Save Your Vision

Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of Read more

March is Colorectal Cancer Awareness Month

  Since 2000, March has been the month to promote awareness of colorectal cancer. Many individuals raise awareness on March 2nd by showing off their blues to call attention to the prevalence of this cancer. Jennifer Giebel, APNP at Sheboygan Cancer Read more

February is Heart Health Awareness Month

  In February heart-shaped decorations, cards, balloons, and chocolates appear everywhere. This is a great reminder that since 1964 February has been American Heart Month. Heart disease is the leading cause of death for men and, through the efforts of Read more

February: Go Red for Women!

You may know that heart disease is the leading cause of death for men. But did you know that heart disease is also the leading cause of death for women? In fact, in the US, 44 million women are Read more

January is Thyroid Awareness Month

  January is Thyroid Awareness Month. The thyroid gland is a butterfly-shaped endocrine gland found in the front of the neck. When functioning properly the thyroid often gets little attention. However, a malfunction can have a profound impact on health and wellness. Read more

Save Your Vision

Physicians Health Network Blog

Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of the whole body. In fact, the eyes, which are only two percent of your body weight, burn 20 percent of your daily energy. This is a massive amount of energy. Your visual system is the single largest energy user in your body. This means that the health of your eyes and the health of your body as a whole are intimately linked.

Here are some lifestyle factors that can impact your eye health:
• Diet
• Eye protection
• Smoking
• Screen time
• Regular eye exams

Let’s look at some of the details of each one:

Diet – Carrots are not the only vegetable to benefit your eyes. Although they are good sources of carotene. Consider other vegetables as well; especially dark leafy greens such as spinach and kale. In addition, the omega-3 fats found in fish and other seafood are important for retinal health. Deficiency of these fatty acids may increase your risk of certain eye diseases.

Eye protection – Protective eyewear includes safety glasses, goggles, and splash shields. The type of protective eyewear needed depends on the activity. Wear protective eyewear for sports, work, handling chemicals or any activity that puts your eyes at risk. If possible look for polycarbonate glasses which are very strong and shatter-resistant.

Smoking – It is no surprise that smoking is bad for your health, but this is especially true for eye health. All the energy that your eyes use creates a lot of inflammatory by-products. The eyes must deal with these by-products and smoking makes the problem even worse. This is why smoking is related to the development of age-related macular degeneration, cataract, and optic nerve damage.

Screen time – Modern computer screens, TVs, phones, and tablets all flicker and are saturated with blue light. As mentioned, the eyes burn enormous amounts of energy and need to deal with the inflammatory by-products. Because of its wavelength, blue light is high-energy radiation which stresses the eyes by fatiguing the eye’s waste disposal systems. The flickering of computer screens is too fast for us to notice, but it is a source of eye fatigue. When using a screen take breaks every 20 minutes. In addition to resting the eyes use these breaks to look off into the distance. If your device features allow, change the setting to lower the amount of blue light and increase the amount of red light coming from the screen. Examples of these features include night mode on Android devices and night shift on Apple devices.

Regular eye exams – Often eye exams are not a top-priority for children and young and middle-aged adults. However, a dilated eye exam can be important for to assess your eye health and screen for progressive diseases. These exams are recommended annually for any individual over 60 and for African Americans over 40. Regardless of your age, if you feel an eye exam is right for you contact your eye care professional.


Campello, L., Esteve-Rudd, J., Bru-Martínez, R., Herrero, M. T., Fernández-Villalba, E., Cuenca, N., & Martín-Nieto, J. (2013). Alterations in Energy Metabolism, Neuroprotection and Visual Signal Transduction in the Retina of Parkinsonian, MPTP-Treated Monkeys. PLoS ONE, 8(9), e74439. doi:10.1371/journal.pone.0074439

March is Colorectal Cancer Awareness Month

Physicians Health Network Health & Awareness Articles


Since 2000, March has been the month to promote awareness of colorectal cancer. Many individuals raise awareness on March 2nd by showing off their blues to call attention to the prevalence of this cancer.

Jennifer Giebel, APNP at Sheboygan Cancer & Blood Specialists says, “Colorectal cancer is highly treatable which makes spreading awareness truly a potential lifesaver.” At the end of the large intestine are the colon and the rectum. When cancer occurs in these areas it is known as colorectal cancer. When it becomes metastatic, this type of cancer most commonly spreads to the liver. Colorectal cancer is the second leading cause of cancer death in the US and it affects women and men equally. The incidence for African-Americans is 20 percent greater than it is for Caucasians. Individuals with a first-degree relative with colorectal cancer, meaning a child, sibling, or parent have two to three times greater risk. “Colorectal cancer can occur in individuals of all ages but is most common in people over 50 years of age. However, it’s important for younger individuals to be aware of the risk factors for this disease to avoid mistakenly ignoring early symptoms,”

Screening for colorectal cancer is very important. This is because the earlier colorectal cancer is found the greater the chance of successful treatment. According to Giebel, “Men and women should have regular screening starting at age 50. Regular screening enables us to find precancerous polyps or colorectal cancer early when they are most easily treated.” In fact, when colorectal cancer is found in early stages, the 5-year survival rate can be 90 percent.
Symptoms can include:
• A change in bowel habits or the shape of the stool.
• Persistent abdominal discomfort – Including cramps, gas, feeling full, bloated or pain.
• Rectal bleeding – Finding blood in your stool or in the toilet after bowel movement.
• Weakness, fatigue or unintentional weight loss.
• The urge to have a bowel movement when the bowel is empty.
• Dark or black stools

In addition to regular screening, you can reduce your risk of colorectal cancer by making some positive lifestyle changes. These include:
• Avoid excess alcohol consumption
• Maintain a healthy bodyweight
• Avoid (or quit) smoking
• Be physically active

Treatment options vary, and Jennifer says, “The course of treatment depends on the size, location, and stage at which the cancer is found. Some smaller, local, early-stage tumors can be treated with surgery alone”. Some of the common treatment strategies for colorectal cancer include:
• Surgery
• Chemotherapy
• Biological Therapy
• Liver-Directed Therapy
• Radiation Therapy

“Symptoms can also be associated with many other health conditions and early colorectal cancer often does not cause pain. Contact your physician if you have symptoms and need to determine the cause,” said Giebel. Consider proudly wearing your blue on March 2nd and help spread to word that early detection of colorectal cancer can be a lifesaver.


February is Heart Health Awareness Month

Physicians Health Network Health & Awareness Articles


In February heart-shaped decorations, cards, balloons, and chocolates appear everywhere. This is a great reminder that since 1964 February has been American Heart Month. Heart disease is the leading cause of death for men and, through the efforts of groups like the American Heart Association, there is growing awareness that it is the leading cause of death for women as well.

Dr. Louie Coulis, MD, FACC, Coulis Cardiology says, “When dealing with heart disease risk it can be helpful for those concerned to look at their risk factors in two categories. Those they can change or modify and those they cannot.” Your age, sex, family history, and racial background cannot be changed. However, those factors that can be modified with lifestyle changes are:

• Blood pressure
• Body weight
• Cholesterol
• Exercise
• Smoking
• Type II diabetes.

“Targeting the modifiable risk factors means that doctors and patients can work together to make dramatic reductions in heart disease risk,” said Dr. Coulis. For example, diabetes is strongly linked to heart disease. In fact, the most common cause of death among type II diabetics is heart or blood vessel disease and their risk of death due to a cardiovascular event is as much as six times greater than non-diabetics. Unregulated blood sugar worsens the risk of heart disease but as Dr. Coulis notes, “even with controlled blood sugar a diabetic’s risk of heart disease is elevated.”

Likewise, smoking is a powerful heart disease risk factor. Smoking doubles one’s risk of heart attack and, according to Dr. Coulis, “smokers who quit can see a four-fold reduction in their risk of heart disease. Quitting also reduces the secondhand smoke exposure for others, which is also a heart disease risk factor.”

Most people survive their first heart attack and make a functional recovery. Dr. Coulis says, “The improvements in emergency cardiology mean that, if caught in time, those who suffer a heart attack can be treated. Still, it is a good idea for individuals at risk of heart disease and their loved ones to be acquainted with the symptoms of a heart attack.”
The symptoms of heart attack include:
• Chest pain, shortness of breath or fatigue. It is important to note that approximately 1/3
of people who have a heart attack do not feel any chest pain. Many of these are women,
non-Caucasian, or older than 75.
• Pain in the middle of the chest which can spread to the back, neck, jaw or arms.
• Nausea & vomiting which are sometimes mistaken for food poisoning or the stomach flu.
• Gas-like pain or pressure in the stomach area which is may be mistaken for indigestion.
• Lightheadedness or dizziness.
• Feelings of restlessness, sweating, or anxiety.
• Bluish lips, hands, or feet.
• Heavy pounding of the heart or abnormal heart rhythm.
• Loss of consciousness.

The word is spreading. There is greater awareness of heart disease, its risk factors, and the symptoms of a heart attack. If you are interested in assessing and lowering your risk of heart disease see your doctor.

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February: Go Red for Women!

Physicians Health Network Blog

You may know that heart disease is the leading cause of death for men. But did you know that heart disease is also the leading cause of death for women? In fact, in the US, 44 million women are affected by heart disease and women under the age of 55 who suffer a heart attack do not recover as well as men in the same age group. In other words, heart disease is as important for women to pay attention to as it is for men.

Heart disease affects all women, but it is important to note that African American and Hispanic women are at greater overall risk and more at risk of developing heart disease earlier in life.

It is estimated that 80 percent of heart disease and stroke events can be prevented with lifestyle changes.

This is why spreading awareness among women is so important and that’s exactly what the American Heart Association’s Go Red for Women campaign is all about. On February 2nd women, and men, will wear red to call attention to the importance of cardiovascular health for women and to help bust the myth that heart disease is only an issue for men.

The connection between heart disease and men’s health is well-known but cardiovascular research has begun to appreciate the risk women face and how that risk differs from men. For example, the classic heart attack symptom for a man is chest pain. While women may also experience chest pain, they are more likely to experience the other types of discomfort associated with a heart attack such as shortness of breath, nausea, vomiting, back pain or jaw pain. Here is a list of heart attack warning signs for women:
● Chest discomfort that lasts more than a few minutes or that goes away and comes back.
● Discomfort in other areas such as one or both arms, the back, neck, jaw or stomach.
● Shortness of breath.
● Cold sweat.
● Nausea or lightheadedness.

Some heart disease risk factors cannot be controlled such as age, race, and family history. But women still have an enormous ability to change their personal risk of heart disease by paying attention to the risk factors they can control by making changes in their lifestyle behaviors. The following lists the risks that can be managed through lifestyle changes to lower your risk of heart disease.
• High blood pressure
● Smoking or tobacco use
● High blood cholesterol
● Lack of regular activity
● Obesity or overweight
● Diabetes

If you need to make improvements in these areas be sure to see your doctor.

Remember to put on your red apparel on February 2nd and help spread the word. Heart disease isn’t just a concern for men.


January is Thyroid Awareness Month

Physicians Health Network Health & Awareness Articles


January is Thyroid Awareness Month. The thyroid gland is a butterfly-shaped endocrine gland
found in the front of the neck. When functioning properly the thyroid often gets little
attention. However, a malfunction can have a profound impact on health and wellness. The
thyroid gland regulates the human body and its metabolic processes much like a thermostat
regulates a furnace or a gas pedal regulates an automobile engine. In other words, the thyroid
gland, by producing thyroid hormones, affects how our cells use energy. Like the gas pedal,
thyroid hormones increase the body’s metabolic rate. In fact, most of your cells have receptors
for the thyroid hormones which means that the thyroid has an enormous effect on our body.
The thyroid regulates body temperature, it influences brain health, heart function, muscle
strength, bone density, and much, much more.

The thyroid hormones have powerful effects and so the thyroid must be carefully
controlled by the body. Too little thyroid hormone and key processes around the body slow to a
crawl. Too much thyroid hormone and the same processes rev dangerously high. Dr. Liz Zurich,
D.O. from Sheboygan Internal Medicine Associates explains, “While the thyroid gland controls
many processes in the body, it is itself controlled by other glands.” That control comes down
from the pituitary gland in the brain in the form of thyroid stimulating hormone (TSH) As the
name implies, TSH signals the thyroid gland to release two hormones. One is triiodothyronine,
also known as T3, and the other is thyroxine, also known as T4. Just as the thermostat in a
house signals the furnace to shut off when the house is getting too warm, the release of T3 and
T4 into the bloodstream signals the pituitary gland to stop producing TSH. This type of control
forms an elegant loop known as a feedback loop.

Imagine a malfunctioning thermostat leading to either an overworked furnace or a furnace that
will not kick on when needed. Dr. Zurich says, “The thyroid gland can malfunction in a similar
way, becoming either underactive or overactive. We call these disease states hypothyroidism
and hyperthyroidism.” When normal thyroid function is disrupted many essential metabolic
processes can also become either underactive or overactive and lead to profound negative
health effects.

Dr. Zurich says, “There are several causes of hyperthyroidism, such as inflammation, viral
infection, or cancer, but most cases are caused by Graves’ disease. Graves’ disease is an
autoimmune disorder in which immune antibodies overstimulate the cells of the thyroid.” This
results in an enlarged and hyperactive thyroid that is producing too much T3 and T4. This
condition is most common between the ages of 30 and 50 and afflicts women more than men.
Because the thyroid influences so much that goes on in the body it is no surprise that almost
every organ can be affected by hyperthyroidism. It is also no surprise that the list of
hyperthyroid symptoms are diverse:

● Increased appetite
● Weight loss
● Nervousness or anxiety
● Irritability
● Increased perspiration
● Racing or irregular heartbeat
● Hand tremors
● Difficulty sleeping
● Muscle weakness
● Osteoporosis
● Diarrhea
● Goiter
● Bulging eyes or vision issues

The numerous and diverse symptoms associated with thyroid dysfunction means that,
sometimes, other health issues can resemble thyroid dysfunction. The thyroid may unfairly take
the blame. Your physician is best equipped to help you determine if you have a health issue
related to the thyroid gland. Dr. Zurich says, “When we want to test for thyroid dysfunction we
can check the levels of TSH, T3, and T4. These levels can tell us if the thyroid is overactive or
underactive. We may also test for the relevant antibodies in cases where Graves’ disease is

The best course of treatment for hyperthyroidism is determined by the patient and his/her
physician. In some cases, it is necessary for the patient to have their thyroid gland ablated, or removed. Thyroid hormone replacements are then taken to maintain normal levels. “Treatment for Grave’s disease, or other cases of hyperthyroidism, include anti-thyroid medications, surgery, or radioactive iodine,” said Dr. Zurich.

Observe thyroid awareness month with an appreciation of the important role the thyroid gland
plays in our health and wellness.

Smith, T. J., & Hegedüs, L. (2016). Graves’ Disease. New England Journal of Medicine, 375(16),
1552–1565. doi:10.1056/nejmra1510030

Opioids and the Battle Against Pain

Physicians Health Network Blog

Atit Shah, MD
Advanced Pain Management
2124 Kohler Memorial Dr.
Sheboygan, WI 53081

Medical Education
University of Illinois College of Medicine, Peoria, IL
Advocate Lutheran General Hospital, Park Ridge, IL
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.
Case Western University, Cleveland, OH

Board Certifications
Pain Management
Fellowship Trained in Pain Management

Professional Memberships
American Medical Association
American Society of Anesthesiology
New York State Society of Anesthesiology
North American Neuromodulation Society

The only person who really knows the extent and severity of your pain is yourself. It is my mission and goal to help alleviate your pain and allow you to gain your life back. I believe if we work together, we can accomplish this mission. – Atit Shah, MD

Prescription opioids, such as oxycodone, hydrocodone, and morphine, do more than block pain. Dr. Atit Shah, MD from Advanced Pain Management explains, “Opioids can have undesirable effects. They can depress the respiratory system which can become dangerous and lethal even when not abused or misused. They can also create feelings of euphoria and lead to dependency.” In fact, one-quarter of the patients on long-term opioid therapy will develop dependency.

The risk of prescription opioid abuse varies widely between people and the incidence varies widely between regions of the US. Risk factors for opioid abuse include:
• Obtaining overlapping prescriptions from multiple providers.
• Taking high daily doses of prescription pain relievers.
• A history of mental illness or alcohol or substance abuse.
• Living in rural areas and having a low income.

Achieving effective pain management presents a challenge. Healthcare providers must strike a balance between the chronic pain management needs of their patients and the risks of longer-term abuse or addiction. Dr. Shah says, “While we need to find solutions to the Opioid Crisis, we do not want to stop focusing on how important pain is to the patient and their health. The solution is not less pain management. Rather, it is better pain management.”

One of the pillars of the Department of Health and Human Services’ strategy to combat the opioid crisis is to promote better pain treatment. Such improvements may come from the development of better opioid medications that act on the specific receptors for pain but ignore the receptors that create euphoria and addiction. Other alternatives are pain-blockers from other drug classes such as anticonvulsants, cannabinoids, anti-inflammatory, corticosteroids, antidepressants, or interventional options.

Dr. Shah says, “A pain treatment does not have to completely replace opioid drugs to help. Any treatment that lowers the patient’s need for opioids is a step in the right direction.” Nerve blockades, for example, help patients use fewer opioids immediately after surgery. Modalities such as electrical stimulation, through the skin or directly to the spinal cord, can lower pain perception. Non-drug treatments, such as cognitive behavioral therapy, physical therapy, yoga, or meditation, may also help liberate patients from opioids.

Another important step in combating the crisis is overcoming the stigma surrounding it. Dr. Shah says, “Prescription drug dependency is often perceived as a criminal issue. Rather, opioid dependence should be a medical issue. Stigmatizing it like a criminal issue makes those individuals suffering from opioid dependence less likely to tell their loved ones and seek help.”

The recognition that pain control is integral to good patient care and medical outcomes has led to an explosion of opioid prescriptions. So much so that it has turned into a crisis of abuse, addiction, and overdose. As we search to resolve the crisis we must avoid minimizing pain and the suffering that occurs with inadequate pain control. Dr. Shah says, “The pitfalls of pain management strategies that over-rely on opioids are becoming more and more apparent. As we shift away from overreliance on opioids, we must take care to keep our sights set on pain and the effect pain has on patients and their health outcomes.”


Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82.

Stay on Your Feet This Winter

Physicians Health Network Blog

Falls due to winter conditions are a safety issue but it is important to note that they are also a healthcare issue. This is because the consequences of a fall can be serious, and in the case of the elderly a fall can lead to a loss of independence. The grim truth is that for older adults some falls ultimately lead to death, which we may call fall-related death. The risk of fall-related death increases dramatically after the age of 65. While women are at a greater risk of non-fatal falls, men are at greater risk of a fatal fall. The higher rate of fall-related deaths in men may be more a result of complicating health issues at the time of the fall rather than the severity of the fall itself.

Individuals under the age of 65 are not immune to falls or fall-related injuries. While younger individuals seldom fracture a bone, they can often experience muscle strains or back injuries. These injuries happen when the individual slips and, to stay vertical, jerk their body or quickly reach out to grab hold of a solid object.

Perhaps the most important defense against falls is awareness. Reminding yourself that slippery hazards are to be expected all winter and that walking outdoors may require shorter, slower steps. The fact that 56 percent of all falls occur outside of the home highlights the need to be mindful of the extra hazards in winter. Good fall prevention can mean strategically planning your route in and out of buildings based on the location of ice and snow hazards. Also, consider that some ice, the dreaded clear “black ice” for example, can be quite hard to see or lurks under a fine dusting of snow. Likewise, the short winter days mean there is little sunshine to light our way. We sometimes have to cross slippery surfaces in the dark. A keychain flashlight can be handy tool to spot any ice in your path.

Falls can also be prevented where the rubber meets the road. In other words, by choosing the appropriate footwear. Rubberized soles with a traction pattern can help keep you stable on snow or slush covered surfaces. If you often need to walk through slippery, ice-prone areas consider augmenting your existing grip with spikes or treads that pull over the sole.

The increased risks of winter falls are a concern for everyone but, as mentioned, older adults are particularly vulnerable. One quarter of Americans over the age of 65 falls once a year and it is no surprise that the incidence of falls among older adults increases in the winter. Falls are the leading cause of accidental death in those older than 75. A hip fracture, which occurs in one to two percent of falls, is the number one reason for fall-related hospital stays. Of those individuals who suffer a hip fracture, half must be discharged from the hospital to a nursing home and one quarter die. Here are some known risk factors for falls:
● Greater than 75 years of age
● Living alone
● Prescription drug use – especially the use of multiple drugs
● Use of a cane or walker
● Cognitive impairment
● A history of falling
● Poor vision
● Poor hearing
● Foot problems – such as the type that occur with diabetes
● Environmental hazards (such as snow and ice)

Winter is known for throwing slippery obstacles in our path. Prepare yourself and avoid potentially serious fall-related injuries. If you are at risk of falling or lack confidence outdoors in the winter, see your doctor or physical therapist. These healthcare providers can screen your balance, help you make balance improvements and reduce your risk of a serious fall-related injury.


Yeung, P.-Y., Chau, P.-H., Woo, J., Yim, V. W.-T., & Rainer, T. H. (2011). Higher incidence of falls in winter among older people in Hong Kong. Journal of Clinical Gerontology and Geriatrics, 2(1), 13–16. doi:10.1016/j.jcgg.2011.02.002

December Health Awareness: SAD

Physicians Health Network Health & Awareness Articles


Beating Seasonal Affective Disorder

Winter is cold, long, and dark. This lack of light can have a profound impact on our health. We often use the expression “winter blues” to refer to the familiar dip in mood and energy that comes with these cold, long nights. Mental Health Counselor Karla Willis is familiar with the profound changes in health some of us experience when the seasons change. She says, “When the winter season depresses our mood, energy, and enjoyment with life we call it Seasonal Affective Disorder, or SAD for short.”
Approximately four to six percent of the population experience SAD and the incidence varies with latitude. For example, about one percent of residents in Florida are diagnosed with SAD compared to nine percent in Alaska. Women are at a greater risk than men and teens and young adults are at greater risk than older adults. SAD starts in the fall as the days shorten, and symptoms peak in the winter. “It’s important to remember that Seasonal Affective Disorder is a type of depression. In fact, individuals with a history of depression are at greater risk for SAD,” said Willis.
Behind the scenes, our eyes do more than just provide us with vision. They send messages on special tracts of nerves to various structures in the brain regarding the time of day and the time of year. These messages are based on the type and amount of light stimulating the eyes. Some of these brain structures, such as the hypothalamus, the pituitary gland, and the pineal gland, govern neurotransmitters and hormones that control hunger, energy levels, sleep, and other important functions. The lack of abundant, full-spectrum sunlight in the winter results in less stimulation to these key brain structures and can impair the natural rhythms of hunger, energy, mood, and much more.
Levels of serotonin, a neurotransmitter that influences mood and appetite, are lowered in the brains of SAD sufferers. According to Willis, “A decrease in serotonin levels is shared by SAD sufferers and those individuals with other types of depression.” Melatonin, which influences, among other things, sleep, your body’s clock, and immunity, is produced excessively during SAD. These alternations in brain chemistry result in the characteristic symptoms of SAD which are:

● Decreased energy levels
● Increased sleep
● Increased appetite often with carbohydrate cravings
● Decreased ability to concentrate
● Social Withdrawal

A diagnosis of SAD is made by matching symptoms with the changing seasons; especially if the symptoms repeat for two years consecutively. “Multiple treatments can be effective for relieving the symptoms of SAD. A mental health professional can help patients decide which treatment or combination of treatments will benefit them,” said Willis.
Light therapy is a common and effective treatment for SAD. This treatment is based on the recognition that a lack of full-spectrum light stimulating the eyes leads to the symptoms of SAD. Light therapy involves looking towards, but not directly at, a special light-box for about 30 minutes every morning. These light boxes are very bright but not as bright a sunny day. Measured in lux, a unit of brightness, a typical light-box used to treat SAD produces 10,000 lux. Outdoors on a sunny day may be around 100,000 lux. Medications, often the same drugs used for other forms of depression, are also used to treat SAD. Particularly drugs known as selective serotonin uptake inhibitors which boost those diminished serotonin levels. Cognitive behavioral therapy, which involves identifying negative thoughts and cultivating positive thoughts and healthful behaviors, can be as effective as light therapy in the treatment of SAD. In fact, there is some evidence that cognitive behavioral therapy can help, not only with the current winter symptoms but with future winters as well. Willis says, “Cognitive behavioral therapy can give SAD sufferers tools that will help them minimize the impact of SAD year after year.” Other treatments that may be beneficial for SAD are vitamin D supplementation, herbal supplements, and exercise. It’s important to note that some of these treatments can take three to four weeks before symptoms begin to improve.
“Mental health professionals recognize SAD as a type of depression and we want to spread the word that it should be taken just as seriously,” said Willis. If you feel you are suffering from SAD contact your mental health provider or primary care physician.


Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes. American Journal of Psychiatry, 172(9), 862–869. doi:10.1176/appi.ajp.2015.14101293

Rohan, K. J., Meyerhoff, J., Ho, S.-Y., Evans, M., Postolache, T. T., & Vacek, P. M. (2016). Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder. American Journal of Psychiatry, 173(3), 244–251. doi:10.1176/appi.ajp.2015.15060773

Energy and Alzheimer’s Disease

Physicians Health Network Blog

Imagine this: You have been put in charge of a crew that must dig an underground tunnel across town. The tunnel is going to be narrow, just big enough to stand in. Somehow you have to get the work crew, generators, lights, and tools in and the rocks and dirt out. If you can imagine how difficult this would be then you have some sense of how hard it is for the neurons in your brain to stay healthy. Neurons have long, thin tubes called axons that they use to send messages. To do this they need lots of energy and supplies. But, much like the tunnel project, how do the neurons transport all these materials? Understanding this problem can help us understand Alzheimer’s disease.

There are 5.5 million cases of Alzheimer’s disease in the US. Almost all of these case are in individuals older than 65 years. Two-thirds are women and Alzheimer’s disease is more common in African Americans and Hispanics compared to European descendants. Alzheimer’s disease is a progressive, degenerative neurological disorder. The hallmark symptom of the disease is memory loss but a collection of symptoms occur depending on what brain areas are affected and to what extent. Other symptoms can include personality changes, issues communicating, and an inability to recognize people, including loved ones. As the neurological degeneration progresses the individual’s symptoms worsen.

The human brain is unique. While it makes up only about two percent of our body weight it uses a full 20 percent of our daily energy. In other words, the brain needs enormous amounts of cellular energy to work properly. It also means that the brain has a lot of oxidative stress to deal with. You might think of oxidative stress like the exhaust fumes from an engine. Just like digging that underground tunnel, meeting the neuron’s energy demands presents an engineering problem. If you were in charge of the tunnel project you might set up a railway system to bring gear and workers in and the dirt out. Your neurons do something very similar. They construct a railway system made of microtubules.

With these massive energy requirements, the brain is very sensitive to any changes in the hormonal control insulin has over blood sugar. Alzheimer’s disease starts when the process of taking fuel from the bloodstream and converting it to a usable form becomes impaired. As the brain’s energy production falls behind a set of chain reactions begin. Although, there may be years between the first lag in energy production and the first symptoms. Slowly, the cellular hallmarks of Alzheimer’s disease begin to appear. Those microtubule railways become blocked by what are called neurofibrillary tangles. These tangles are made of a protein called tau protein that is supposed to help build the railways. The tangles block the delivery of nutrients down the long thin axons. The neuron doesn’t get the energy and resources it needs and it becomes stressed. The circuits between neurons that make up memories and perform important brain functions begin to break down. Eventually, the neuron will die. It is here, among the stressed, energy-starved, and dying neurons that oxidative stress increases and chronic inflammation develops. This begins a cycle where more damage to the neurons begets even more damage.

The neurons begin to secret plaques made of beta-amyloid peptides. These plaques build up around the cells and, in the Alzheimer’s brain, they are not properly broken down and cleaned-up as they are in healthy brains. As the disease progresses these plaques further block the flow of resources. As more and more neurons die the brain shrivels. The hippocampus, an area of the brain which is crucial for memory, is hit hard by Alzheimer’s disease. As the hippocampus shrivels it causes memory failure and dementia.

There is no cure for Alzheimer’s disease. The neurofibrillary tangles and the beta-amyloid plaques are often the targets for drug development but, to date, none are effective in fighting the disease. There are other treatments that can address the symptoms only, but unfortunately, these treatments do not stop the overall progression of the disease.

The connection between Alzheimer’s disease and cellular energy production is receiving more and more attention. The term type III diabetes is being used specifically to highlight the role that insulin resistance and impaired sugar metabolism play in the disease process. In the past, when Alzheimer’s disease was less common, it was seen as a stroke of unfortunate luck. Emphasizing the role impaired energy production helps medical professionals and patients reframe Alzheimer’s disease as something that is intimately tied to lifestyle factors. This opens the door to other treatments and preventative measures that involve lifestyle, nutrition, metabolism, and exercise. Afterall, long before symptoms appear the first sign of Alzheimer’s disease is a change in the way neurons use energy. This means that the time to think about prevention is, likewise, long before symptoms appear. Alzheimer’s prevention isn’t just for those who just blew out the candles on their 65th birthday cake. Rather, it becomes one more reason to target lifestyle changes at any age. Here is a list of habits for Alzheimer’s prevention from the National Institutes of Health that are appropriate for people of all ages.

● Exercise regularly.
● Eat a healthy diet that is rich in fruits and vegetables.
● Spend time with family and friends.
● Keep one’s mind active.
● Control type 2 diabetes.
● Keep blood pressure and cholesterol at healthy levels.
● Maintain a healthy body weight.
● Stop smoking.
● Get help for depression.
● Avoid drinking a lot of alcohol.
● Get plenty of sleep.

De la Monte, S. M., & Wands, J. R. (2008). Alzheimer’s Disease is Type 3 Diabetes—Evidence Reviewed. Journal of Diabetes Science and Technology, 2(6), 1101–1113. doi:10.1177/193229680800200619

Kodl, C. T., & Seaquist, E. R. (2008). Cognitive Dysfunction and Diabetes Mellitus. Endocrine Reviews, 29(4), 494–511. doi:10.1210/er.2007-0034

Raichle, M. E., & Gusnard, D. A. (2002). Appraising the brain’s energy budget. Proceedings of the National Academy of Sciences, 99(16), 10237–10239. doi:10.1073/pnas.172399499

November is National Diabetes Month

Physicians Health Network Health & Awareness Articles


November is national diabetes month; a time to promote awareness of the challenges faced by those with diabetes. In 1958 there were just over 1.5 million cases of diabetes in the US. In recent decades that number has steadily, and dramatically, climbed. In 2015 there were 23 million American adults with diabetes. this is a combined total of both type 1 and type 2 diabetes. Of the combined totals, only about 5 percent is attributed to type 1 diabetes. And the rest are type 2. Read more