Q. BRAIN GYM

For those of you who exercise, we can safely assume that you are looking for certain benefits such as increased strength, flexibility, energy and enhanced mood, not to mention good looks. So why is it that many of us donʼt feel the same way about our brain? Why do we assume that the brain requires no enhancement or in the least, some amount of attention? Scientific data clearly document the many benefits of exercising our brain. Henceforth, I will call it “brain gym” for lack of a better term (please let me know if you have an alternative phrase). For this article, we shall remain focused on what is going on inside the skull and the rest of our body. We wonʼt speculate on the connection between the brain and the mind or of any spiritual or religious matters.

The brain, similar to many organs in the body, adheres to the “use it or lose it” dictum. The brain either improves its functions or when left alone, steadily deteriorates over time. Toxins, poor circulation, high blood pressure, diabetes, infections, inflammations and the normal again process cause functional or structural deterioration. So does lack of use. The brain loves to be stimulated with activities such as playing music, problem solving, learning a new language (anyone speak Thai)? Through a process called “neuroplasticity” the brain cells, with repeated stimulation for a specific function, will grow in numbers in certain regions, enhancing performance. London cab drivers have large hippocampus (a primary memory area) due to their extensive memorization of city streets and famous landmarks; violinists have larger brain mass involving the area of brain that deals with hand movements; senior citizens who meditate regularly (45 minutes or more daily) actually add brain tissue in the area of the brain which deals with “executive functions” while non-mediators steadily lose brain tissue in the same area due to the normal “aging” process.

Q. Sleeplessness

Sleeplessness or insomnia is close and dear to many of us. We spend about a third of our lives sleeping and yet we know very little about sleep. For this article, I will focus on the causes of insomnia and its dire consequences and how to remedy the problem. We can have a conversation some other time on the mysteries of sleep.

Sleep is one of the three main pillars of health, the other two being nutrition and exercise.

There are many forms of sleeplessness. We can have difficulty in falling asleep, in staying asleep, waking up too early or unrefreshed when waking up. Since sleep is an integral part of our lives and a major player, we may need to approach it from a fresh perspective. For some reason, early morning routines such as taking a shower, shaving, hair grooming, putting on a make up, perhaps a bit of exercise or stretching and breakfast are a fixed routine and considered not only important but essential to get prepped for the day. And yet, going to bed usually doesn’t command our attention. We get tired, lie in bed and hope to fall asleep. No ritual or preparation takes place. There is no closure for the events of the day. We are about to enter into another realm of which very little is known about. In my opinion, going to sleep requires some amount of consciousness or savoir faire. We can’t expect to have a good nights rest (unless we are teenagers) after overeating and over drinking, as an example. Many other less dramatic instances causing poor sleep are a poor sleeping environment (bed, mattress, ambient noise, lighting, electromagnetic field, etc.); “busy mind” (anxiety, depression, excitement), dehydration (this is a big one, especially in Thailand); medications, drugs and of course jet lag.

Q. Dengue Hemorrhagic Fever

I have two questions for Dr. Bhark:
    1.    In October of 2010 I was diagnosed with Dengue Hemorrhagic Fever.  It was bad enough that I chose to spend close to 10 days in a local hospital.  After about two weeks, my doctors declared me free of the virus based on blood tests. However, the affects of Dengue were anything but gone.  I suffered from severe fatigue for the next full month.  I was working at the time, and it was one of the most difficult things I had to do just dragging myself to work every day.  After about six weeks the fatigue became less severe, but I just did not feel “right.”  I also lost about five kilos of weight over the next few months, and in April 2011 I decided to quit work due to constant fatigue.  It’s now February 2012.  I started feeling better near the end of 2011 and joined a health club.  I’ve been working out consistently, have gained my lost weight back, and I’m planning to go back to work after Songkran.  It’s been very difficult to get my family and friends to understand how tired and fatigued I was for over a year – but it was very real, and very debilitating – it wasn’t just “in my head.”  Can Dengue Hemorrhagic Fever have such a long term effect on an individual?
    2.    I’ve noticed that my blood pressure fluctuates rather extremely.  One day I might visit the doctor and my BP is 115/70.  The next visit it may be normal.  The next visit it may be 160/90.  But every time I visit a doctor and I get a high reading, they immediately recommend high blood pressure medicine.  I think that if I averaged my BP over a period of a year, the “average” would be in the normal range.  But I have a very wide range of BP.  What could cause such a wide range of BP readings?

Dan

Q. Working Out

I would like to comment this month on working out. I hope everyone here in Chiang Mai is delighting in our perfect weather. It is easy to be outdoors, swooned by the song birds, dazed by the brilliant flower blossoms and comforted by the gentle winds and the warm sun. No need to get out early in the morning before the furnace like heat causes a melt down nor do we have to wait until sunset to exercise, exposing us to the hungry mosquitoes during their feeding frenzy or the dogs who are fully alert by now in protecting their turf. So what is the “best” exercise? This question gets asked often by all comers.

Q. Medications

A reader asked me how to obtain Lipitor, a cholesterol lowering drug.

I have only had limited experience with local pharmacists and therefore will make the following suggestions with a caveat.

Yes, Lipitor is readily available as are many brand name medicines. However, prices vary and therefor you need to do due diligence and find a pharmacy you feel comfortable with.

Drugs manufactured in Western countries or elsewhere but under the guidance of the parent company need to meet very high standards of production. Unfortunately, this is not true for drugs coming from some of our neighboring countries. I believe that generic Thai pharmaceuticals are fine, especially if the cost of medication is a consideration. So ask your pharmacist where the drug is manufactured and by whom before making a decision. You will also notice that some brand name drugs are cheaper here than back in the West. The simple reason is that the parent company has subsidiaries in this part of the world. Cheaper brand name drug doesn’t mean that it is fake, however, fake drugs are common, especially on the Web. Fake drugs are not only ineffective but can be quite dangerous. They are usually made with highly toxic chemicals. They can look uncannily real. Therefore it is important to work with a pharmacist whom you can trust. Finally, about 80% of generic drugs are just as effective as the brand name. Therefore, when taking a generic medication, make sure that it is doing whatever it was designed to do. So for example, if you were taking a brand name drug to lower your cholesterol and then switch to a generic med and a follow up cholesterol check reveals a markedly elevated blood level for no apparent reason, it would be possible that the generic med is less efficacious. For this particular article, I will not comment on other means of lowering your cholesterol.

All the Best, Philip Bhark, M.D., FACC

Email: newsletter@chiangmaiexpatsclub.com for a chance to have your health questions published in Expat Newsletter and online at www.chiangmaisos.com/d-o-c

Q. Drug Side-Effects?

Dear Dr Bhark,

Following on from your very interesting talk last Saturday (@ChiangMaiExpats), may I ask you a question. 

Our daughter aged 45, suffered an unexpected ‘cardiac event’ about 18 months ago, following a period of overwork and chronic stress.   

Thankfully she fully recovered after treatment at a leading cardiac hospital in the UK.    Her own GP put her on Simvastatin 40gms, Ramipril 10gms and Congescor 2.5mgs.  Since then there has been a radical and negative change in her personality.  

Have you experienced similar personality changes with patients on statins? 

Q. Alzheimer’s Test?

Dear Dr. Bhark,

Are there valid tests for Alzheimer’s for people over 70? How do you distinguish between dementia and Alzheimer’s?

Al

Dr Philip Bhark – Doctor On Call

Introducing Dr. Philip Bhark who will be offering free medical advice in Expat Newsletter in response to your emails from the December issue onwards.

Philip Bhark, M.D., FACC is a Columbia and Harvard trained cardiologist. He has also worked as a volunteer physician in Korea, Nepal and Tibet. He is currently living in Chiangmai with his wife Isabelle.

Email: newsletter@chiangmaiexpatsclub.com for a chance to have your health questions published in Expat Newsletter and online at www.chiangmaisos.com