Tag: Doctor

Beat your cold weather cravings: 8 effective techniques

The foods you crave are likely to be high in sugar, fats and carbohydrates — such as pizza, chocolate, cake and chips . Cravings can derail your efforts at weight control and may lead to binge eating, but you can learn how to manage them and stay on course with these tips.

  • Enjoy a small portion. Don’t give up these foods. In your overall healthy diet, include a small portion of the less healthy foods you crave. Better to enjoy a square of chocolate than to avoid it altogether.
  • Eat something healthy first. It’s often easier to eat less of the food you’re craving if you’re not ravenously hungry.
  • Keep the food you crave out of the house. Buy the item only when you plan to eat it, or order it at a restaurant.
  • Change your mental picture. When you experience a craving, replace the image of the food with a picture of yourself doing your favorite activity or some other pleasant image.
  • Distract yourself. Food cravings usually pass after 20 minutes. Try taking a walk or talking to a friend.
  • Chew gum. Chewing sugarless gum reduces hunger and cravings for sweet and salty snacks.
  • Get enough sleep and exercise. These habits help lower your levels of the hormone ghrelin, which stimulates appetite. Lack of sleep can lead to food cravings and overeating.
  • Substitute a healthier option. Satisfy your craving for something smooth and creamy with something low-fat or fat-free, such as yogurt, pureed fruit or buttermilk. Eat a piece of fruit as a healthy sweet snack.

Experiment to see which strategies work best for you so that you can control your cravings — not the other way around.

Top 10 stress-relieving tips

It’s a fact of life: Everyone experiences stress. But when it goes unmanaged, daily stress can harm your health and reduce your quality of life. Fortunately, stress doesn’t have to overcome or overwhelm you. Gain control and live better with these stress-reducing suggestions.

  1. Make a list. Write a to-do list, breaking down tasks into smaller steps. Prioritize the items and tackle them one at a time.
  2. Take care of yourself. Get enough sleep and eat a healthy diet. Avoid — or limit — alcohol and caffeine.
  3. Set realistic goals. Don’t expect perfection from projects or people — including yourself.
  4. Mind your schedule. Don’t take on too many responsibilities or agree to attend too many social events. If you’re overwhelmed, eliminate some obligations or share the work.
  5. Talk it out. Call on the support and guidance of good friends and family.
  6. Exercise regularly. Thirty minutes of physical activity a day can help fight stress.
  7. Set aside time every day for stress management. Meditation, deep-breathing exercises, yoga and guided imagery are all good techniques to try.
  8. Have fun. Spend time each day doing a hobby or other activity that you enjoy.
  9. Resolve conflicts. Work toward repairing — or coming to terms with — any broken or difficult relationships.
  10. Visualize success. Imagine how difficult situations might be resolved in a less stressful way.

By managing — and reducing — the stress in your life, you can make better, healthier decisions and improve your overall wellness.

Fresh Puttanesca with Brown Rice

 

 

 

 

Ingredients
4 cups plum tomatoes, ripe, chopped
4 whole olives, Kalamata, pitted, sliced
4 whole olives, green, pitted
1 1/2 Tbsp capers, rinsed and drained
1 Tbsp garlic, minced
1 Tbsp Ultra Premium Extra Virgin Olive Oil
1/4 cups basil, fresh
1 Tbsp parsley, minced
1/8 tsp red pepper flakes
3 cup(s) cooked brown rice

Instructions
In a large bowl, combine tomatoes, olives, capers, garlic, and EVOO.
Add the basil, parsley, and red pepper flakes, stirring to combine.
Cover and let stand at room temperature for 20-30 minutes, stirring occasionally.
Serve over hot cooked rice.

Nutritional analysis per serving
Serving size: About 2 cups
  • Calories: 250
  • Total fat: 6 g
  • Saturated: fat 1 g
  • Trans fat: 0 g
  • Monounsaturated fat: 4 g
  • Cholesterol: 0 mg

Serves 4

 

Recipe makeovers: 5 tips for healthier dishes

Can you count your grandmother’s beloved bread pudding as a healthy recipe? Scrumptious as it may be with four cups of whole milk, one stick of butter and four eggs, you probably wouldn’t find it on a list of healthy recipes. But you don’t have to remove it from your recipe box. Just modify that bread pudding with a few simple change-ups, and you’ve got another healthy recipe for your collection — not a fat and calorie disaster.

Here are five techniques you can use to help create healthy recipes. Remember, these are just some examples. Use your imagination and experiment to find other ways to create healthy recipes — maybe you can even serve them to Grandma!

  1. Reduce the amount of fat, sugar and salt

    You can often reduce the amount of fat, sugar and salt without sacrificing flavor in healthy recipes. Use these general guidelines:

    • Fat. For baked goods, use half the butter, shortening or oil and replace the other half with unsweetened applesauce, mashed banana or prune puree. You can also use commercially prepared fruit-based fat substitutes found in the baking aisle of most grocery stores.
    • Sugar. Reduce the amount of sugar by one-third to one-half. Instead, add spices such as cinnamon, cloves, allspice and nutmeg, or flavorings such as vanilla extract or almond flavoring to boost sweetness.
    • Salt. For most main dishes, salads, soups and other foods, you can reduce the salt by half or even eliminate it. You can reduce salt by half in baked goods that don’t require yeast too. For foods that require yeast, you may need to experiment: Some salt may be necessary for leavening to keep baked goods from being too dense or flat.
  2. Make a healthy substitution

    Healthy substitutions not only reduce the amount of fat, calories and salt in your recipes but also can boost the nutritional content.

    • Pasta. Use whole-wheat pasta instead of enriched pasta. You’ll triple the fiber and reduce the number of calories.
    • Milk. Prepare a dessert with fat-free milk instead of whole milk to save 66 calories and almost 8 grams of fat per cup.
    • Meat. When making casseroles, scale back on meat, poultry or fish and increase the amount of vegetables. You’ll save on calories and fat while gaining more vitamins, minerals and fiber.
  3. Cut back some ingredients

    In some recipes, you can eliminate an ingredient altogether or scale back the amount you use.

    • Toppings. Eliminate items you generally add out of habit or for appearance, such as frosting, coconut or whipped-cream toppings, which are all high in fat and calories.
    • Condiments. Cut condiments, such as pickles, olives, butter, mayonnaise, syrup, jelly and mustard, which can contain a lot of salt, sugar, fat and calories. Use low-sodium soy sauce in a smaller amount than a recipe calls for to decrease the amount of sodium.
    • Cheese. If a recipe calls for 1 cup of shredded cheddar cheese, use 1/2 cup instead.
  4. Change cooking and prep techniques

    There are several healthy cooking techniques that can capture the flavor and nutrients of a well-loved recipe without adding excessive amounts of fat, oil or salt. Try these preparation techniques for healthy recipes.

    • Cooking method. Healthy cooking techniques include braising, broiling, grilling, poaching, sauteing and steaming.
    • Basting liquid. If the directions say to baste the meat or vegetables in oil or drippings, use a small amount of wine, fruit juice, vegetable juice or fat-free vegetable broth instead.
    • Nonstick cookware. Using nonstick pans or spraying pans with nonstick spray will further reduce the amount of fat and calories added to your meals.
  5. Downshift your speed and downsize the portion

    No matter how much you reduce, switch or omit ingredients, some recipes may still be high in sugar, fat or salt. You can help your diet by not rushing through meals and cutting back on the portion size too.

    • Slow down. Eat your meals more slowly to give your body a chance to register the fact that you’re filling up. Put your fork down between bites if necessary. You’ll eat less in the long run.
    • Check portion sizes. Many portions today are so large you may not realize what a true portion or serving is. Train yourself by using smaller plates, spoons and cups. And learn to use common visual cues to understand servings — one serving of whole-grain cooked pasta is about the same size as a hockey puck, for instance.

 

Putting it all together to create healthy recipes

Before plunging ahead with a recipe, look it over and think about what you can change to turn it into a healthy recipe. Make notes of any alterations so that you can refer to them the next time you prepare the recipe. You may have to make the recipe a few times before you get the results you want, but finding the right combination of ingredients — for the desired taste, consistency and nutrients — is well worth the trouble.

Flexibility: Stretch your way to better health

You might be thinking that it’s hard to carve out time in your schedule for exercise, let alone stretching. But most cardio and strength-training programs cause your muscles to tighten. That’s why it’s important to stretch regularly to keep your body functioning well.

Regular stretching:

  • Increases flexibility, which makes daily tasks easier
  • Improves range of motion of your joints, which helps keep you mobile
  • Improves circulation
  • Promotes better posture
  • Helps relieve stress by relaxing tense muscles
  • Helps prevent injury, especially if your muscles or joints are tight

 

Stretching essentials

Keep these key points in mind:

    • Target major muscle groups. When you’re stretching, focus on your calves, thighs, hips, lower back, neck and shoulders. Also stretch muscles and joints that you routinely use at work or play.
    • Warm up first. Stretching muscles when they’re cold increases your risk of injury, including pulled muscles. Warm up by walking while gently pumping your arms, or do a favorite exercise at low intensity for five minutes. If you only have time to stretch once, do it after you exercise — when your muscles are warm and more receptive to stretching. And when you do stretch, start slowly.
    • Hold each stretch for at least 30 seconds. It takes time to lengthen tissues safely. Hold your stretches for at least 30 seconds — and up to 60 seconds for a really tight muscle or problem area. Then repeat the stretch on the other side. For most muscle groups, a single stretch is usually sufficient.
    • Don’t bounce. Bouncing as you stretch repeatedly gets your muscles out of the stretch position and doesn’t allow them to relax, making you less flexible and more prone to pain.
    • Focus on a pain-free stretch. Expect to feel tension while you’re stretching. If it hurts, you’ve gone too far. Back off to the point where you don’t feel any pain, then hold the stretch.
    • Relax and breathe freely.

Don’t hold your breath while you’re stretching.

 

Fit stretching into your schedule

As a general rule, stretch whenever you exercise. If you don’t exercise regularly, you may want to stretch at least three times a week to maintain flexibility. If you have a problem area, such as tightness in the back of your leg, you may want to stretch every day or even twice a day.

Think about ways you can fit stretching into your daily schedule. For example:

  • Do some stretches after your morning shower or bath. That way, you can shorten your warm-up routine because the warm water will raise muscle temperature and prepare your muscles for stretching.
  • Stretch before getting out of bed. Try a few gentle head-to-toe stretches by reaching your arms above your head and pointing your toes.
  • Sign up for a yoga or tai chi class. You’re more likely to stick with a program if you’re registered for a class.

 

What you should know before you stretch

You can stretch anytime, anywhere — in your home, at work or when you’re traveling. But if you have a chronic condition or an injury, you may need to alter your approach. For example, if you have a strained muscle, stretching it as you usually do may cause further harm. Talk with your doctor or a physical therapist about the best way for you to stretch.

Healthy meal ideas for hectic days

Do your intentions to eat well seem to fly out the window when you have a packed schedule? Stay grounded with these simple tips, no matter how long your to-do list is:

 

  • Make an effort to eat as a family at least once a day. A pleasant meal that isn’t rushed promotes family bonding and improves the likelihood of eating a well-balanced meal. Be flexible with timing: You may need to eat dinner early or make a plan to always sit down together just for breakfast to accommodate everyone’s hectic schedule.
  • Cook ahead. When you have time to cook, make a double batch and freeze leftovers for quick meals on busy days. For instance, simmer enough pasta for two days. Serve it hot one night with sauce, then chilled in a salad with tuna and low-fat salad dressing the next.
  • Stock your pantry with foods for simple meals. Good examples are whole-wheat pasta, fresh and frozen vegetables, fresh and canned fruits, 100 percent whole-wheat bread, lean deli meats, salsa, canned dried beans, and low-fat or fat-free yogurt and cheese.
  • Go for health and convenience. Some convenience foods are designed to be healthy and lower in calories. A healthy frozen entree or side dish is an option on busy days. Read labels for calories, fat and sodium. Stock healthy versions of quick foods like instant brown rice.
  • Look for shortcuts. Simplify your meal prep and save time by buying pre-cut fruits and vegetables, precooked meats, shredded low-fat cheeses, packaged salads, and frozen or canned vegetables. There’s nothing quicker than fresh fruit, but fruit canned in its own juice (not sugary syrup) is also OK. Rinse canned vegetables with water to remove excess sodium.
  • Keep a list of simple menu ideas. Recipes that include common staples and take 20 minutes or less come in handy on days when you’re rushed.

 

It always helps if you plan meals ahead, but if your house is stocked with healthy choices you can wing it and still eat well. Remember that healthy eating doesn’t have to be complicated or involve hard-to-find ingredients.

 

By Mayo Clinic Staff.

Grip strength can predict lifespan

How strong you can grip may be a better predictor of future health and longevity according to a recent study published in the British Medical Journal. After accounting for age and a wide variety of other factors, such as diet, amount of time being sedentary, and socioeconomic status, researchers found that muscle weakness—defined by a grip-strength measurement of less than 26 kilograms (57 pounds) for men and less than 16 kilograms (35 pounds) for women—was associated with a higher risk of premature death and a higher risk of heart and lung disease, and cancer.

Researchers in Norway found that those who have excellent grip strength in their 80s and 90s are more likely to live in good health into their 100s. The role of skeletal muscle is often under-appreciated. It not only controls our body movement; skeletal muscle also stores protein and plays a major role in glucose and lipid metabolism.

 

Published July 30, 2018 by Dr. Daniel Thomas, DO, MS

Whole grains vs. regular grains: What’s the difference?

Chances are you eat lots of grains already. But are they the healthiest kind? If you’re like most people, you’re not getting enough whole grains in your diet. Aim to choose whole grains for at least half of all the grains you eat. Read on to learn about the different types and why you should skip refined and enriched grains.

Types of grains

Also called cereals, grains and whole grains are the seeds of grasses cultivated for food. They come in many shapes and sizes, from large kernels of popcorn to small quinoa seeds.

  1. Whole grains. These unrefined grains haven’t had their bran and germ removed by milling; therefore, all of the nutrients remain intact. Whole grains are better sources of fiber and other important nutrients, such as selenium, potassium and magnesium. Whole grains are either single foods, such as brown rice and popcorn, or ingredients in products, such as buckwheat in pancakes or whole wheat in bread.
  2. Refined grains. In contrast to whole grains, refined grains are milled, a process that strips out both the bran and germ to give them a finer texture and longer shelf life. The refining process also removes many nutrients, including fiber. Refined grains include white flour, white rice, white bread and degermed cornflower. Many breads, cereals, crackers, desserts and pastries are made with refined grains, too. These processed foods will not keep your blood sugar levels steady, which is why you will be hungry again soon after consumption.
  3. Enriched grains. Enriched means that some or many of the nutrients that are lost during processing are added back in later.

 

Most refined grains are enriched, and many enriched grains are also fortified — meaning nutrients that don’t occur naturally in the food are added — with other vitamins and minerals, such as folic acid and iron. Enriched grains lack fiber and are not an optimal choice because while they have traces of nutrition, many important vitamins and nutrients are lost during processing.

Choosing whole grains

Eat whole grains rather than refined grains as often as possible. Examples of whole grains include:

  1. Barley
  2. Brown rice
  3. Buckwheat
  4. Bulgur (cracked wheat)
  5. Millet
  6. Oatmeal
  7. Whole-wheat bread, pasta or crackers
  8. Wild rice

 

It’s not always easy to tell which grains are in a particular product, especially bread. For instance, a brown bread isn’t necessarily whole wheat — the color may come from added coloring. If you’re not sure something has whole grains, check the product label or the Nutrition Facts panel. Look for the word “whole” on the package, and make sure whole grains appear among the first items in the ingredient list.

How to enjoy more whole grains in your diet

Try these tips to add more whole grains to your meals and snacks:

  1. Enjoy breakfasts that include whole-grain cereals, such as bran flakes, shredded wheat or oatmeal.
  2. Substitute whole-wheat toast or whole-grain bagels for plain. Substitute low-fat bran muffins for pastries.
  3. Make sandwiches using whole-grain breads or rolls. Swap out white-flour tortillas with whole-wheat versions.
  4. Replace white rice with kasha, brown rice, wild rice or bulgur.
  5. Feature wild rice or barley in soups, stews, casseroles and salads.
  6. Add whole grains, such as cooked brown rice or whole-grain bread crumbs, to ground meat or poultry for extra body.
  7. Use rolled oats or crushed bran cereal in recipes instead of dry bread crumbs.

 

Eating a variety of whole grains not only ensures that you get more health-promoting nutrients but also helps make your meals and snacks more interesting.

Lack of sleep and sitting all day damages the brain

If you are sleep-deprived or if your job has you sitting all day, your brain is being damaged. If both apply to you, that is a double-whammy that no brain can withstand. Regularly getting less than 6 hours of sleep a night can cause the same long-term brain damage as alcohol abuse. Sitting at a desk all day or spending hours watching television damages the brain in a way that can increase the risk of dementia.

Recent research found that getting too little sleep causes the brain to literally eat itself. Specialized brain cells called astrocytes are more active in brains that are sleep-deprived. Astrocytes act like miniature vacuum cleaners, sucking up unwanted cellular debris. While normally this is good, when the vacuuming goes on too long, the astrocytes begin sucking up portions of the brain’s connections called synapses.

Sedentary behavior such as prolonged sitting has been found to be associated with thinning of the medial temporal lobe of the brain. This portion of the brain is crucial to the formation of new memories. Thinning of the medial temporal lobe can be an early sign of cognitive decline and dementia.

 

Published June 18, 2018 by Dr. Daniel Thomas, DO, MS

Exercise & Weight Control

Before you start an exercise program or routine, a thorough medical history and evaluation are recommended so you and your doctor can identify limitations on certain exercise movements. It is highly recommended that you receive proper instructions for performing these exercises before beginning your exercise routine or program. Anaerobic exercise is not recommended for some people with certain heart or orthopedic conditions. Discuss this with your doctor.

Types of Exercise

Types of Exercise

The two basic types of exercise include:

  • Aerobic exercise: any activity involving large muscles, done for an extended period of time. Aerobic exercise is done primarily for cardiovascular fitness and weight loss.
  • Anaerobic exercise: any activity that does not require oxygen for completion of movement. Usually refers to resistance training. Anaerobic exercise is done primarily for increased muscle mass and toning.

Aerobic Exercise

Aerobic exercise has three important parts:

  • Warm-up – three to five minutes of exercise at a lower intensity (for example: speed or grad for treadmill) to warm up your muscles and slowly increase your heart rate
  • Conditioning – aerobic exercise conducted for a specific duration (e.g. 30-45 minutes) in which the target heart rate is achieved and maintained.
  • Cool-down – three to five minutes of exercise at a lower intensity to bring down your heart rate and lessen risk of injury
  • Mode — The type of activity you choose to do. Activities should include those that work the large muscles, such as walking, jogging, swimming, aerobic dance, or cycling. There are many types of exercise you can do. Find an activity you enjoy and will tolerate long term. Recommended: any activity that you enjoy.
  • Intensity — How hard you work for the duration of the activity. Recommended target heart rate: 60% to 80% of your predicted maximum heart rate. (Predicted maximum heart rate = 220 minus your age).

For example: a 45-year old person’s maximum heart rate would be 220-45 or 175; the target heart rate range (60%-80% of maximum heart rate) would be from 105-140 beats per minute. Another way to determine the intensity of your activity is the Rated Perceived Exertion Scale (https://my.clevelandclinic.org/health/articles/rpe-scale-heart-health) (RPE).

Those with heart disease should discuss exercise with their physician. Some heart conditions may require a modified or supervised exercise program. Medications may have an effect on heart rate; therefore if you are taking any cardiac or blood pressure medications, ask your doctor if they have any impact on your target heart rate.

  • Duration – Length of time of the activity. Recommended: 30 to 60 minutes, depending on your goals.
  • Frequency – The number of days per week that you exercise. Recommended: three to seven days per week, depending on your goals.

The American Heart Association (AHA) guidelines call for a minimum of 30 minutes of aerobic physical activity performed at moderate intensity (60%-80% maximum heart rate), either in one continuous period or in intervals of at least 20-minutes duration on most — preferably all — days of the week. This is the amount called for to reduce the risk of coronary disease. It is equivalent to briskly walking at least 1.5 miles per day or raking leaves for half an hour. For weight control, you may need to increase the amount of time you exercise to burn more calories.

Anaerobic Exercise

Anaerobic exercise involves using free weights or machines to build muscle mass and tone.

  • Mode – The activity that you choose to work a particular muscle group.
  • Intensity – The amount of weight you lift during a set.
  • Repetition – A complete movement of a particular exercise.
  • Sets – A group of repetitions. For toning, 12 to 20 repetitions with lighter weights are usually recommended. In contrast, fewer repetitions (such as 8 to 12) with heavier weights are performed to build muscle mass.
  • Recovery – The amount of time you rest in between sets. The recovery ranges from 0 to 180 seconds.
  • Frequency – The number of days per week that you perform strengthening exercises. Strengthening exercises should be performed with a day or two of rest in between workouts.

Set Goals

Exercise advertisements often target simplified exercise routines and spot reduction. Some exercise advertisements sell the belief that one machine will work your entire body and give you the results you need. Some machines are good for cardiovascular conditioning; however, they may not be good for other reasons, such as joint or balance limitations. To establish a proper exercise routine, you need to follow a few basic guidelines.

Before you start an exercise program or routine, a thorough medical history and evaluation are recommended so you and your doctor can identify limitations on certain exercise movements. It is highly recommended that you receive proper instructions for performing these exercises before beginning your exercise routine or program. Anaerobic exercise is not recommended for some people with certain heart or orthopedic conditions. Discuss this with your doctor.

Set goals

A complete exercise program requires three components:

  1. Stretching – to enhance flexibility of your joints and limit injury
  2. Aerobic or conditioning – to help you lose weight and improve cardiovascular fitness
  3. Anaerobic exercise or toning – to help you build or tone muscles

When setting goals, it is important to design a program that you can do in a schedule that you will definitely keep. Look at your calendar and schedule in your exercise sessions. You do not have to do all three components of the exercise program every day, but to lose weight the most important component will be aerobic conditioning. If you need to start by exercising in 10-minute increments, that’s OK. Every week or so, your goal will be to increase the amount of time you exercise until you are exercising at least 30 minutes per session.

Track Success

Exercise advertisements often target simplified exercise routines and spot reduction. Some exercise advertisements sell the belief that one machine will work your entire body and give you the results you need. Some machines are good for cardiovascular conditioning; however, they may not be good for other reasons, such as joint or balance limitations. To establish a proper exercise routine, you need to follow a few basic guidelines.

Before you start an exercise program or routine, a thorough medical history and evaluation are recommended so you and your doctor can identify limitations on certain exercise movements. It is highly recommended that you receive proper instructions for performing these exercises before beginning your exercise routine or program. Anaerobic exercise is not recommended for some people with certain heart or orthopedic conditions. Discuss this with your doctor.

Keep track of your success

There are several ways to monitor your success:

  • Improvement in endurance – keep an exercise diary. Note changes in how your feel with your exercise, such as: being able to go farther, having to increase the intensity of the activity to achieve your target heart rate, feeling less short of breath, etc.
  • More room in your clothes – you should feel better in your clothes. They should fit better or you may notice they are getting bigger (you are getting smaller!).
  • Keeping measurements – Keeping records of your weight or inches may be helpful to track your success. However, some people get discouraged if they do not see big changes. While your fat level may be decreasing, you may be increasing in lean body mass. Since muscle weighs more than fat, it may appear that you are not losing weight, but maybe even gaining weight. Use other measurements for success instead of weight loss such as toner legs and arms, decreases in waist, hip or arm measurements, increased energy levels or improvements in your overall health.

What is a body composition test?

A body composition test is a way to determine your current percentage of body fat. It is also a way to track progress during your exercise program. A body composition test is more accurate in determining your ideal body weight. The ideal range for females is 18 to 26% body fat. The ideal range for males is 12 to 17% body fat.

When to Call the Doctor

Exercise advertisements often target simplified exercise routines and spot reduction. Some exercise advertisements sell the belief that one machine will work your entire body and give you the results you need. Some machines are good for cardiovascular conditioning; however, they may not be good for other reasons, such as joint or balance limitations. To establish a proper exercise routine, you need to follow a few basic guidelines.

Before you start an exercise program or routine, a thorough medical history and evaluation are recommended so you and your doctor can identify limitations on certain exercise movements. It is highly recommended that you receive proper instructions for performing these exercises before beginning your exercise routine or program. Anaerobic exercise is not recommended for some people with certain heart or orthopedic conditions. Discuss this with your doctor.

When to call the doctor

If you have any of the following symptoms while exercising, stop the activity and rest. If the symptoms do not go away, call your doctor:

  • Heart palpitations (feeling of “skipped” heart beat or irregular heart beat)
  • Chest pain
  • Increased shortness of breath
  • Dizziness or lightheadedness
  • Pressure or pain in your chest, neck, arm, jaw or shoulder
  • Weakness
  • Unexplained weight gain or swelling (Call your doctor right away)

 

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