Archive for November, 2012


The leaves are falling, there is a brisk feel to the air, and the clocks are falling back to daylight savings time. These are sure signs of fall and the winter months to follow. Most people dread the short cold winter days and long nights. However, this is the time of year that it is imperative that you stay healthy. Unlike the bears who hibernate during winter, humans need to step up thoughts of good nutrition and exercise. The most common geographic areas that SAD is prevalent are the upper north where there are limited hours of sunshine.

Seasonal Affective Disorder  (SAD) affects up to 9% of the US population. This is a disorder that is commonly triggered by falling temperatures and lack of sunshine during the winter months. Most persons who are affected by SAD have no symptoms during the spring or summer months when there is more daylight and outdoor activities are abundant.

Some of the symptoms of SAD include depression, excessive sleeping, lack of energy, weight gain, fatigue and difficulty concentrating. The symptoms can come and go, but are more noticeable during times when the daylight is shortest (typically December and January).  Some persons who suffer from SAD may require counseling or hospitalization if the symptoms become severe.

There are several treatments for SAD- but if the symptoms become severe, or thoughts of suicide arise, the person should seek medical attention immediately.

Some suggestions for preventing and helping persons experiencing SAD:

  • Outdoor activity — get outside and participate in physical activity. Go for a walk at lunchtime when the sun is typically the brightest. Participate in outdoor winter sports, such as snowshoeing, skiing, ice skating or sledding. Raking leaves in the sunshine is a great activity, and will also help to keep the weight off. Any physical activity that is in the sunshine will help.
  • If you cannot get out in the sunshine, some people benefit from full spectrum light therapy. This is a special light that can be found in many stores and set up in the home or office. Although full spectrum light does not take the place of sunshine, it is much more effective that a typical light bulb.
  • Good nutrition- Weight gain is very common during the winter months. This is a time that focus on healthy nutrition is essential. Try to avoid processed foods (chips, snacks) and foods containing gluten (breads, cookies, cake, etc).  Focus on lean meats (chicken, fish, pork, beef, etc), vegetables, fruits, and nuts (unless allergic). Fill the plate with steamed vegetables and lean protein.  Avoid high fat, high calorie deserts (such as pie, cake and cookies) and treat yourself to fresh fruit instead. A small serving of high quality dark chocolate has antioxidants that can actually help mood.
  • If the symptoms of SAD become out of control, the advice of a health care professional is necessary. Don’t be afraid to talk with your health care provider about your symptoms- we are here to help!

With Thanksgiving fast approaching, many people are looking forward to a big turkey dinner with all of the ‘fixins’. But, how healthy is that dinner? And what are some healthier alternatives?

  • TURKEY- is a great source of high protein (along with fish and eggs) that is low in calories. Roast turkey is also low in cholesterol thereby making it a great choice for heart-healthy diet. Turkey is low in carbohydrate, thus improving the stability of insulin production after a meal. Roasting the turkey is much healthier that frying—which increases the cholesterol content significantly. Choosing white meat (such as the turkey breast) is healthier than red portions (such as thigh or wing).  Some people are concerned about the amount of tryptophan found in turkey. Tryptophan is an amino acid that is similar to Melatonin, and often helps people sleep.  Research has shown that the amount of tryptophan in turkey is actually no greater than that found in foods such as chicken, tuna or other meats. People who blame sleepiness after a large turkey dinner should consider that other foods that accompany turkey might be the culprit.
  • Dressing or stuffing—this is probably one of the highest calorie and fat options on the table. One single serving (one cup) of regular bread dressing has over 350 calories, 17 grams of fat and almost no protein—and that is just 1 cup!! In addition, stuffing is loaded with gluten, which has been shown to cause inflammation in the system. As an alternative, try fruit and nut “stuffing” – its both delicious and looks beautiful. Another option would be cauliflower rice or mashed cauliflower- the recipe can be found at http://paleoterran.squarespace.com/journal/2011/10/12/eat-this.html
  • Bread or biscuits—another high calorie, gluten rich side dish that can be avoided. Instead of bread or biscuits, how about substituting a rice cake? If you just have to have bread, reach for the gluten-free type.  Or you can just eliminate this side altogether and add another vegetable.
  • Cranberries—oh yes, that yummy side dish that may not be as bad as you thought! If you serve cranberries from a can, keep in mind that it is loaded with sugar and calories. Think about substituting fresh or dried instead of canned. Fresh cranberries are a wonderful addition to almost any table, and are one of the highest berries in antioxidants. Research has shown that fresh cranberries help reduce the incidence of urinary tract infections, help people with gum disease and help to reduce stomach ulcer formation. Fresh cranberries also contain Flavinoids which can help prevent heart disease. With zero fat and only 51 calories per cup, cranberries are a great choice!
  • Vegetables—almost any vegetable is suitable with turkey. Try steamed carrots, green beans or peas instead of canned. 2/3 of the dinner plate should be filled with vegetables. Also try fresh veggies as a side- such as celery hearts filled with hummus.
  • Desert—ok, everyone loves desert after a great meal… but think about some healthy choices. A small slice of pumpkin pie has over 300 calories and over 15 grams of fat—and that does not include the whipped topping!!  Instead, choose fresh sliced apples, sliced kiwi or a fruit salad. For a real treat, try high quality dark chocolate- which has antioxidants galore!
  • And after that big meal… go outside for a walk! Play ball with the kids or walk the dog. About 30 minutes of exercise will help digestion and ward off the feeling of bloating and tiredness.

 Start a few new traditions

  • Instead of cooking a big meal, volunteer you and your family to serve at the local soup kitchen
  • Take a meal to a shut-in or elderly person who lives alone
  • Offer to drive your elderly neighbor to church or a family gathering
  • Volunteer at your local nursing home to visit with the residents
  • Join a group of carolers at the local children’s hospital or nursing home
  • Volunteer at the local food bank
  • Take the money you would spend on a big meal and purchase a few coats/hats/gloves for the needy
  • Adopt a family – there are many families who do not have any food to eat

 “For each new morning with its light,
For rest and shelter of the night,
For health and food,
For love and friends,
For everything Thy goodness sends”

Ralph Waldo Emerson (1803-1882).

 

Cerebral Aneurysms

Cerebral aneurysms are a weakness in the blood vessel’s wall that leads to a small focal dilation.  The etiology is debated, but they most probably start as a congenital wall weakness and later enlarge and dilate; changing size and morphology as we age.  The true prevalence of aneurysms in the general population is difficult to predict, but a reasonable estimate is ~5%.  15-20% of patients with an aneurysm will actually have multiple aneurysms.  Risk factors over time for aneurysmal enlargement include older age, smoking, hypertension, atherosclerosis, amphetamine use, head injury, heavy alcohol consumption, blood infections, and low estrogen after menopause.  Congenital risk factors include connective tissue disorders, polycystic kidney disease, coarctation of the aorta, and family history of aneurysms.  Aneurysms also have been found to occur in predictable locations such as branches off blood vessels.  Anterior communicating artery and posterior communicating artery aneurysms are the most common.

Aneurysms may either be identified after rupture (usually presenting as a subarachnoid hemorrhage or intracerebral hemorrhage), after surveillance imaging for a new neurologic deficit or headaches, or incidentally on imaging for an unrelated issue.  Ruptured aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.  Usually the aneurysm temporarily thromboses following the initial bleed, however re-hemorrhage may occur.  The initial treatment for subarachnoid hemorrhage is to stabilize the patient in an intensive care unit followed by surgical treatment of the aneurysm.

A noncontrast computed tomography (CT) scan is useful in determining if a subarachnoid hemorrhage has occurred and may identify larger aneurysms.  If the clinical findings suggest a bleed but the CT scan appears negative, a lumbar puncture may be performed to identify red blood cells or xanthrochromia in the cerebral spinal fluid.  If an aneurysm is suspected, ruptured or unruptured, a CT angiogram or magnetic resonance angiogram are also useful tests to identify possible intracranial aneurysms.  However a dedicated four vessel cerebral angiogram is the gold standard for diagnosis.

Great debate exists as to the treatment of unruptured cerebral aneurysms.  As a result there have been a number of efforts to determine the natural history of aneurysms in relation to morbidity and mortality, patient age, aneurysm size, and aneurysm location.  The International Study of Unruptured Intracranial Aneurysms (ISUIA) was a two part study attempting to evaluate these issues.  Based on size and location, aneurysms smaller than 7mm appear to have a very low risk of rupture and it is not until they are larger than ~13mm that significant risk or rupture exists, unless the aneurysm is in the posterior circulation.  If the aneurysm is a posterior communicating artery aneurysm or in the posterior circulation, aneurysms larger than 7mm pose a fairly significant risk of rupture.  Of course these are not steadfast rules.  Any aneurysm may rupture at any time, and patients should be counseled regarding their specific risk factors for rupture and desire for prophylactic surgery.  A young patient with a 3mm aneurysm who is a smoker has a different risk profile to an older healthy patient with same size aneurysm.  Any patient with an aneurysm should be evaluated by a neurosurgeon.

There have been no identified conservative management strategies for aneurysm treatment other than changing modifiable risk factors.  Surgery is the only definitive treatment.  Surgery may be performed as an open procedure where a metal clip is placed on the aneurysm or as an endovascular procedure where small metal coils are placed inside the aneurysm.  In either strategy, the aneurysm dome is blocked so that blood cannot enter and the vessel wall repairs with time.  There are advantages and disadvantages to either procedure.  A large study called the International Subarachnoid Aneurysm Trial (ISAT) was reported in 2002 to compare the two treatments.  It appears that either treatment may successfully treat aneurysms.  However, the aneurysm location, morphology, and patient preference are the key features that should determine whether an aneurysm is microsurgically clipped or endovascularily coiled.

For and evaluation please call The Neurosurgery Center of Colorado at 303-481-0035 and make an appointment with Adam P. Smith, MD.