccoli stems. There are “simple ones” and “complex ones,” which relate to a concept called glycemic loads in conjunction with what else you’re eating at the time – but let’s not make this a chemistry lesson. 
The low carb diet has long been a staple of discussion for fad diets, but keep this in mind: though your body can make sugar from other sources, you need some carbs on a regular basis for your brain. If you don’t take in something carbohydrate, you will feel a little mentally foggy and irritable.
The carb bottom line: get your sugars from fruits, vegetables and high fiber grain breads. And there is almost never a justification for things like Gatorade. Unless you’re a successful marathoner, in which case you’re not likely reading this post.
Next up is proteins. Protein is the building block of functional tissue; think of it as more of a structural component. What you’re made of. Your body can use proteins to make carbs, but the process is also more drawn out and causes the same mental fogginess and lack of energy.
Protein is an important fuel source, but unless you’re (again) a marathoner in training, the super high protein diet is overrated and unnecessary. The human body generally turns over about 80% of the protein needed on a daily basis, which means most protein that’s broken down is recycled and reused. The most important two things about protein are the essential amino acids (i.e. proteins that your body can’t make) and the fact that proteins make you feel full. 
Finally we have fats, which tend to get a bit of a bad rap. Fats are long term fuel supplies. Though your body needs some carbs to burn fats, fat is the best type of long duration energy. Fatty meals are higher in calories because fat is calorically dense. Here’s a positive trend on the rise – the return of fat as significant source of food intake. After decades of an errant cultivation of fat-fear and high sugar replacement foods, scientific research is yielding data that healthy dietary fats (i.e. NOT foods in a wrapper) are A-OK. Dietary cholesterol guidelines are on the way out, and the idea is that it was the sugar all along, not the fat. There are many bridges to cross yet on this one, and surely there is and will be an overzealous “fat” trend that acts like many other trends, but keep an eye on forthcoming fat-related findings. 

So in summary, take the following points:
1. Food is fuel, not entertainment. Be disciplined above all.
2. Carbs, proteins and fats. That’s all there is. And there are healthy varieties of each.

Two more things to note – 
No matter what you’re eating, if you’re eating too much of it, you will not maintain a healthy weight or energy level, and you’ll be disposed to mood swings and mental changes. This obviously doesn’t help you maintain that discipline. Don’t gorge. Leave yourself just a little bit hungry.
Finally, the most difficult point in today’s culture – don’t eat out of thin plastic packages or fast food wrappers. Make it a rule and stick with it. The stuff that comes out of this packaging is SUPER calorie dense, very high in sugar and has little nutritive value. Think of it as waste product and avoid at all costs. 

Fever – how do you do it right? I am feeling hot tonight!

By Allison Godchaux, NP

Fever – how do you do it right?  I am feeling hot tonight!

Fevers: something we or our friends and family have had at one time or another.  It should be easy to figure out whether or not someone has a fever.  It should be pretty straightforward determine this, but it’s not.  So, let's spend a moment to talk about it.

What is a temperature?  To make it simple:

FireShot Capture 254 -  - file____Users_simonapostolski_Desktop_fever__how_do_you_do_it_right.pdf.png

Unfortunately, taking a temperature isn’t so precise that we can say to specifically add or deduct 0.5 or 1.0 degrees Fahrenheit (F) or 0.3 to 0.6 Celsius (C).  If a patient is sick, we don’t just rely on the number on the thermometer, we also look at the patient's other symptoms as well!  

Other factors to consider when taking a temperature:

1.     Type of thermometer you are using.

-       Ear (Tympanic) – the amount of earwax in an ear can lower the number you get.  A narrow ear canal can also lower the number.  Don’t try and push it in, either!

-       Axillary or armpit – if the thermometer isn’t positioned correctly, the number you get will likely be lower than it really is.  Make sure you place the thermometer deeply into the center of the armpit, then lower the arm on top of the thermometer next to the body, holding it firmly.

-       Orally – if you have had anything to eat or drink within ½ hour of taking your temperature, it may falsely lower or raise the number depending on what you have consumed.

Remember: No drinking or eating (if you can avoid it) up to ½ hour of taking an oral temperature!

2.     Consider the age of the person whose temperature is being taken when choosing the appropriate thermometer type.  Below is a diagram that makes it simple:

FireShot Capture 255 -  - file____Users_simonapostolski_Desktop_fever__how_do_you_do_it_right.pdf.png

 Common questions medical providers are asked in regard to taking temperatures:

How long should I take the temperature?  Unless your thermometer beeps at you to indicate when to stop, leave it in place for 3 minutes.

Should I compare the temperature in two different areas if I am not sure I am right?  Not necessarily, and it isn’t necessary to double-check with different types of thermometers.  Find a thermometer you like, and get used to using it. Try it on your family members.  When you need to use it, you will be comfortable using it, and will have faith in the numbers you get.

I prefer a pacifier thermometer for my baby, what do you think of those?  Honestly?  I love them! …I love the idea of them anyway.  The problem is, when you have a sick kiddo, they usually don’t want to keep the pacifier in long enough to get a good reading.  Unless your experience of this is different than mine, I would stick with a temporal (forehead) or rectal thermometer.

I don’t want to use a rectal thermometer- I’m worried that I will push too far or hurt my baby!  I absolutely understand.  When you use a rectal thermometer, use a little Vaseline or petroleum jelly (same thing) on the end of the thermometer, then insert it a ½ inch into the rectum.  I insert it with my thumb and index finger and use my other fingers to brace my hand and the thermometer against the baby’s bottom so as to not push it in too far. If your thermometer is the type that beeps at you, wait for the beep, and then remove thermometer. Don’t forget to read it immediately!  If it isn’t the kind of thermometer that beeps at you, then hold it in place for 3 minutes, and then take out the thermometer.

I was told that I should never use a rectal thermometer orally, even if I wash it really well.  Is this true?  As a matter of safety, it is true.  I am sure that you do wash it well, but we don’t want to take any chances.  If we were to transfer some bacteria from the rectum accidentally, we could make our sick child even sicker.  Good question!

If you have any other questions or concerns, don't hesitate to log on and ask your Ns1ghter provider!

What is bronchitis? And how do I treat it?


Doctor, I have a cough. Do I have bronchitis?
Cough is a symptom of several diseases, one of them being bronchitis.

So, what is bronchitis, doctor?
Bronchitis is a swelling of the lining of the air passages connecting our nose and the lungs. Acute bronchitis is a sudden inflammation of short duration and is also known as a chest cold. Chronic bronchitis means inflammation of the lining of the air passages lasting for more than three months and occurring in two consecutive years.

Is bronchitis an infection? What causes it?
Acute bronchitis is usually an infection caused by viruses like the influenza virus or bacteria and is contagious. Chronic bronchitis, on the other hand, is not an infection but follows irritation of the air passages by cigarette smoke, dust, fumes and pollutants in the atmosphere.

How will I know that I have bronchitis?
The symptoms of both acute and chronic bronchitis are similar. While the onset of acute bronchitis is sudden, chronic bronchitis occurs over a long period of time. The symptoms include:

  • Cough which is persistent (can last from weeks to months in chronic cases and is called smoker’s cough).

  • Difficulty breathing

  • Excessive mucus in sputum

  • Fever with chills

  • Pain in the chest

  • Throat pain

  • Fatigue

  • Nose block

  • Squeaky noise as you breathe (wheezing)

How is bronchitis diagnosed?
Bronchitis is diagnosed based on your symptoms, and the history of whether you suffered from a cold or flu recently or whether you were exposed to cigarette smoke and/or air pollutants. Using a stethoscope, I can listen to your lungs. I can also check your blood oxygen levels with an oximeter and have your mucus checked for bacteria. In addition, an X-ray of your lungs and pulmonary function tests will help to confirm the diagnosis.

What is the treatment, doctor?
Treatment includes:

  • Adequate rest

  • Drinking plenty of fluids

  • Breathing warm and moist air

  • Cough suppressants

  • Pain medication to relieve pain while breathing

  • Oxygen may be required if breathing is difficult

  • Antibiotics may be required to treat bacterial infection, although no medication is prescribed for viral bronchitis

  • Medicines to liquefy the mucous (mucolytics)

  • Steam and a humidifier to loosen the mucus

  • Stop smoking or exposure to fumes and other respiratory irritants

Is there any complication due to bronchitis?
Pneumonia is an important complication and typically occurs in the very young (infants), very old (elderly), in individuals who smoke, and in those with poor immunity, lung diseases or multi-organ illnesses.

How can I prevent bronchitis? 
Some effective measures to decrease your risk of bronchitis are:

  • Avoid smoking and second hand smoke

  • Wear a mask to decrease your risk of exposure to smoke, fumes and other lung irritants

  • Hand washing to reduce risk of viral infections

  • Get a flu and pneumonia vaccine




When is a headache serious?

By William Jantsch MD

What can I do about this headache?


Headaches are a common affliction among humans, with almost 90% of people experiencing this during their lifetimes. Happily, most headaches are simply a benign nuisance, commonly the result of tension of the muscles, ligaments, and nerves of the scalp. However, headache can also be a symptom of a serious underlying disorder. These “serious headaches” are relatively rare, but it is the doctor’s duty to try to make sure that the patient he or she is treating does not have a potentially crippling or lethal condition. 
What options, then, are open to someone who is experiencing a headache? What follows is some background information, and perhaps some general guiding principles.
Most mild headaches, while uncomfortable, will resolve in time and not leave any health-related consequence. “Tension headaches”, often felt by people under stress, tension, or eye strain usually come and go gradually, are not associated with “sick” symptoms (such as nausea, vomiting, dizziness, light sensitivity), and will usually resolve with over the counter analgesics such as acetaminophen or ibuprofen. People with tension headaches usually have a long history of episodic headaches of a similar nature.

A “migraine” is a clinical syndrome, not just a headache. Migraine sufferers experience periodic headaches that may be preceded by visual or neurological symptoms (such as flashing lights in one eye, focal weakness or numbness in the arms, face, or legs), followed by a severe headache on one side of the head, associated with light sensitivity, nausea, and vomiting. 

“Serious” headaches are those that signal the presence of an underlying disorder that would require urgent or emergent treatment to minimize death or disability. Examples of such conditions would include:
- Intracranial hemorrhage (bleeding), due to:
o Aneurysm of a brain artery (enlargement with possible rupture of the blood vessel)
o Intracerebral hemorrhage (bleeding into the brain)
o Subdural or epidural hemorrhage (usually seen after a serious head injury)
- Stroke
- Meningitis
- Brain tumor
- Vasculitis (blood vessel inflammation, such as seen in Lupus)

Symptoms that could indicate the presence of one of these life threatening conditions would include:
- Very sudden onset of very severe headache (doctors call this a “thunderclap” headache), sometimes described by patients as “the worst headache I have ever had”
- Impairment of level of consciousness
- Fever
- Uncontrollable vomiting
- Impairment of vision, weakness or numbness anywhere on the body

Notice that migraine headaches can be severe and be associated with “sick” feelings; one of the first questions a doctor will ask in evaluating such a headache is “have you ever had a similar headache in the past?" A presumptive diagnosis of “benign" headache can be made just on the basis of documenting a previous pattern of similar headaches, and no further testing may be needed prior to instituting treatment.
If you have a previous history of recurrent headaches, and happen to be suffering from yet another episode with pain that is similar in character and location, then it is probably not a “serious” headache even if the pain is severe. On the other hand, if you are the kind of person who never gets headaches, and there is a sudden onset of severe pain along with any other symptom, then it would be prudent to go a hospital emergency department in order to get immediate testing and treatment. Appropriate evaluation of a “new, severe, sick” headache cannot be performed in a doctor’s office or an urgent care center.

If there is any question about where to go for evaluation and treatment of a headache, you have several options:
- Call your primary doctor for advice.
- Try a telehealth consultation, such as with an Ns1ghter provider. Ns1ghter has the advantages of being free and readily available, and can quickly give you an idea of how best to get an appropriate evaluation. Some of the national telehealth services offer the additional benefit of prescribing medication, but they may not be as thorough with follow-up evaluations as your primary doctor might.
Treatment options for benign headaches will be the subject of another blog post.

Thanks for reading, and I hope that this advice has helped.