Melatonin for Sleep

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Melatonin is a hormone made by the pineal gland in the brain that controls the sleep/wake cycles.  Our body has an internal clock that dependent on the time of day will control how much melatonin is produced.  As insomnia can be a common symptom among patients, one of the recommended treatments for the often requested “natural” alternative is the dietary supplement melatonin.

Studies suggest that melatonin supplements may help people with disrupted circadian rhythms (such as people with jet lag or those who work the night shift) and those with low melatonin levels (such as some seniors and people with schizophrenia) to sleep better.  Melatonin supplement doses can range from 0.3 mg to 80mg.

Melatonin is a dietary supplement and therefore it is not federally regulated.  Thus the dose listed on the bottle may not be congruent to the dose contained inside.  The timing of the dose can also be tricky as some sources recommend taking Melatonin up to 30 minutes before sleep while others suggest increasing the time by 30 minutes to as much as 6 hours to have an optimal effect on shifting the internal biological clock.

Melatonin has been found to be more effective on people that have already natural low levels of melatonin such as the elderly.  Thus it is recommended that it be taken in the day time when low internal levels of melatonin already exist.  It has also been found that the best method for delivery of melatonin is sub-lingual (under the tongue) or trans-dermal (through skin usually creams or patch) for better absorption.

All in all, the effectiveness of melatonin in treating insomnia is questionable and very individual.  It is good to be aware that beta blockers and anti-depressants can suppress or reduce melatonin levels and thus may impact the effectiveness of the supplement as well.  If insomnia becomes a chronic issue, it is recommended that you see your primary care provider for evaluation and treatment.
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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Malignant Melanoma

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What is melanoma?  Melanoma is the deadliest skin cancer. The incidence of melanoma has more than tripled in the white population in the past twenty years and with this increase, the number of deaths. This truly can be a deadly disease and great diligence is needed to avoid it as well as to discover it early. The good news is that melanoma is uncommon in children ( but it does exist!)

                                     

 

Who is at risk of getting it?  The risk factors for developing melanoma are both environmental as well as genetic. There is an interplay between these two factors. Males are more at risk; lower extremity lesions (skin abnormalities found on the legs and/or feet) were more common in non-white groups. There is overwhelming evidence of the association between melanoma rates and UV exposure (mainly associated with being in the sun). This is more true for exposed areas of the skin to the sun (sorry sun lovers!). The bad news is that bad sunburns even in childhood or adolescence increase the risk of melanoma. The data leans more toward intermittent intense sun exposure, in other words the occasional weekend sunburn from all day at the beach.  Also, geography plays a role. The farther from the equator and the farther south increases the risk. If one has had a diagnosis of melanoma already, reducing the sun exposure recreationally really does help decrease the odds of getting a second melanoma. 

As noted, it is interesting that the pattern of sun exposure is unique to the risk of getting melanoma. This tends to be associated with intense, intermittent sun exposure and frequently occur in areas exposed only sporadically such as the back in men or the legs in women. Melanomas of the head and neck are more common in outdoor workers. Parents, it is REALLY important to know that five or more severe sunburns in childhood give an estimated twofold greater risk of developing melanoma. 

Most sunscreens with sun protective factor( SPF) will protect against UV-B and far less against UV-A. Unfortunately, there is no good data to prove sunscreens really protect against getting melanoma or any other skin cancer.

What about tanning beds?  The hot topic is tanning beds. Technically, melanoma is more highly associated with UV-B but there is also strong data linking this cancer to UV-A  which means patients using tanning beds and those treated with puva light therapy for psoriasis at an increased risk. The risk seems worse with the newer high speed, high intensity units.  So, like a good doctor, I discourage the use of tanning beds, no matter what! If you want a tan, perhaps the best idea is the self-tanning lotions with DHA. It will help you look brown without the UV damage to your DNA.

What about moles?  There are studies from Australia showing that the number of moles(or nevi) may be associated with increased risk. Someone with 50-100 moles is more strongly associated with melanoma risk ( up to 5% increase). It is very important to understand that if you’ve had a melanoma, you are greater risk of getting a second one. Thus, get your skin checked!

Be on the outlook for atypical moles. What is atypical?  These are larger than the common mole(4-12MM); different colors( shades of tan or brown and pink or dark); some notched borders. Atypical moles have a higher risk of developing melanoma.  If you have a funny looking mole, a dark mole, a new mole, a mole that has changed in its appearance, a lot of moles, or a family history of skin cancer, get a skin check up.

Even if these risk factors don’t apply, it is still a good idea just to get a skin check, period.

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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High Cholesterol and Risk of Heart Disease

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Hypercholesterolemia refers to increased levels of lipids (or fats) in the blood, which includes cholesterol and triglycerides. High cholesterol does not make you feel bad, but it can significantly increase your risk of developing  heart disease, which is also called coronary heart disease.  High cholesterol can lead to hardened arteries of the heart.  These hardened arteries can be a cause of chest pain or heart attack or both. Because of the risk of this happening, treatment for high cholesterol or high triglycerides is usually recommended. 

One type of cholesterol is LDL cholesterol, known as bad cholesterol, and it is the most accurate predictor of coronary disease, i.e. the higher the number, the more your risk of coronary disease. If you have had a heart attack or another significant vascular event, such as a stroke, your LDL goal should be less than 70. Otherwise anything less than 130 is optimal.

Other risk factors:  Once you are aware of your cholesterol numbers, there are some other factors that also affect ones risk of coronary disease (heart disease).  Other factors that can increase your risk for coronary disease include: cigarette smoking; high blood pressure; family history of heart disease( usually males younger than 55 or females than 65); males; and increasing age.

As well there are certain diseases that increase the risk of complications with coronary disease. Some of these are: Diabetes, type I and 2; symptomatic carotid artery disease—like stroke or TIA; peripheral artery disease; abdominal aortic aneurysm; and kidney disease. 

Do I need treatment? The decision of who gets treatment for cholesterol and at what cholesterol number is treatment recommended is confusing at best for the public. This blog will give the ACP (American College of Physicians) guidelines and a table to determine your own level of risk. The ACP recommendations are based mostly upon the LDL cholesterol and the number of cardiac risk factors as noted above. 

It is important to note that the ACP considers diabetes, carotid disease, aortic aneurysms and peripheral artery disease as heart disease equivalents (in other words equal to heart disease. The others such as smoking, high blood pressure and age are considered major risks, but not equivalents.

If two or more risk factors other than high LDL are present in a patient without heart disease (or an equivalent such as noted above), the ten year risk of developing heart disease is calculated by a risk table( see below).

NOTE:  If you have 0-1 risk factors your 10 year risk is less than 10%. 

Adapted from Adult Treatment Panel III at http://www.nhlbi.nih.gov/ The point total is determined in each category and the 10-year risk determined in the bottom row.

NOTE: These risk estimates for the development of coronary heart disease do not account for all important cardiovascular risk factors. Not included are diabetes mellitus (which is considered a CHD equivalent), family history of CHD, alcohol intake, and the serum C-reactive protein concentration.

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Estimate of 10-Year Risk for Coronary Heart Disease
Framingham Point Scores

Estimate of 10-Year Risk for Men

Framingham Point Scores by Age Group

Age	Points
20-34	-9
35-39	-4
40-44	0
45-49	3
50-54	6
55-59	8
60-64	10
65-69	11
70-74	12
75-79	13

Framingham Point Scores by Age Group and Total Cholesterol

Total Cholesterol	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
<160	0	0	0	0	0
160-199	4	3	2	1	0
200-239	7	5	3	1	0
240-279	9	6	4	2	1
280+	11	8	5	3	1

Framingham Point Scores by Age and Smoking Status

	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
Nonsmoker	0	0	0	0	0
Smoker	8	5	3	1	1

Framingham Point Scores by HDL Level

HDL	Points
60+	-1
50-59	0
40-49	1
<40	2

Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BP	If Untreated	If Treated
<120	0	0
120-129	0	1
130-139	1	2
140-159	1	2
160+	2	3

10-Year Risk by Total Framingham Point Scores

Point Total	10-Year Risk
< 0	< 1%
0	1%
1	1%
2	1%
3	1%
4	1%
5	2%
6	2%
7	3%
8	4%
9	5%
10	6%
11	8%
12	10%
13	12%
14	16%
15	20%
16	25%
17 or more	30%

Estimate of 10-Year Risk for Women

Framingham Point Scores by Age Group

Age	Points
20-34	-7
35-39	-3
40-44	0
45-49	3
50-54	6
55-59	8
60-64	10
65-69	12
70-74	14
75-79	16

Framingham Point Scores by Age Group and Total Cholesterol

Total Cholesterol	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
<160	0	0	0	0	0
160-199	4	3	2	1	1
200-239	8	6	4	2	1
240-279	11	8	5	3	2
280+	13	10	7	4	2

Framingham Point Scores by Age and Smoking Status

	Age 20-39	Age 40-49	Age 50-59	Age 60-69	Age 70-79
Nonsmoker	0	0	0	0	0
Smoker	9	7	4	2	1

Framingham Point Scores by HDL Level

HDL	Points
60+	-1
50-59	0
40-49	1
<40	2

Framingham Point Scores by Systolic Blood Pressure and Treatment Status

Systolic BP	If Untreated	If Treated
<120	0	0
120-129	1	3
130-139	2	4
140-159	3	5
160+	4	6

10-Year Risk by Total Framingham Point Scores

Point Total	10-Year Risk
< 9	< 1%
9	1%
10	1%
11	1%
12	1%
13	2%
14	2%
15	3%
16	4%
17	5%
18	6%
19	8%
20	11%
21	14%
22	17%
23	22%
24	27%
25 or more	30%

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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