Evidence based medical wellness for active people from a doc who walks the walk

April 22, 2017
by PookieMD

Oral Turmeric for knee pain–safe? helpful?

I have been taking a capsule of raw turmeric (smells icky!) every couple of days or so to see if it helps with my knee pain.  My operated knee is always stiff, and it didn’t help to mess up the MCL recently.  Since I am taking  the turmeric, it seemed reasonable to see if the stuff actually works!

I hunted around the internet, and there is a good article (click here to read) looking at various treatments of osteoarthritis.  The article reviewed 11 studies on turmeric, and all but one showed decreased pain and improved function with oral turmeric use.  One study compared turmeric taken at a one 500 mg tablet 4 times per day with ibuprofen (two 200 mg pills taken two times per day.) Patient that took the turmeric had decreased pain, especially with stair walking or climbing than those in the ibuprofen group.

Turmeric appears to be safe taken in oral form.  (I did read a case where a patient received an IV injection and died, so I would not be doing this!) According to WebMD, oral turmeric is “likely safe.” Side effects of the oral form are minimal, but can include diarrhea, nausea and stomach upset.  However, turmeric may prolong bleeding, and so should not be used with medications like aspirin, or warfarin.

SO, yeah, I take it. It’s safe, it likely doesn’t hurt anything, and I’m hoping it will help with my dang knee stiffness! I haven’t been diligent about taking it frequently enough, so that could impact my results.  I feel like it makes me sleepy, but I didn’t notice that listed as a side effect, so it’s probably just me.

Any one out there with experience with turmeric?

My strong smelling turmeric capsules.

Back of bottle, listing mgs.




February 24, 2017
by PookieMD

Friday Inspiration: adult playgrounds, tiny dancers, and Tools of Titans.

Check out some fun and inspirational pix, videos and a book recommendation to get you started on a great weekend!

I live across the street from an elementary school, and occasionally go over to swing on the monkey bars when school is out. I also used a tennis ball and a broken “chuk it” ball thrower to play a complete round of golf on the school grounds one summer afternoon with my 19 year old daughter.  (Fortunately for me, she enjoys my shenanigans.) Believe it or not, there are adult playgrounds. (I am referring to G rated ones, for pity’s sake!) How cool would it be to have one of these next door?

Playground  looks like fun for everyone!

Cool! Bring it on!







Next, a great video that shows beautifully how sports, music and dance are open to all.

Lastly, a book recommendation. I have been reading Tools of the Titans, by Tim Ferriss.  I get a little Ferrissed out as he is so ubiquitous on line, in pod cast interviews and in print media,  but none the less, enjoyed it.  I am most taken with the first section, which he devotes to fitness.  I am not thrilled with his emphasis on LSD, and other mind altering drugs, so be forewarned he goes in to the supposed beneficial uses of these drugs in a couple of sections.  He does have some theories and experiments, like underwater work outs that could be interesting. (If you do this you have got to tell me about it!!)  And I have to say, I am a big fan of sauna/cold shower/sauna/cold shower, repeat, which I started doing after reading about it.

Tools of Titans. The section on “healthy” is worth the read.

And for those who care, Superbowl weekend, I did my favorite double black at Vail–Prima (twice!).  It was my first double black in three years, thanks to the pesky knee surgeries.   It was bittersweet, as usually our daughter Tat  is with us, but now that she is a big college girl she wasn’t there.  My hubby was suitably impressed (kind of  -“I knew you could do it, duh.”)

Get out and have some fun! Life is short, so play hard!!!




February 22, 2017
by PookieMD

Should you wear minimalist running shoes?

I love my Hoka “clown shoes” (that’s what my husband calls ’em.)  They are ugly as sin, but my half artificial knee seems to like them.  My physical therapists aren’t crazy about them, and there is a new study looking at runners that wear minimalist running shoes with out all the cushion of the Hoka that says they may be right.

My current clown shoe, the Hoka Stinson, ugly as sin!

Hanna Rice, PhD, who works at Harvard Running Center (who knew Harvard had a running center?), and pals studied 28 runners. (Click here to read the article.)  They wore either regular running shoes or “minimalist” running shoes. As you may know, for a while barefoot running in glove like “shoes” was the rage , but went out of favor because of injuries. Dr. Rice studied runners stride and noted whether they landed on their heels (“rear foot strike”) or on the front of their foot (“fore foot strike.”) She then had them run in a usual running shoe (Nike Air Pegasus) and looked at how much force  occurred to the leg when runners ran with a heel strike or a fore foot strike.  She then had the runners wear a “minimalist” shoe and looked at the total force that the leg received.

In the usual cushioned shoe, the leg received the same force whether the runner used a fore foot strike or a heel strike.  This means the shoe equalized the force no matter what type of strike the runner used.  However, when she looked at runners wearing the “minimalist” shoe, those with a forefoot strike encountered lower total force to the leg than the when wearing the usual shoe.

So what do we take away from this? Well, a couple of things before we all run out and buy some inov-8 TM BARE–X–200 shoes. First, this was a small study, only 29 people, with just seven women. Second, the key was that if the runner already had a forefoot strike, they would encounter less force when using a minimalist shoe.  However, those with a rear foot strike did not experience lower forces when running in a minimalist shoe. Lastly, we are assuming that lower force transmitted to the leg leads to less injuries.


  1. Get your gait analyzed. If you have a forefoot strike, using the minimalist shoe could decrease injuries.
  2. If you have a rear foot strike, you would have to change your running style to a forefoot strike for this to have any benefit.  Otherwise, you will likely encounter more injuries if you use the minimalist shoe.
  3. If you do change to minimalist shoes, do so gradually and with guidance.  (I.e. with a coach!)

Let me know if you try them out.

The minimalist Bare X 200 running shoe

The traditional Nike Pegasus running shoe

January 11, 2017
by PookieMD

An Exercise Prescription for Depression

You know I believe that exercise helps almost all maladies, and it definitely falls in to my “it certainly isn’t harmful” doctrine.  But there is great proof that exercise can be helpful for depression, and can be useful with and with out medications to treat depression. It also amazes me that insurance will pay hundreds of dollars for prescription medications, but not for gym memberships. But enough this is not a rant about insurance!  Instead, let’s look at the facts, and develop a plan as to how much exercise is needed.

Nearly 10% of Americans will have depression at any given time, with women more likely to suffer from depression. The rate of depression in the United States is not improving, (same with Canada.) Interestingly, the more time people spend watching television, or on the computer, the more likely they are to suffer depression.  It may be because more screen time = less exercise! Multitudes of studies have shown that exercise improves depression! For the grand daddy of ’em all, click here to read a scientific summary of the data.

So what is the exercise prescription?

  • Type: Aerobic exercise
  • Frequency: 3- 5 times per week
  • Intensity: 40-85% of maximum heart rate. (Higher intensity improved depression the most.)

Caveat: anything is better than nothing!  Start by walking up the stairs, around the block, or with a friend.  To be cliche, Just Do It!

Excellent reference: Scientific American Mind, January/February 2017.


For more information, check out the Jan/Feb 2017 edition of Scientific American Mind

December 16, 2016
by PookieMD

Friday Inspiration: Christmas Edition

Sorry I have been remiss with the inspiration.  But to make it up for it, here is some really fun stuff, guaranteed to lift you up! Love you all, and please love on each other, because that is what it is all about!!!!

First, a clip from my most favorite holiday movie “It’s a Wonderful Life”.

Next, a clip from the best animated Christmas movie ever, “Rudolph the Red Nosed Reindeer”.

Last, an early present I bought my self — Game Changers, The Unsung Heroines of Sports History, by Molly Schiot.  This book is a coffee table book about the famous and not so famous women that have changed sports. For instance, it profiles Edith Green, the “Mother of Title IX”, and Gretchen Fraser, the first AMERICAN ever to medal in an alpine ski event at the Olympics.  Yup, she was not the first woman, but the first American to medal!  Fraser received  a silver medal in the 1948 Olympics in St. Moritz, Switzerland.  The book has great pictures and biographies of many women in many different sports and is a luscious, no calorie treat!

Game Changers, a luscious Christmas treat!












December 1, 2016
by PookieMD

Will a Fitbit help you lose weight? Probably not, but here are some tips.

I wear a Fitbit Surge on my wrist, and have had various wearable devices.  I particularly like the Surge because it tracks heart rate (but not very well as I have talked about previously.) A lot of people wear these devices because they are fun, and are supposed to make us exercise more and lose weight.

Whoa there cowboy! A study in JAMA (click here to read the article from the September 20, 2016 edition) showed that having obese young people use “wearable technology” did not help them lose weight. In the study there were two groups, one that didn’t wear devices and one that did.   The group that DIDN’T wear the devices lost MORE weight. The article doesn’t really go into why the wearables didn’t help.  But if you read the article carefully, there are some lessons as to what makes people lose weight.

Here is what works:

  • Weekly texts reminders to work and eat healthily
  • Monthly meeting with a weight loss counselor
  • Group counseling sessions
  • Food diary.

I am keeping a food diary now, and boy does keep me honest!  (Sigh.) When I exercise, I watch the heart rate monitor, but tend to believe the heart rate I get on the bicycle is more reliable.

I am not throwing out my Fitbit just yet.

And if you want me send you a text to remind you to exercise and eat less, let me know!!


November 23, 2016
by PookieMD

Weight training for beginners: what the ACSM recommends

I have been in the weight room almost all my life, doing what ever exercises seemed fun.  (Hmm, probably not very effective!)  I read lots of magazines, my favorite is FitnessRX. (If you go the website, please ignore all the supplement ads.  I am in no way advocating for unproven supplements!!!)  All the magazines seem to focus on either 1) hard core lifters with biceps the size of Popeye 2) 20 somethings in leggings and sports bras that are undoubtedly fitter, prettier, smarter, healthier, and wealthier than I ever was or will be or 3) “elderly” patients sitting on exercises balls lifting one pound weights.  I thought it would be helpful to know what the garden variety new comer to weights should do.

Luckily, the American College of Sports Medicine came to the rescue! In the September/October edition of ACSM Health and Fitness Journal, they include the following program of resistance training for most adults:

  • Frequency: train every muscle group 2 -3 times per week
  • Intensity: 60-70 % of 1 rep max.  What you say? Conservatively, start with a weight you can lift comfortably for 10 -15  times in a row.  (This is a “set”.)  Once you can do that comfortably for several sets, increase the weight by 5%.
  • Do each exercise for 2- 4 sets, each set containing 10 -15 repetitions.

Okay, fair enough.  BUT WHAT EXERCISES TO DO? ACSM gives the following programs:

Machine exercises for beginner exercisers:

  • leg press
  • chest press
  • seated row
  • lateral raise
  • abdominal
  • low back
  • leg curl
  • shoulder press
  • pull down.
  • They also recommend let extension, but given all my knee issues, I just couldn’t include it.

Free weight exercises for beginning exercisers, using dumbbell or kettle bell:

  • squat
  • bench press
  • bent over row
  • lateral raise
  • biceps curl
  • triceps extension
  • stationary lunge
  • step up
  • shoulder raise
  • pullover.

If you are a beginner, or coming off a period of inactivity or injury, or chronic illness, check with your doctor for medical clearance.  A personal trainer can show you the basics, and of course physical therapists can bring you back from injury stronger than before!  Maybe I will see you in one of the sports mags!

Last, a great resource to see exactly how the exercises are done is by watching the Revo Physiotherapists demonstrate them on  YouTube.  Check out the bent over row below.  You can go to YouTube and search for Revo, and lots of helpful videos pop up. That’s Bryan Briggs, in the video below– the PT that I see, demonstrating proper form on the bent over row.



November 16, 2016
by PookieMD

Does coffee raise blood pressure?

I love coffee, and so do many patients.  A patient I was taking care asked if coffee was making her blood pressure harder to control. Great question: does coffee raise blood pressure? If so, who should avoid caffeine?

I dug in to the research (click here to read it) to find some answers.  As is most things in medicine, the answers are clear as mud (get the pun?!). None the less, here ya go!

  • Caffeine, in the quantity of 200-300 mg (1 1/2 to 2 cups of caffeinated coffee) caused blood pressure to go up for about 3 hours after consumption in those with high blood pressure. The systolic (top number) blood pressure went up by about 8 in the first hour after drinking coffee, and the diastolic blood pressure (bottom number) went up by 6 .
  • The paper recommends that patients with poorly controlled blood pressure avoid caffeine. However, those with well controlled blood pressure could drink 1-2 cups of coffee.
  • People with out high blood pressure also experience an increase in blood pressure after drinking caffeine.
  • Coffee may contain some substances (chloragenic acids) that are helpful to decrease blood vessel inflammation and some substances that are harmful (hydroxyl hydroquinone).  There are not strong recommendations available on drinking coffee with and with out these substances.

So what do I do? I drink one latte in the morning that is half decaf.  The rest of the day I drink decaf (much to the disbelief of my husband!)

My morning half caf!

My morning half caf!

November 11, 2016
by PookieMD

Friday Inspiration: Veterans Day Edition.

This Friday Inspiration is for the Men and Women that have served our country.  From the bottom of my  heart, I say thank you and God bless!

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.” 
—John F. Kennedy

Jonathan Mendes is a 96 year old former bomber pilot who fought in World War II and Korea.  He also went to Dartmouth, and Harvard.  He ran the New York Marathon this year, his 16th. As Runners Magazine said, “he is a certified badass.” You betcha!

96 year old Jonathan Mendes crosses the New York Marathon finish line

96 year old Jonathan Mendes crosses the New York Marathon finish line.

Lastly, this has been a tumultuous week on many fronts.  Please examine how YOU can make a difference in America.


November 10, 2016
by PookieMD

Why you and I aren’t Olympic Athletes, or Tom Brady

I was having a rough day yesterday, and was sharing my middle aged angst with my friend. I told her that as a kid, I wanted to go to the Olympics in figure skating (didn’t happen), and that I wanted to be a physician since I was five. Not only that, I wanted to be a doctor with impact, like the surgeon general. (Still waiting for that call!) She pointed out that it was no wonder that I felt I had failed in life if I persisted in comparing myself to Olympians and famous physicians. I argued back that these people are my peer group. (Yup, I said that!)

Not quite true.

What does it take to become an Olympian or Tom Brady for that matter?

  • Genetics. It certainly helps to be tall if you want to play basket ball, and to have the ACTN3 gene if you want to be a sprinter.
  • Childhood trauma.  Many super-elite athletes experienced a major setback as a child. Shortly after the negative event, many found sports.  Sports provided a positive outlet, which then translated into the increased effort by the young athlete. (I guess growing up in the picturesque foothills outside of Boulder to a middle income family doesn’t count.)
  • Focus–no matter what.  Super-elite athletes can focus on the task at hand, blocking everything out.  This is an acquired skill, that gets better the more it is practiced.  (I was such a headcase while skating, that one of my coaches told me he had to over prepare me because my performance would suffer so much in competition. This got better with sessions with a sports psychologist, but I never completely managed my nerves.)
  • Obsessive need to win.  The super-elite focus on winning to the exclusion of fortune, fame and happiness.  They are willing to sacrifice almost anything to win.  They also focus more on beating themselves than beating rivals.
  • Good coaching.  Have a supportive coach that fosters competence and believes in the athlete goes a long way.

Which brings up the question: what am I willing to do to become a better athlete, doctor, human?

Much of this post if from Scientific American Mind, July/August 2016 edition.  Click here to view.

Olympic Rings

Olympic Rings