Losing Weight

Almost everyday I hear the question, “Dr. Endo, what is the secret to losing weight?”  Sorry to disappoint you, but I have no secrets.  Losing weight takes work and effort, with incremental changes that eventually get incorporated into your daily habits.  The list below is taken from the National Weight Control Registry.  These are habits of people who have lost an average of 67 pounds and maintained the weight loss for an average of 5 years!  Hopefully this list can help you on your way to a healthier you!

Individuals who lost the weight AND maintained the weight loss made the following PERMANENT changes to their diet, physical activity levels and weekly routine:

1)  Being physical active for 60 to 90 minutes every day

2)  Eating a lowfat diet the is rich in complex carbohydrates (ie: fruits and vegetable)

3)  Eating a HEALTHY breakfast everyday

4)  Weigh themselves at least once a week


Bedtime Leg Cramps

Leg cramps during the night are such a common concern.  They occur in up to 60 percent of adults with a slight predominance in women.  Unfortunately, the likelihood of developing leg cramps increases with age.  The difficult thing about leg cramps is that at this day and age the cause is uncertain. The cramps primarily may be caused by muscle fatigue, but nerve dysfunction may play a role as well.

This may surprise you, but neither exercise-related cramps nor night time cramps have been associated with dehydration or abnormalities in potassium, sodium and magnesium.  However, certain medications and medical conditions can be associated with leg cramps.

So, if you have them, what can you do for them?  Well, that truly is a black box for now because no current treatments for leg cramps have been proven both safe and effective.

Stretching and deep tissue massage are harmless and may be helpful.  Some evidence indicates that mild exercise such as a few minutes on a stationary bicycle of treadmill before bedtime.

Although no medication can be recommended for routine treatment of leg cramps, vitamin B12 complex and possibly magnesium may be considered for some people.  For some, a brief trial of the muscle relaxant carisoprodol, diltiazem, verapamil, gabapentin, or norflex may be warranted.

Quinine was the go-to medication for leg cramps for years.  However, the USDA issued a warning in 2010 regarding the many potential adverse interactions with quinine and other medications.  It was clear that the potential serious adverse effects of quinine outweighed its modest benefit with leg cramps.  Some of the more serious effects of quinine can occur unpredictably, and even with only the first dose.  So, don’t risk it!

Give some of these suggestions a try and let us know what seemed to benefit you the most.  Thanks for visiting with us!

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Posted by on November 28, 2012 in General



Nosebleeds are so very common, and as our patients have demonstrated over the years, there are a myriad of approaches in attempts to stop and treat them – stuffing nose with tissue, ice to the neck, ice to the nose, wet cloth on the forehead, pinching the bony bridge of the the nose, and so on and so on…

Hopefully this blog will shed some light on the common nosebleed, and when and when not to worry about them.

Nosebleeds can be caused by many conditions including trauma, infections, polyps, foreign bodies, dry mucous membranes or climate, medications and air conditioning. Most nosebleeds occur in the front of the nose. It is because of this location that most nosebleeds can be controlled by pinching the nostrils gently (NOT the bony part of the nose) and continuously. Do this for at least 10 to 20 minutes. The reason for this long continuous pressure is that you must hold it long enough for the blood to clot. If during that 10 to 20 minute time period, pressure is released, the process may have to be started again. The nosebleed may stop by itself or quit with pressure.  In cases where the nose bleed is profuse and cannot be controlled within the hour, a visit to the Emergency Room may be in order and possibly a  need for concentrated heating ( cautery)  of the bleeding area or application of  pressure from nasal packing.


  • If your nose was packed, try to maintain the pack inside until your physician removes it. If a gauze pack was used and it starts to fall out, gently replace or cut the end off. Do NOT cut if a balloon catheter was used to pack the nose. Otherwise, do not remove unless instructed.
  • Avoid blowing your nose for 12 hours after treatment. This could dislodge the pack or clot and start bleeding again.
  • If the bleeding starts again, sit up and bending forward, gently pinch the front half of your nose continuously for 20 minutes.
  • If bleeding was caused by dry mucous membranes, cover the inside of your nose every morning with a petroleum or antibiotic ointment. Use your little fingertip as an applicator. Do this as needed during dry weather. This will keep the mucous membranes moist and allow them to heal.
  • Maintain humidity in your home by using less air conditioning or using a humidifier.
  • Do not use aspirin or medications which make bleeding more likely.
  • Resume normal activities as able but try to avoid straining, lifting or bending at the waist for several days.
  • If the nosebleeds become recurrent and the cause is unknown, your caregiver may suggest laboratory tests.


  • Bleeding recurs and cannot be controlled.
  • There is unusual bleeding from or bruising on other parts of the body.
  • You have an oral temperature above 102º F (38.9º C), not controlled with medication.
  • Nosebleeds continue.
  • There is any worsening of the condition which originally brought you in.
  • You become light headed, feel faint, become sweaty or vomit blood.
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Posted by on March 25, 2012 in General



Insomnia plagues millions of people.  After more than a decade in medicine,I have realized that the prescribed pharmaceutical sleep aids are just not good for people or their sleep.  For years I have been trying to identify sleep aids that do not disrupt the sleep-wake cycle, have little interaction with prescribed medication, and have no significant hang-over effects.  The agents listed below have been studied rather extensively, and may provide those insomniacs out there some degree of relief from their sleepless nights.

For awhile now, I have been recommending Valerian Root Extract.  The usual adult dose is 600-900 milligrams nightly.  Valerian Root has no known drug interactions, has not hang-over effect, and is more effective when taken on a nightly basis rather than an as-needed basis.  The only down side – it smells pretty bad – so plug your nose as you swallow your capsules and hopefully you’ll be sawing logs.

For older patient, a combination of melatonin 5 milligrams, magnesium 225 miiligrams and zinc 11.5 milligrams taken 1 our before bedtime for eight weeks seemed to improve sleep quality scores.  It is unknown whether this regimen is effective for younger adults.

Hope this helps!

Craig Endo, MD



It is September and the influenza season is upon us once again.  Here is the United States the flu season usually extends from early fall to early spring, with the peak of activity occurring anytime from November through March.  The health impact of influenza on the population is significant.  Each year between 5 to 20% of the population get the flu, more than 200,000 people are hospitalized with flu-related complications, and deaths from flu-related causes average 23,000 a year with the very young and the very old most susceptible to serious complications.   Although the H1N1 flu pandemic reportedly ended in 2009, the H1N1 flu virus is circulating again this flu season, along with the other influenza viruses.

Just to dispel some common myths and misunderstanding surrounding influenza:

1)  The influenza vaccine CANNOT make you sick.  The influenza virus is killed in the flu shot, and weakened in the flu nasal spray vaccine.  With the nasal spray some people experience some headache, mild body aches, and/or runny nose, but recipients do not get influenza.

2)  The “Stomach Flu” is NOT the same as seasonal influenza.  The “Stomach Flu” is a popular term used for an intestinal infection, often with nausea, vomiting and diarrhea.  Influenza is primarily a respiratory disease with symptoms such as high fever, cough, runny nose, sore throat and severe body aches.  Nausea, vomiting and diarrhea can occur with influenza, but this is more commonly seen in children rather than adults.

Currently the BEST prevention we have for influenza is the vaccine.  The vaccine is indicated for people age 6 months and older and should be administered as soon as it is available.  Most people will receive the flu shot – and that includes pregnant women.  The influenza nasal spray is only for healthy people age 2 to 49 years old.

The only reasons to NOT get the influenza vaccine – if you were diagnosed with a rare condition called Guillan-Barre within 6 weeks of receiving an influenza vaccine, or if you have a SEVERE allergic reaction to chicken eggs or other components of the vaccines.

For more information on influenza, please visit

If you have any comments please feel free to send them our way.  Also, if you are interested in a blog on a certain topic, please let me know.

Craig Endo, MD

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Posted by on September 7, 2011 in General


What are the signs and symptoms of a stroke?

A stroke can generally occur in either of 2 ways.  First, there may be a blockage in a blood vessel that block blood flow to or from the brain.  Secondly, there can be a bleeding vessel in the brain.

In evaluating a person for a suspected stroke, use the F.A.S.T mnemonic.

Remember, stroke is an EMERGENCY.  Act F.A.S.T.  Know the signs and symptoms of stroke.

Face – Facial droop, Uneven smile

Arm – Arm numbness or weakness

Speech – Slurred speech, Difficulty Speaking or Understanding

Time – Call 911 immediately.  Ask to be transported to a nearby hospital / emergency room that is an  approved stroke center if possible.  Also, if would be ideal if the hospital had and interventional radiologist or neurosurgeon that could perform a procedure to treat the blocked or bleeding blood vessel.


What about newborn circumcision?

Circumcision is actually more of a cultural “American thing”. Aside from religious groups that practice newborn circumcision, not a whole lot of the global community circumcises there newborn son. In the United States, newborn boys are circumcised primarily because their fathers or brothers are circumcised. There is no definitive medical advantage to circumcision. In our practice only about 30% of the newborn boys are circumcised.
Now to the more technical stuff about circumcision…


Circumcision is the surgical removal of the foreskin
The physician will numb the penis with local anesthesia before the procedure starts. The numbing
medicine will be injected at the base of the penis.
There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the
head of the penis and clamped with a metal or plastic ring-like device.
If the ring is metal, the foreskin is cut off and the metal device is removed. The wound heals in 5-7 days.
If the ring is plastic, a piece of the suture is tied tightly around the foreskin. This pushes the tissue into a
groove in the plastic over the head of the penis. Within 5-7 days, the plastic covering the penis falls free,
leaving a completely healed circumcision.
The baby may be given a sweetened pacifier or lollipop during the procedure. Tylenol (acetaminophen) may
be given afterward.
• Risks related to circumcision:
• Bleeding
• Infection
• Redness around the surgery site
• Injury to the penis
• Poor cosmetic result. Scarring
Some research has suggested that uncircumcised male infants have an increased risk of certain conditions,
• Cancer of the penis
• Certain sexually transmitted disease including HIV
• Infections of the penis
• Allergic reaction to iodine or lidocaine
• Philmosis (tightness of the foreskin that prevents it from retracting)
• Urinary tract infections
• the overall increased risk for these conditions is thought to be relatively small.

There you have it, parents, but the decision to circumcise or not is entirely yours.

Craig Endo, MD