Issues with Antibiotics in 2017

By William Jantsch MD

Prior to the use of penicillin by the general public in the 1940’s, bacterial infections in humans often led to devastating consequences, including amputation and death. When antibiotics became available, such infections were often cured in just a few days. 
Unfortunately, the impressive power of antibiotics to cure has resulted in an expectation that these wonder drugs can cure anything, and the drugs have been prescribed for all sorts of conditions, whether or not the disease is caused by bacterial infection. 
The most devastating result of the overuse of antibiotics is that many bacteria have become resistant. In fact, there are now some bacteria that are resistant to all known antibiotics. A patient with an infection caused by such an organism would have only the same options for treatment that patients had before the development of antibiotic; that is, wound care, debridement (amputation), and general supportive care. Many people with these resistant bacterial infections die.


It is very important to limit the use of antibiotics to cases where there is a high probability that their use is necessary. Doctors have been advised to follow these guidelines:
- No antibiotics for uncomplicated upper respiratory infections
- Use shorter courses of antibiotics for established bacterial infections
- Avoid broad spectrum antibiotics when more focused treatment is reasonable
“Uncomplicated viral upper respiratory infection” includes coughs, colds, most sore throats, and stuffy, congested noses and sinuses. Almost all of these illnesses get better spontaneously, and require no specific treatment. However, the experience of having one of these infections is unpleasant, and can last for 5-7 days. It is very common for people to go to doctors, urgent care centers, and even emergency rooms with these infections. Doctors have unfortunately been in the habit of prescribing antibiotics for these infections, just because that is the only thing they can do, even though the likelihood of benefit is near zero. Patients, then, become used to getting treatment for their coughs and colds, and that has reinforced the expectation of “getting something to knock this out” when going to the doctor. 


There are instances in which the use of an antibiotic is likely to help; for instance, bacterial infections of the middle ears, sinuses, pneumonia, skin and soft tissue infections, and urinary tract infections. However, even in these cases, antibiotics are not always needed for resolution of the infection (the human body has immense powers to ward off infection naturally). 
The dictum now is “treat for the shortest time necessary"- usually just as long as there are symptoms. For instance, treatment for pneumonia now is typically 5 days of oral antibiotic, and sometimes just a single dose for lower urinary tract infections. We often advised patients to “finish all your antibiotics, even though you feel better”, but that has changed. Doctors should be telling patients to stop the antibiotic once there is no more pain, fever, or resolution of whatever symptoms were associated with the original infection. 
Certain broad spectrum antibiotics should be avoided for treatment of infections outside the hospital. That would include the use of “fluoroquinolone” antibiotics, such as Cipro, Levaquin, Avelox, and others. These drugs are very potent, and can help to cure a wide variety of bacterial infections, but their overuse has resulted in the emergence of strains of bacteria that are no longer susceptible to these agents. In addition, it has been recognized that there are potentially serious side effects of the quinolones, including tendon rupture, heart rhythm disturbances, and nerve damage. 


The old paradigm of “get a cold, go to the doctor, hope to get an antibiotic” should now become: “get a cold, treat myself at home, go to the doctor if not getting better, hope NOT to need an antibiotic.”

What is Lupus?

What is Lupus?
Lupus is a disease in which our body attacks itself, especially our skin, joints, kidneys,
heart, lungs and blood vessels. It is called an autoimmune disease because antibodies
are formed by our body to harm organs in our own body. It is also a chronic disease
which means that the symptoms last for more than six weeks and sometimes for several
years.


Are there different types of lupus?
Yes, systemic lupus erythematosus affects different parts of the body; discoid lupus
erythematosus causes a persistent skin rash; drug-induced lupus is caused by certain
drugs; neonatal lupus typically occurs in newborns; and subacute cutaneous lupus
erythematosus causes sores on the part of the skin exposed to the sun.

 

What causes Lupus?
Despite advances, we do not yet know the cause of lupus. Studies indicate that genes
and the environment together contribute to the development of the disease. Some of the
environmental stimuli initiating lupus are:
 Medicines like certain antibiotics, blood pressure medicines and anti-seizure
medicines.
 Exposure to sunlight can trigger skin rash in genetically susceptible people.
 Infections can trigger lupus or its relapse.

 

Are there any risk factors for Lupus?
Lupus typically occurs in women between the 15 to 40 year age group and is more
common amongst African-Americans, Asians and Hispanics. So gender, age and race are
the main risk factors.

 

Is Lupus contagious?
No, it is not contagious and you cannot “catch lupus” from anyone.

 

What are the symptoms?
Your symptoms will depend on which organ in your body is affected by lupus and
whether it develops suddenly or slowly. A majority of people with lupus have mild
symptoms which flare up off and on. Common symptoms include:

- A butterfly shaped rash on your cheeks
- Fever and increasing fatigue
- Muscle pain
- Pain or swelling in the joints with stiffness
- Skin lesions which become worse when exposed to sunlight
- Pale or blue fingers and toes, especially on exposure to cold or during periods of
stress
- Difficulty breathing
- Pain in the chest
- Dryness of the eyes
- Mouth ulcers
- Swelling of the glands
- Confusion, loss of memory and headaches

 

How is it diagnosed?
It is difficult to diagnose lupus as it resembles several diseases, which can sometimes
delay the diagnosis for several years. Your doctor depends on an accurate report from you about your health history along with what is found after examining you to reach a diagnosis. In addition, a blood
test to detect antibodies for lupus (ANA) is obtained and if positive, then more specific
tests for lupus will be ordered. A biopsy from the skin or the kidney may be required to
confirm the presence of the condition. Other tests may also be required depending on
the organ suspected to be affected.

 

Are there any complications associated with Lupus?
Lupus related inflammation can affect other organs in your body, such as:

- Kidneys: severe kidney damage, and even death due to kidney failure.
- Lungs: inflammation in the lungs can lead to pleurisy and even pneumonia.
- Heart: inflammation of your heart muscle and lining of the heart results in a
higher risk of heart attacks.
- Miscarriages: Women with lupus can have repeated abortions due to complications, high blood
pressure during pregnancy, and also premature delivery.


What is the treatment for Lupus?
Your doctor will prescribe medications depending upon the severity of your symptoms,
and the organs affected by lupus. Common prescriptions include NSAIDS (non-steroidal anti-inflammatory
drugs), corticosteroids, immunosuppressant and anti-malarial drugs like
hydrochloroquine.

References
https://www.niams.nih.gov/health_info/lupus/lupus_ff.asp
https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=47
http://resources.lupus.org/entry/what-is- lupus

Signs and symptoms of heat exhaustion and heat stroke

It is summertime – schools are out, weather is hot and it’s the time to enjoy the outdoors. But it is also the time for heat strokes.

 

How will you know that you have a heat related illness?

Muscle cramps are the first sign of an illness related to heat exposure. Look out for it if you are outdoors and are exposed to the sun and heat for long periods of time. Heat stroke and heat exhaustion are two events related to excessive heat exposure.

 

What is a heat stroke?

Heat stroke is a a more serious type of heat related illness caused due to overheating of your body after being exposed to long periods of exposure to high temperatures.

 

Are there types of heat strokes?

Yes, heat stroke can be of two types –classical and exertional.

Classic heat stroke is due to exposure to heat in the environment and leads to an increase in our core temperature above 104 degrees Fahrenheit over several days. It mainly affects the elderly and those who have chronic diseases and can lead to delirium, convulsions and coma.

Exertional heat stroke affects active, young people. It develops rapidly over a few hours and is also associated with a high core temperature.

 

What are the symptoms of heat stroke?

  • Abnormal changes in heart rate (arrhythmias)

  • Mental state changes like confusion, irritability, seizures, coma

  • Heart failure

  • Shock

  • Kidney failure

  • No sweating

  • Bleeding

  • Liver failure

Heat stroke usually requires treatment by trained medical personnel as it is a more serious condition.

 

What should I do when heat stroke occurs?

If you yourself have a heat stroke, you may not be able to help yourself as it is a serious condition. However, if you see a person affected by heat stroke, then follow these steps:

  • Move the person to a cool place

  • Call 911 or call for medical help

  • Cover the person with cool clothes or ice packs

  • Avoid giving any fluids to the affected person

 

What is heat exhaustion?

Heat exhaustion is a milder version of a heat related illness compared to heat stroke and is more common.

 

What are the symptoms of heat exhaustion?

  • Sweating profusely

  • Cold, pale skin

  • Weak and fast pulse rate

  • Nausea or vomiting

  • Feeling faint

  • Dizziness

  • Thirst

  • Feeling weak

  • Headache

  • Malaise

Heat exhaustion usually improves within a few hours.

 

What can you do?

  • Move to a cool place or indoors

  • Wear loose clothing or loosen your clothing

  • Apply ice or cool packs to your body

  • Sip water continuously to prevent dehydration

 

How can you prevent heat exhaustion / heat stroke?

  • In summer, wear loose and light clothes, and maintain hydration by drinking plenty of fluids.

  • If you are an athlete or plan to perform an exertional activity, then practice for a few days in hot conditions to acclimatize.

  • If you are above age 65, then you may be more prone to heat related conditions. If you do not have air conditioning at home then visit places which are likely to be cool like the local community center or museum while maintaining hydration.  

 

References

https://www.cdc.gov/extremeheat/warning.html

http://www.aafp.org/afp/2005/0601/p2133.html

What is cupping?

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I saw Michael Phelps getting some funny treatment during the Olympics. Is that called cupping?

Yes, he received cupping therapy.

What is cupping?

According to Traditional Chinese Medicine, qi is the free flowing energy around us and it also flows through our body. Disruption of qi can cause imbalances and stagnation in our bodies. Cupping is believed to help remove the stagnation and restore the free flow of qi. During cupping, suction cups of different sizes are attached to the body to remove stagnant blood. Cupping was also believed to have been used by the ancient Egyptians

Are there different types of cupping?

Yes, there are two types of cupping: dry and wet.
-In dry or air cupping, the cups are applied to the body for three to twenty minutes depending on the person’s condition, to draw blood to the surface of the skin.
-In wet cupping, the therapist makes tiny incisions in the skin with a scalpel blade, after removing the cups, to draw out a tiny amount of blood.

What are the cups made of?

The cups can be made of glass, bamboo, silicon or earthenware.

How does cupping therapy work?

Cupping is believed to improve blood circulation, draw toxins to the surface and then remove them. In modern medical terms, cupping helps to loosen the fascia and stimulates blood flow to the area where the cups are applied. This promotes relaxation of the tissues and increased communication between individual cells. It simulates a deep tissue massage.

Which conditions can be treated with cupping?

In China, cupping is used to treat several disorders ranging from anxiety, depression, cough, asthma to hypertension, diabetes, anemia, insomnia, infertility, skin conditions, arthritis, pain and paralysis. It has also been used to treat shingles (herpes zoster), cervical spondylosis and acne.

Are there any overall health benefits of cupping therapy?

Cupping is believed to improve health overall by removing obstacles to the passage of energy/blood. It helps to relieve pain and relax the muscles.

Is cupping dangerous or life threatening?

No, cupping is not life- threatening and can be safe for healthy individuals when performed by trained therapists.

Does cupping have any side-effects?

The main side-effect of cupping is bruising as the cups draw blood to the surface of the skin. The bruises can be prominent in fair skinned individuals and can last up to a few days or few weeks. Successful cupping treatment is indicated by decrease in bruising with repeated cuppings. Other side-effects include skin infection and mild soreness at the site of cupping.

What precautions should I take during cupping?

Avoid cupping on a burn or an open wound or on inflammed skin. Also, if you suffer from a bleeding disorder (e.g. hemophilia) or are being treated with anti-coagulants, then cupping is not advisable for you.

References

https://nccih.nih.gov/news/cupping


 

Jellyfish Stings

Jellyfish stings

For more than 500 million years, jellyfish have been out there in our waters. Although they look like a primitive creatures, the evolutionary adaptations they have developed are amazing and effective, yet simple. Some species are tiny, less than a centimeter in diameter, and some are huge with tentacles that can reach up to 40 meters. No matter how small or big their tentacles are, they all sting! Luckily, most of them do not produce aggressive toxins that can do severe harm to humans. Usually the extent of damage is stinging, burning or itching, but that’s all. Unfortunately, there are species that can kill a human in under 3 minutes. Depending on the time of the year, jellyfish stings are a risk that people swimming or diving in seawaters must face.

 

What are the symptoms of a jellyfish sting?

Depending on the reaction to the sting, the symptoms may be localized or systemic. Localized symptoms occur only in the area of the contact between tentacles and skin. Systemic response is characterized by the reaction of the whole body and symptoms include a wide range of conditions that involve all body systems (nervous, cardiovascular, urinary system, etc.)

Localized reaction: Most of the species produce toxins that trigger only a local skin reaction. Usually, the area of the sting is swollen, mildly painful, with red marks. Severity of the symptoms depends on the species.

A list of localized reactions to the jellyfish sting includes:

- Pain

- Swelling

- Itching

- Burning or tingling sensation

- Skin marks that look like tentacles (tentacle print on the skin)- the color of the marks is usually red, although they may appear as brown, pale or pink patches.

- Throbbing pain that propagates around the area of the sting

 

Systemic reaction: If systemic body response occurs, the intervention of health professionals is needed. As soon as you notice health problems that occurred after the jellyfish sting go beyond the local skin reaction, you should seek for a medical help immediately! Have in mind that not all of these may be present simultaneously and maybe not immediately after the sting. Problems may occur hours after the sting as well.

A list of systemic reactions to the jellyfish sting includes:

-  Headache

-  Vertigo

-  Faintness

-  Problems maintaining body balance

-  Nausea and/or vomiting

-  Muscle cramps

-  Painful joints

-  Fever

-  Weakness

-  Loss of consciousness

-  Breathing difficulties

-  Arrhythmia (Palpitations, tachycardia, bradycardia)

- Chest pain

- Blood pressure changes (low or high blood pressure)

 

How to treat jellyfish stings on your own:

As mentioned above, stings should be treated only if they are mild and if presented without systemic reaction.

Immediate treatment steps include:

1. Exit the water.

2. If the jellyfish is still attached to your body, remove it carefully. (Keep in mind that you could get more stings if you touch the tentacles, so use a towel or a plastic bag as a glove.)

3. Wash the area with seawater to remove the stings.

*4. Deactivation of stings can be achieved with vinegar or baking soda solution. Rinse the affected area with solution for 30-40 seconds.

*5. Soak the affected area in hot water for at least 20 minutes (water should be hot but not cause burns). If the hot water is not available, you can use cold packs.

 *Steps 4 and 5 apply to the Indo-Pacific area. If you got stung in some other area of the world, skip step 4 and 5. Instead, rinse the affected area of the skin with water for a few minutes.

After immediate treatment follow these recommendations:

- Itching and swelling can be relieved with hydrocortisone cream and oral antihistamines.

- If needed, use over the counter pain killers.

- Keep the affected area clean. At least 3 times a day, wash it with mild soap, keep it away from salty water.

- Apply antibiotic ointment if there are signs of inflammation in the affected area (redness, tenderness, pulsating pain, warm skin).

If any of the systemic body response signs show up, seek help from a health professional.

 

When to seek help from a medical professional:

- Medical help is needed in cases of systemic body response.

- Severe allergic reaction should be treated as soon as possible by health professionals!

- If the surface of the affected area is bigger than ½ of the leg or arm surface.

- If you are not sure whether or not the reaction is severe, call 911 and they will provide you the guidance and information. Local health professionals know exactly what species of jellyfish live in the nearby waters and can estimate how serious is the reaction to the sting simply by talking to you on the phone.

- The box jellyfish sting is an emergency situation! Ask for a medical help immediately!!! Most of dangerous species are restricted to the tropical Indo-Pacific region, but they can be found in other parts of the world as well.

Before going to an exotic place for a vacation, inform yourself about dangerous animals that live there. Learn what they look like, so you can recognize them in case an encounter happens.  It can also be helpful to seek out local people to provide you with quality information about dangerous species that live on both land and sea.

 

Sources:

http://www.mayoclinic.org/diseases-conditions/jellyfish-stings/basics/symptoms/con-20034045

http://www.webmd.com/first-aid/jellyfish-stings-treatment

Ticks – How to Evict Them From Your Skin!

Just the thought of this conversation makes me want to check my skin for ticks!  If you are like me, go ahead and check. Then come back and read what to do about getting the tick off your skin, as safely as possible.

Why should I worry about Ticks?

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Other than being bothersome, ticks can transmit diseases to humans.  There are many diseases that can be spread by ticks, but what we tend to be more worried about is the Deer tick. It can carry diseases such as Lyme disease and Rocky Mountain Spotted Fever.  In 2014, there were 33,461 reported cases in the U.S.  Rocky Mountain Spotted fever accounted for 3,647 of those cases.  There are other tick-borne diseases, but they are not as common.  Overall, the incidence of these diseases are increasing in the United States every year. 

Is that why Ticks are so hard to remove?

Ticks are especially adapted to do what they do best: latch on, hang on, and suck blood.   As they latch on to your skin, they inject an anesthetic so you can’t feel them latching on.  The tick then secretes a ‘glue’ locking itself in place, so it won’t fall off, or get pulled off easily.  After it has glued itself to you- if you are thinking of removing it, think of it like removing a part of your body from your skin….  It is like that!  Then, once they have attached themselves to you, the bacteria- that have been lying dormant in the tick’s gut- is awakened by your blood that the tick has ingested.  The bacteria can then flow into your bloodstream and make you sick.  This is why you don’t want to squash that tick to get him off of you!  You might cause the tick to disgorge the bacteria filled contents into you!  The whole process of the tick attaching itself to you, ingesting your blood which awakens the bacteria in the tick’s gut (that had been lying dormant quietly),  takes about 24 hours, so you do have a little time to remove them, before they are able to transmit disease to you. 

How should I remove a Tick?

The best way to remove a tick it is to use a fine tipped, curved forceps or tweezers, and slowly pull the tick straight out.  Try not to squeeze the body, but grab the area where the tick is attaching to your skin and pull straight out.  If you are out somewhere, and do not happen to have tweezers or forceps with you, you can use a credit card in between the body and your skin, to raise the tick off you.  As awful as it might sound, mouthparts might be left under the skin, which can make you itch.  The good news is, these should eventually work themselves out of your skin on their own.   

Whatever you do, you don’t want to just pull it out.  If you do, you could squeeze the contents of the tick’s gut into your skin along with disease causing bacteria with it.  Lighting it with a flame, smothering it with Vaseline, or covering it with fingernail polish are no good either. Ticks can live without air for a long time, and survive attached to your skin- without breathing- for hours; much longer than you want it attached to you!  And, while you are waiting for it to let go and fall off on its own, it could be disgorging its contents into you!

The first step is tick-proofing your environment. For more information on how to tick-proof your environment, read the blog on Ticks – How to Evict them from my Life!  And, for a quick read on you might know if you have Lyme Disease or Rocky Mountain Spotted Fever from a Tick bite, read: Ticks –  Is it Lyme Disease, or Something Else?  And, if all else fails, contact us and we can advise you!

By Ns1ghter Provider: Allison Godchaux MD

 

Thyroid Disease

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The thyroid gland is a small butterfly-shaped gland on the front of the neck which regulates many important body functions such as metabolic control, heart rate and heat regulation. The thyroid gland produces the thyroid hormones T3 and T4 as well as other hormones after receiving a chemical signal from the brain. About 1 in 8 of us develop conditions associated with improper thyroid function. You develop symptoms of thyroid disease if the thyroid gland is overactive or underactive. Rarely cancer can develop in the thyroid gland as well. Sometimes your body will attack the thyroid gland and the resulting inflammation will result in a condition called thyroiditis. Hashimoto’s thyroiditis is a common cause for hypothyroidism, or underactive thyroid. Risk factors for thyroid disease include a family history of thyroid disease, female gender (especially after pregnancy or during menopause), exposure to radiation and previous thyroid surgery. Symptoms of underactive thyroid include fatigue, dry skin, hoarseness, feeling cold when everyone else is warm, constipation, weight gain, swelling in the face or feet, depression and changes in your menstrual cycle. High cholesterol may also be associated with hypothyroidism. Many of these symptoms are common in women and should be discussed with your doctor if they occur. Thyroid disease is diagnosed with blood work after a complete evaluation by your medical provider. TSH is the lab test most often used to monitor thyroid function but your doctor will often check your levels of T3 and T4 as well. Hypothyroidism is treated with prescription medication. It is very important to take your medicine as prescribed every day for best results. Please consult with your doctor if you continue to have symptoms after you start medication as medication adjustments are sometimes required after starting therapy.

Hyperthyroidism, or overactive thyroid, is a serious and sometimes life threatening condition which requires immediate attention. Hyperthyroidism occurs when your body produces too much thyroid hormone. Symptoms of hyperthyroidism include rapid or irregular heartbeat, weight loss, irritability, dizziness, shaky hands, vision changes, infertility, difficulty sleeping and elevated blood sugar. Please see your provider if these symptoms occur. Hyperthyroidism is diagnosed through blood work, but often further testing such as ultrasound or thyroid scanning is required to determine the cause of thyroid hormone overproduction. Hyperthyroidism is typically treated with medication but sometimes the overactive gland will be to be treated with a chemical called radioactive iodine to destroy the excess glandular tissue causing symptoms. Rarely surgery is required to remove the malfunctioning gland. You may have to take thyroid hormone replacement therapy after thyroid surgery or radioactive iodine ablation if the procedure destroys too much thyroid tissue. Thyroid disease is a common and debilitating illness that is very treatable. Please schedule an evaluation with your provider today if you have symptoms of thyroid disease.

By Ns1ghter Provider: Traci L French MD

Ticks – How to Evict Them From your Property

Does my even mentioning the thought of ticks make you itch and double-check your arms and legs, or look in the mirror to make sure that you don’t have of these travelers on you?  It does me.  Tick season is coming upon us, so let's take a look at what we can do to help you evict them from your property.  In another blog, we will discuss what to do should a tick get past your defenses and find its way onto you!

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What is wrong with ticks?

Beyond being bothersome, ticks can transmit diseases to humans, as well as to our dogs! The Deer tick can carry diseases such as Lyme disease and Rocky Mountain Spotted Fever. 

When should I worry about ticks the most?

Late Spring and early Summer is when the risk of getting Lyme disease is greatest (during their nymphal stage). That doesn’t necessarily mean you are safe from them at other times.  They can be active in the warmer parts of the year as well.  They love humidity.

What can I do to keep ticks away from where we live?

What you can do to keep the tick population down is by creating a ‘tick-free safe zone’.  This is an area that is clear of leaf debris and clutter.  It is something that creates a separation between the family’s outdoor living area, and that of the treed and leafy areas surrounding your property. This separation, or "safe-zone," can be made by using wood chips, mulch, stones, decking or tile.  This sounds like a lot, but if you can manage it, make your zone 6-9 feet wide.  If this cannot be managed in your home, make it as wide as possible.  Any tick-free safe-zone is better than none at all.

This tick-free safe-zone will help keep the ticks where we want them: on the other side of the zone you have created!  Keep your lawn mowed and trees pruned.  For added protection from possible ticks that might make it past your safe-zone, make sure that any lawn chairs and play equipment are set up away from the zone you have created.  

Evict the animals that can carry ticks to the safe side of your safety-zone!

Mice and chipmunks tend to bring in ticks closer to the home, as do your dogs.  You can relocate your mice and chipmunks by relocating stonewalls or woodpiles to an area further away from your outdoor living area.  And, we want to discourage your dogs from bringing their tick-friends home to you, because ticks are just as risky for your dogs as they are for you.  Keep them out of forested areas, and away from dense shrubs, if possible.  Ticks like to climb shrubs until they are 18-24 inches off the ground, a perfect height to attach themselves to your beloved pet.

What can I do to protect my dogs – I don’t want them to get ticks, and I don’t want them bringing them home either!

You do have some options for tick management of your dogs as well as your cats.  I suggest natural treatments first.

-  Apple Cider Vinegar- add 2 tablespoons to your pet’s food or water bowl daily

-  Garlic, add a clove to their daily meal.  In addition to keeping the vampires away… hopefully the garlic will keep the ticks away as well. Plant-life to avoid is ground cover near your family activities.  Plant-life you might consider is wildflower meadows, herbal gardens, etc.  Not only will you decrease ticks in these areas, you will attract butterflies to your outdoor home.

-  Talk to your vet!  If these remedies don’t work, then the vet will be able to suggest treatments that can help, such as a tick collar, or sprays or drops that can be applied monthly to the dogs skin.  There are also pills your dogs can take.  Talk to an expert to help you make the best decision.

Ticks can be bothersome to us and our pets, and they can cause diseases as well.  For more information on how to handle a tick should it manage to get past your tick-free safe-zone, read the blog on Ticks – Evicting Them From Your Body

By Ns1ghter Provider: Allison Godchaux MD

 

 

Coronary Artery Disease

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Introduction
Coronary heart disease (CAD) is the most common cause of death in the United States. Nearly 1 in 4 Americans will die of heart disease, regardless of race or gender. CAD occurs when inflammation causes raised lumps of fatty tissue or plaques to develop in your arteries, clogging the main blood vessels in your heart. If the blood flow in these vessels becomes completely blocked, the surrounding tissue will die and cause a heart attack. Risk factors for CAD include increasing age, obesity, diabetes, male gender, high blood pressure, smoking and excessive alcohol use. Almost half of Americans are obese and have high blood pressure and high cholesterol, the three most common risk factors for heart attack.

Warning Signs
Serious symptoms that should never be ignored include chest pain, pressure or tightness, especially if is accompanied by arm, neck, or jaw pain, as well as shortness of breath, dizziness, nausea, sweating, difficulty thinking and tingling in your arms or legs. Women and people with diabetes may different symptoms of a heart attack including severe fatigue, sweating, and jaw or back pain. CALL 911 immediately if you have these symptoms. Delay can mean death or serious injury. 

Diagnosis and Treatment
Diagnosis and treatment of coronary artery disease is based on the severity of your symptoms and risk factors. Acute symptoms often require emergency intervention to prevent damage to cardiac tissue and prevent development of worsening disease. After the condition is diagnosed and stabilized, your provider and treatment team can help develop a strategy to manage your symptoms and halt disease progression. Yearly checkups can help identify risk factors for heart disease such as high cholesterol or high blood pressure. Discussing any warning symptoms with your doctor is a very important way to minimize the risk of having a heart attack or other serious heart issues.

Prevention
Lifestyle modification is key in the prevention of coronary artery disease. You can decrease your risk of a heart attack 50% just by quitting smoking. Obesity affects almost 40% of the population and the risk of obesity increases by 5% each year. Diet changes shown to lower cholesterol and decrease the risk of heart attack include eating fatty fish such as salmon twice a week, adding 2 tablespoons of nuts to your daily diet and increasing the amount of fruits and vegetables in your diet. A nutritionist can assist you in developing a healthy customized diet plan, but a general guideline is that each meal should consist of 50% fruits and vegetables, 25% whole grains and 25% lean protein. Exercise is incredibly important for lowering stress, improving mood, weight loss and adding muscle to the body. Exercising 150 minutes per week decreases heart attack risk by 30%. Other lifestyle changes shown to decrease heart attack risk include consuming moderate alcohol (2 drinks/day for men, 1 drink/day for women) and avoiding the trans fats found in processed and fast foods. Heart disease is a serious but preventable disease. Regular checkups with your medical provider can mean the difference between life and death.  If you have the warning signs, don’t neglect them.

By Ns1ghter Provider: Traci L French MD

 

Citations: Am Fam Physician. 2003 Apr 15;67(8):1769-1770. Coronary Artery Disease: How Your Diet Can Help. http://www.aafp.org/afp/2003/0415/p1769.html PRINT
https://www.cdc.gov/heartdisease/facts.htm
http://www.webmd.com/heart-disease/ss/slideshow-visual-guide-to-heart-disease
http://www.who.int/tobacco/quitting/benefits/en/

 

Ticks - How Do I Know if I Have Lyme Disease?

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If you have been reading my other blog posts on ticks, you will know that Lyme Disease from tick bites is increasing every year!  And if these milder seasons continue, then the possibility that you could get Lyme disease from a Tick increase as well!

But, how do you know if you might have it….?

-  Have you been bitten by a Tick?  You could have, if you have been working outside, with plants, raking leaves… or even if your dog has had exposure.  Your dog can bring them in your home to you!!

-  Redness where the tick was? Redness that continues to grow in size over the next week?  Could be.  If it begins to clear in the center, it is what we call a "bulls-eye rash." 

-  Bulls-eye rash?  About ½ of the people with Lyme disease develop a rash, and ½ don’t!  If you have a rash, then that helps you figure out your risk.  If you don’t have one, it doesn’t mean you don’t have Lyme disease.  But if you do have it, we can be more certain that we are looking at Lyme disease.

-  Fever, chills, headache, muscle and joint aches, and fatigue… these symptoms can be due to Lyme disease from a tick bite, and can help us decide if you need further testing.  If you are concerned, let us know!  But these symptoms are tricky, they can be related to many other causes as well.  So, it is important to really look at this!

I recently had a patient with Lyme Disease, a great example of a typical case.  She had an itch on her arm, looked down and saw an engorged tick on her arm.  She didn’t intend to knock it off, but she brushed against it and it fell off.  The next day she had an area of redness around the area where the tick was.  The next day the area of redness was larger, and the center of it was skin colored again (typical bulls-eye type rash).  For the next week she was tired and weak, off and on.   She came into the clinic after about 10 days.  I tested her for Lyme disease (and other tick-related diseases), and she was positive for Lyme Disease!  She was treated with doxycycline and has been fine ever since.  The key here is getting evaluated and treated if you think you might have it. 

Had she not been treated, long term issues could have been extensive and life changing.  There is another patient I know of, who did not get treated, and she has experienced feeling tired and weak, and has intermittent joint and nerve pains – that do rule her life.

Contact us, let us see a picture of your rash, and talk with you more about your symptoms.  If we think that it could be Lyme disease then we can talk with you more about it.  Perhaps you will have to take antibiotics.  Antibiotics that we typically use are doxycycline and amoxicillin.  Both of these are fairly common and relatively inexpensive. 

Read my other blogs on ticks, Ticks- How to evict them from your skin, and Ticks- How to evict them from your property.

 

 

 

Osteoarthritis

Arthritis is a condition which affects nearly 1 in 4 of us. Arthritis is the name for a number of conditions that cause wear and tear on the joints of your body. The most common type of arthritis is degenerative joint disease, which occurs when the cartilage that cushions joints such as the hip, knee or fingers wears out over time from overuse or injury, but arthritis may be caused by inflammation or infection as well. When the underlying bone begins to rub together, pain, swelling, and stiffness result. Obesity and being overweight place extra strain on joints and are big risk factors for developing the condition. Other risk factors include previous joint injury, aging, family history of arthritis, and female gender. Common symptoms of arthritis include swollen, painful, stiff joints that are difficult to move, especially upon waking. Fever, bright red joints or drainage from aching joints are not common symptoms of osteoarthritis and should be brought to the attention of your medical provider immediately.

Diagnosis and Treatment

Arthritis is a chronic condition that often progresses with time. Diagnosis of arthritis often consists of a thorough history and exam, but sometimes bloodwork or x-rays may be needed to confirm the condition. There are many therapies available to reduce inflammation and joint pain once the diagnosis is confirmed. Anti-inflammatory medications such as naproxen and ibuprofen are long-standing and effective treatments for joint pain, but can have serious side effects such as gastrointestinal bleeding if taken improperly. Topical remedies such as anti-inflammatory creams, capsaicin and menthol often have fewer side effects and can block pain and decrease joint stiffness. Many herbal remedies have been shown to have pain-reducing characteristics as well. Turmeric, ginger, SAM-e and boswellia all have documented anti-inflammatory properties. Please consult a knowledgeable practitioner prior to using these and all alternative therapies to determine proper dosage and to prevent harmful interactions between these substances and prescription medications. 


Dietary changes have been noted to prevent worsening of joint damage and decrease pain. Adding essential fatty acids such as GLA (gamma-linolenic acid) and omega 3 fatty acids, preferably by consuming a diet rich in fruits, vegetables and whole grain foods and moderate amounts of fatty fish such as salmon has been noted to slow the progression of joint damage. A plant-based diet as described above may help with weight loss and has many other beneficial side effects such as decreased risk of high blood pressure, osteoporosis, diabetes and heart disease. Just a 15 lb. weight loss has been shown to decrease arthritis symptoms by 50%. Exercise is also known to decrease pain, increase joint range of motion and assist with weight loss. Aim for 20-30 minutes of moderate exercise such as swimming or walking in order to improve arthritis symptoms. Physical therapy can be useful to reduce pain, improve joint mobility and decrease risk of falls. Sometimes a therapist may recommend assistive devices such as a cane or walker for additional support if joint function is severely affected. Your physician can refer you to physical therapy for further evaluation if necessary. 


Surgery is a last resort with good long-term outcomes for patients with severe debilitating arthritis. You may be a candidate for joint replacement surgery if pain and loss of joint function restrict the performance of your daily activities, if medication and lifestyle modification fail to decrease pain and/or improve joint function and if severe damage is noted on x-rays or other studies such as CT or MRI. “Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years” (American Association of Hip and Knee Surgeons). If you have had long-standing arthritis unimproved with a trial of conservative therapy such as weight loss, exercise and medication, please discuss further therapeutic options with your doctor.

By Ns1ghter Provider: Traci L French MD

Citations: 
9 Supplements for Arthritis.-Arthritis Foundation. http://www.arthritis.org/living-with-arthritis/treatments/natural/supplements-herbs/9-supplements-arthritis-13.php
Arthritis-Related Statistics-CDC.gov. 3/6/2017. https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
Osteoarthritis Fact Sheet-CDC.gov 1/9/2017. https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
Arthritis 2015; 2015 708152 Chelsea M. Clinton, Shanley O'Brien, Junwen Law, Colleen M. Renier, and Mary R. Wendt . Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359818/
Total Knee Replacement- American Association of Hip and Knee Surgeons. http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-repacement/total-knee-replacement/

What kind of medicine is that?

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One of the hottest topics in medicine that has gained much steam over the past few years is that of Integrated or Alternative Medicine. According to WebMD, the percentage of hospitals that offered non-traditional (or non-allopathic) therapies has increased dramatically in the past 20 years, with a large percentage of organizations with a plan to breach the market that is complementary therapy. With all of the fuss then, what exactly is integrated/alternative/complimentary or holistic medicine? 


Integrated medicine refers to the seemingly limitless variety of potential medical therapies that does not fall under the traditional standard of Allopathic (Western) medicine. The word Allopathic comes from two Greek terms meaning “different disease.”  This term (sometimes used in the negative) indicates a foundation of germ theory, or that foreign bacteria, viruses and pathogens cause disease in humans. These foreign pathogens become the target for medicines and treatments. Other words for this type of medicine include "scientific medicine" or "evidence-based medicine." 


If Western medicine deals with external causes of disease, alternative medicine takes the opposite view – that the causes of disease are primarily internal, and can be cured or remedied by restoring proper function of the body. The umbrella of alternative medicine literally covers anything that one might attempt for restoration, from chiropractic, massage, acupuncture and vitamins to homeopathy, tai chi, cupping, urine tonic and colloidal silver therapy.


What type of medicine should be trusted? A few things to note: there is great variation between alternative therapies as to their scientific basis – for example, chiropractic therapy versus cupping are worlds apart. To make things even more difficult, there is also great variation within alternative therapies that color the scientific validity of the approach – for example, while chiropractic therapy is widely used and has been shown to help with back pain, the fundamental reasoning behind chiropractic is dubious at best. This idea leads to the primary problem with non-western medicine – lack of evidence. Integrative therapies may work or they may not, but there is an overwhelming void when it comes to research and evidence for their use. Unfortunately for the most part, non-traditional medicines have come about largely due to a perhaps legitimate dissatisfaction with western medicine; the holistic movement is reactionary in large measure. 

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So we’re again left with the question of what to trust? Here are a few facts that one should take into consideration when thinking about medicine in general:
1. There are only two types of medicine – medicine that works and medicine that doesn’t. The dichotomy between western/allopathic, naturopathic, alternative, integrative etc. etc. is a bad way of thinking about these things. The questions should be:
“Does this work? How does it work? How do I know?”
2. The foundation is important. If someone is selling you a therapy that’s based upon personal subliminal messages received from outer space, you can pretty much discredit that one because it's not subject to inquiry – it can’t be tested, ergo it can’t be validated or disproven. Does it work? It might, but you’ll have nothing but personal experimentation to back it up. 
3. Just because the foundation of a medicine is false, doesn’t mean the therapy is. This makes it doubly difficult and here is where a whole new discussion of “mind/body medicine” could take place. But you have to refer back to the questions about how to get your bearings: “How will I know that this works?”

One point of great interest regarding the foundations of the holistic movement is that the idea of prevention and limited use of medication has long been a staple of Western Medicine. In fact, it's in a form that many of us have seen and probably trusted for years – the D.O. A doctor of Osteopathic Medicine (D.O.) undergoes the same level and rigor of training as the standard M.D., and is licensed in the same way. In addition, some well-respected, traditional U.S. universities are well known for their practice of alternative medicine.


A great resource for those who want an in-depth and entertaining look into complementary therapies of many shades is a book called “Trick or Treatment: Alternative Medicine on Trial” by Simon Singh and Edzard Ernst. This will give you a good starting point on how to evaluate medical therapy of all kinds.


Good luck and good health to you!

By Ns1ghter Provider: Joseph Accursio MD

Utilizing healthcare

Let’s face it – the healthcare system as we know it is a mess. It can be confusing and exceedingly difficult to navigate for both patients and providers. It is hard to know where to go and when because so many services seem to overlap. Believe it or not, each segment of the medical industry does have a particular thing it does best. One goal here at Ns1ghter is to provide a forum to have self-help questions, remedies and guidelines available for your use, and to fill gaps where we can. 


Let’s discuss one of those important “know-where-to-go” questions – Urgent Care versus the Emergency Room. You have probably seen public service advertisements in your area about “urgent or emergent” care. Though most people believe that the two are similar, they are in fact very different, and in a medical emergency, time is of the essence. 
So what are the differences? 


Urgent care (or immediate care) facilities are designed to take care of small medical problems and take some of the overflows away from primary care. Things such as lacerations (cuts that may need sutures), colds, flu, bronchitis, strep throat, nausea/vomiting/diarrhea, rashes, strains and sprains, skin infections…things that can be treated successfully with a single visit. Urgent cares can also be used for temporary medication refills in a pinch, though this is generally frowned upon and should go through your primary provider for better continuity of care. An urgent care should NOT be used for routine vaccinations, regular medication refills, annual physicals or referrals for further testing or to specialty clinics. 


For things that are long standing and require further looking into, your regular provider is the place to go. That’s ideally the role of the mysterious “Primary Care” – the first touch point in the system that will help you make connections with any other place you might need to go. But even more importantly, primary care is about prevention. Most people (including providers) would agree that staying out of the doctor’s office, to begin with, is the best route. That’s the role of primary care. 


The ER or ED (emergency room or department) is exactly as the name implies – for emergencies. Life threats, things that can’t wait, serious problems that need treatment now. The buck stops in the ER – whatever needs to be looked at, scanned or treated can be, and if it can’t, the ER can send to where you need to go to have these things done. 


Unfortunately, the confusion between the ER and Urgent Care leads to countless healthcare dollars being wasted. Because it’s so well equipped, the cost of an ER visit is many many times that of the Urgent Care, even if you receive the same exact services. On top of that, inappropriate use of the ER takes up space and resources that might be needed for life threatening emergencies. Another problem with going to the ER is the possibility of being subject to more extensive testing than is necessary for your condition, just because of the setting you’re in. 


So in the world of healthcare, knowing where to go and when is of the utmost importance. 

A simple rule for someone without a lot of medical knowledge might be the following:

  • If I think something is seriously wrong, or might be seriously wrong, I should go to an emergency room or call 911.
  • If I think something can be fixed or figured out without in-depth studies, I should go to the urgent care.
  • If I think something is routine or is not significantly affecting my daily life, I should call my primary care.
  • If I have a general need and questions, or aren’t sure what to do, log onto Ns1ghter! 

 

By Ns1ghter Provider: Joseph Accursio MD

GERD (Heartburn)

By Ns1ghter Provider: Traci L French MD

Heartburn is a common and annoying problem which affects most of us at some point in time. Overindulging in fatty, spicy foods combined with alcohol can be a recipe for the burning pain, bloating and nausea that often accompanies this condition. Acid reflux or heartburn occurs when the lower esophageal sphincter(a tight ring of muscle at the top of your stomach) relaxes and allows stomach contents to flow backwards into your esophagus. Sometimes the acidic contents of your stomach can flow backwards into your lungs causing coughing, wheezing or choking. Almost a third of us suffer from this condition on a daily basis. Common causes of acid reflux disease include obesity, smoking, alcohol use, pregnancy and other hormonal changes and eating too-large portions. 

Diagnosis and Treatment


Left untreated, GERD can develop into severe health problems. Some conditions associated with severe long-term acid reflux disease include asthma type symptoms as described above, insomnia, and pre-cancerous changes to the esophagus as well as cancer of the esophagus in very rare cases. There are several home remedies you can try to treat occasional heartburn. Effective remedies include weight loss and avoidance of trigger foods such as fast food, carbonated drinks, chocolate, caffeine and citrus foods. Along with preventing many other problems such as heart disease, cancer and lung disease, many people find that reflux symptoms improve as consumption of alcohol and tobacco products decrease. If your symptoms flare at bedtime, elevating the head of your bed slightly can decrease acid reflux. If your symptoms persist for more than a few days or are accompanied by weight loss, recurrent vomiting or blood in the stool an urgent visit to your provider is warranted. Simply discussing your symptoms with your provider can help you and your physician develop a plan to manage your symptoms but sometimes further testing is warranted to rule out more serious conditions. 

Treatment


As with many conditions, the primary therapy for GERD includes lifestyle modification. A 10 lb. weight loss is often enough to noticeably improve acid reflux symptoms. Switch to smaller meals every 3-4 hours and follow a low fat diet high in fruits, vegetables and lean protein. Herbal remedies for GERD include the use of cardamom or licorice to improve digestion and decrease bloating. Ginger is a well-known remedy for nausea and may decrease reflux by acting as an antispasmodic as well as by tightening the esophageal sphincter. Avoid trigger foods and add spices such as mint, ginger, cardamom and fennel to your diet if these remedies improve your symptoms. Decrease alcohol consumption, especially close to bedtime, and stop smoking. Tight clothing can worsen symptoms as well. There are many pharmaceutical treatments for heartburn that are safe for short-term use but have long term side effects including B12 deficiency, osteoporosis with hip fracture, gastric polyps and C. diff coliti s. It is typically recommended that prescription heartburn medications be used for no longer than 6-8 weeks without a physician’s recommendation. There’s no need to suffer in silence. Acid reflux disease is an unpleasant and often painful condition that can be improved with a few lifestyle changes. Speak with your provider today to develop a treatment plan. 

Citation: David C. Metz, MD. Gastrol Hepatol (NY). 2008 May; 4(5): 322-325. Long-term Use of Proton-Pump Inhibitor Therapy. 

 

 

Diabetes Self Care

By Ns1ghter Provider: Traci French MD

Diabetes is a disease noted by elevated blood sugar which affects almost 10% of the US population according to the CDC (2014 National Diabetes Statistics Report). There are two major types of diabetes. About 5% of patients have type I diabetes, which occurs when your body completely stops making insulin, a hormone which regulates blood sugar levels. The majority of diabetics have type II diabetes, which is caused by insufficient insulin production. Risk factors for diabetes include age, obesity, and belonging to certain ethnic groups.

Consequences of uncontrolled diabetes include blindness, infertility and birth defects, poorly healing wounds, heart disease, stroke and depression as well as many other conditions. Many of these outcomes can be avoided by following your doctor’s treatment regimen and performing routine self-care. 


Diabetic diet: dietary change is a cornerstone in the prevention and management of diabetes. Current guidelines recommend 150 minutes of exercise weekly along with behavioral modification. Your doctor will be happy to refer you to exercise and nutritional specialists who can tailor an individualized plan that meets your needs and preferences. A weight loss goal of 7-10% of your current body weight can delay the onset of diabetes in high-risk individuals and decrease the risk of consequences in patients diagnosed with diabetes.


Vision care: Yearly eye exams are recommended to monitor and limit the damage caused by elevated blood glucose on your eyes with more frequent visits recommended for patients with more severe disease.


Dental care: More frequent dental visits are recommended for diabetics in order to prevent tooth loss and gum disease.


Immunizations: Diabetes can weaken the immune system and increase your chances of catching diseases such as influenza and pneumonia. It is important to get a yearly flu shot and stay up to date on your pneumonia vaccine. Discuss getting a shingles shot with your doctor in order to prevent the debilitating skin rash and chronic nerve pain caused by the shingles virus.


Foot care: Your feet are your primary form of transportation and require some TLC. Avoid walking barefoot and check your feet daily for cuts, scrapes, calluses or other signs of wear and tear. This is a great excuse for a foot massage with healing lotion and be sure to contact your medical provider for further evaluation if you develop a wound or abnormal sensation in your feet.


Last but not least, follow up with your doctor on a regular basis to monitor your weight, blood sugar and blood pressure. Lifestyle changes are the primary treatment for diabetes along with the proper medical regimen. You have the power to lead a happy, healthy and full life when you and your care team develop a safe and effective disease management regimen.

When is it more than "just a cold"

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By Ns1ghter Provider: William Jantsch MD

Every human being on the planet is susceptible to catching a cold. The experience is annoying and frustrating, because when the illness starts, you generally know that you are going to feel miserable for several days and you hope that there is something you can do to make it better. 
A “cold” is what a doctor would call a “viral upper respiratory infection”, which is actually a whole range of conditions, caused by a fairly large number of different viruses. Depending on your age and general health status, the same virus that causes a runny nose and cough in one person may cause you to have a sore throat and a hoarse voice. 


In general, however, a cold will generally start with a feeling of body aches and fever, followed by some combination of: stuffy nose, facial pain, ears feeling plugged, sore throat, pain in the eyes with upward gaze, headache, cough, hoarse voice. 


Very commonly, the nasal stuffiness or sore throat will resolve in a day or two, then followed by a cough that will persist for up to several weeks. The alternative is also possible: an initial cough may give way to facial pressure and nasal congestion that goes on for weeks.
The general approach to treating a cold is entirely based on symptom relief. There is no scientific evidence to show that any treatment is effective in shortening or lessening the course of any viral upper respiratory infection. On the other hand, there are hundreds, if not thousands of treatments available that claim to relieve symptoms of a cold. Unfortunately, none of these works very well. 


So, what does a doctor do when a patient comes in to his office and requests help with a cold? The doctor knows that the patient is suffering from a benign, self-limiting disorder for which there is no good treatment. The patient is a wits’ end due to days of suffering with feeling unwell, and is hoping for a cure.


The prudent practitioner will attempt to accomplish two goals:
a. Reassure you that there is nothing serious needing any special attention
b. Identify and treat any other condition that may present with “cold symptoms”
The issue of antibiotics


Ever since the discovery of penicillin in the 1920’s there has been the hope of “getting something to knock this infection out”. However, now almost 100 years later, we have come to realize that antibiotics have been overused for so long that many bacteria are no longer susceptible to them. We need to stop using anti-bacterial antibiotics to treat viral infections, because there is no benefit from those antibiotics, and ultimately their overuse harms us all as a society.


An antibiotic should not be used for “just a cold”. But there are conditions that may benefit from antibiotic use that may be associated with cold symptoms, including:
a. Sinusitis
b. Pneumonia
c. Otitis media (middle ear infection)
d. Influenza
e. Streptococcal (“strep”) sore throat
Sinusitis is manifested by facial pressure, fever, and thick nasal discharge that has lasted for over a week. Most cases are still caused by viruses, but your doctor should be able to help determine if an antibiotic would be helpful.


Pneumonia usually is a complication of a viral upper respiratory infection, and the symptoms of this would include shortness of breath, high fever, chest pain, and unremitting cough. The diagnosis can be established with physical exam or with a chest x-ray.
Otitis media presents with pain and loss of hearing in an ear. There is often fever as well. Ear drainage may be present if there is a rupture of the ear drum.


Influenza (“flu”) is characterized by sudden onset of fever, muscle aches, headache, cough, and profound weakness. (It usually does not cause vomiting and diarrhea, as many people believe.) There are antiviral antibiotics that may be of some benefit if started early during the illness.
Strep throat causes sore throat, fever, and swollen glands. It does not cause cough or nasal congestion. Most sore throats are caused by viruses, and a doctor will not be able to tell for certain that you have a strep throat just by looking at you. On the other hand, a doctor may be able to tell you that strep is unlikely due to your symptoms and findings. There are rapid tests and cultures that can settle the issue. 


So, when should you see a doctor regarding your “cold”?
If you are otherwise healthy, and have no chronic medical conditions such as heart failure, diabetes, chronic lung disease, or cancer, and if you develop a cough, nasal stuffiness, sore throat, and mild muscle aches and fever, I would recommend:
a. Wait a few days and treat yourself with plenty of oral fluids, rest, and acetaminophen or ibuprofen as needed for fever or discomfort
b. If you feel better after a day or two, it is likely “just a cold”; note however, that full resolution of the nasal stuffiness, sore throat or cough may take up to 2 weeks
c. Seek medical attention if:
a. Fever is high (over 102 degrees Fareinheit) and associated with headache and weakness
b. Cough gets progressively worse over several days, and becomes associated with fever, chest pain and trouble breathing
c. Facial pain and nasal stuffiness persist for more than 10 days
d. Severe ear or throat pain

 

Hypertension: Silent but Deadly

By Ns1ghter Provider: Traci French MD

Hypertension or high blood pressure is a serious and common problem in the Western world. According to the CDC, 1 in 3 Americans have a diagnosis of hypertension currently being treated by a doctor. Nearly half of us have abnormally elevated blood pressure and are unaware of the issue. Untreated high blood pressure leads to heart damage and stroke as well as several other health issues including memory loss, eye damage and kidney failure. 


Causes of Hypertension
Hypertension occurs when your blood pressure remains above 140/90 on multiple occasions. High blood pressure often is inherited, but preventable causes of hypertension include smoking, excessive alcohol intake, obesity, diabetes and lack of exercise. 


Diagnosis and Prevention
You can decrease your chances of getting high blood pressure by exercising 20 minutes 3-5 times per week, maintaining a healthy weight, and quitting smoking. Switching to a diet based primarily on plants and lean meats with minimal processed foods and restaurant meals will lower your blood pressure and help to obtain and maintain a healthy weight. Regular checkups with your medical provider will help you set healthy lifestyle goals as well as screen for health warning flags such as abnormal sugar levels. Yearly visits with your eye doctor can help prevent dangerous consequences of high blood pressure such as glaucoma or retinal disease.


Hypertension Treatment
Your doctor will likely begin treatment of elevated blood pressure by prescribing a low fat, low sodium diet along with an exercise regimen such as walking. Just losing 10 pounds can lower blood pressure significantly, especially when added with lifestyle changes such as stress reduction, smoking cessation and decreased alcohol intake. If lifestyle modification isn't sufficient, your doctor may recommend one or more medications or additional testing based on your personal history. It is important to take the medications as prescribed on a daily basis and follow up with your doctor periodically to ensure that your treatment regimen is effective. High blood pressure is a common and important illness that has dangerous consequences if left untreated, but it can be safely controlled when you and your doctor work together to develop a treatment plan.

Ear pain when flying

By Ns1ghter Provider: William Jantsch MD

What to do when your ears feel plugged and you have to fly…

A common question I am asked when seeing patients in our Urgent Care Center is “how can I fly in an airplane with this ear and sinus congestion?”

The space behind the ear drum is called the “middle ear”, and this space is vented through a small channel called the eustachian tube into the nasopharynx. You can feel the eustachian tube opening up when you swallow or yawn; this opening is the source of your feeling your ears “pop”. When you experience a change in air pressure, such as a commercial air flight, you need to keep balancing the pressure behind your eardrums with the outside pressure. Hence the need to yawn or chew gum while taking off and landing in an airplane.

However, the eustachian tubes can fail to function properly if inflamed or full of secretions, as happens with a cold, sinus infection, or upper airway allergies. If you try to fly under this circumstance, the air pressure in your middle ear will not balance with the outside pressure, and there will then be tension on the ear drum. This can be very painful, and lead to hearing loss, ringing in the ear, and even rupture of the eardrum. Damage due to air pressure differences is called barotrauma.

Multiple interventions have been proposed to avoid ear barotrauma, and to treat it once it has occurred.

Prevention:

- Don’t fly if you have nasal congestion due to upper respiratory infection or allergy, and you feel like you can’t “pop” your ears

- Oral Sudafed, taken 1 hour prior to flight

- Topical decongestant (e.g. Afrin, used just before boarding the plane)

- Ibuprofen (in anticipation of pain)

- OTC antihistamine (if your symptoms are allergy related)

- Earplugs

The benefit here is if you place an air-tight plug in your ear at ground level, there will be no need to equalize the pressure in your middle ear at altitude. This can work well, but the plug must be air tight- use a “sticky” moldable silicone plug (e.g. Mack’s or Ear Plane) available at the drug store

Treatment:

- Valsalva maneuver (Traditional, Frenzel, Toynbee)

Tradition says to take in a breath, then hold your nose closed by pinching with your thumb and forefinger; imagine then trying to force air out through your nose (even though it is blocked), and gradually increase the amount of force against your nose until one or both of your ears “pops”. Be careful not to try to hard, because you can damage your eardrums with this maneuver

Dr. Frenzel suggests holding your nose and repeated make the sound “kah” or “gah”

Dr. Toynbee seems to have gotten good results with holding his nose shut and trying to swallow repeatedly

- Steam from hot-water soaked paper napkins

Ask the flight attendant for a cup of hot water, and an extra empty cup, along with several napkins. Crumple a napkin in the bottom of the empty cup, and soak the napkin with some hot water. Hold the steaming soaked napkin up against the painful ear; I have not tried this, but people have reported substantial pain relief with this method

- Sucking on hard candy vs chewing gum

Hard candy is believed to work better, because it causes you to swallow more than with standard chewing gum

- Allowing a child to feed

Having a baby with an ear infection on the flight is no fun for the child or anybody else. The act of swallowing is the best way to vent the eustachian tube, so make sure you have plenty of fluids for the baby to drink

Seek Medical Care if:

- Severe pain

- Unable to hear after a flight, or persistent unusual ringing sound

- Bleeding or discharge from an ear

- Dizziness or “spinning” sensation

- Fever, headache, confusion

Have a good flight!

Stress isn't a "thing"

By Ns1ghter Provider: Allison Godchaux MD

As I tell my patients, stress isn’t a ‘thing’. It isn’t like having the ‘flu’ or having a headache, or having your back hurt. Stress isn’t ‘a thing’ it is a reaction to things that happen to us in our everyday world. It is how our body reacts to what it senses is a threat to our well-being.

 For example, think back to the caveman days. A bear is chasing you, and your body goes into the normal “stress” (fight or flight—in this case, flight) reaction. And you run. If you run fast enough, you escape from the bear, and your stress goes away. If you don’t run fast enough, stress is not your biggest problem! Not being the bear’s next meal, is!

To help your body run away from this ‘threat’, it does a number of things. Your body increases the amount of ‘stress’ hormones (adrenalin, noradrenaline and cortisol), to help you run away from the bear. An increase in these hormones causes the following things to occur in your body:

- Heart rate, and therefore, output of blood from the heart increases

 (in medical terms, cardiac output)

- Respiration (the amount you breathe) increases.

- Blood vessels dilate that go to your arms and legs, carrying more oxygenated blood to your muscles (very necessary, of course, for running as fast as you possibly can!)

- Sugar is released into the bloodstream by the liver (glycogen—you may have read about it) to give you the energy you need.

- The stomach produces more acid to digest whatever is in it, and empty itself. (ever try to run fast with a full stomach?)

- Muscles tense up, allowing them to function optimally.

As you successfully run away from the bear, your body reabsorbs the chemicals it had been putting out, and you, thankfully, having escaped, and return to a more normal physiological state.

But what if it isn’t the bear that is the problem, what if it is too many deadlines, or responsibilities, too many bills to pay, the daily drive in traffic, a sick child or parent, in a day that is already filled with other responsibilities….

The problem isn’t that there is a bear chasing us—either you outrun the bear—or you don’t, but, in either case, the stress is over pretty quickly, either way. The problem is when “the bear never stops chasing us,” that the “chronic” stress response becomes a greater problem than escaping the bear! That wasn’t how it was meant to be.

With long-term stress what we begin to see is: our blood pressure goes up and we have high blood pressure; our blood sugars go up, and we become diabetic; we have tension or migraine headaches from the constant muscle tension;  and stomach ulcers from all that acid we’re producing.  

The immune system can be affected as well (adrenalin suppresses the immune system), and you get sick more often. Stress affects our sleep, and if we aren’t getting enough sleep, it makes everything that we have to deal with in life, that much worse.

So, you are stressed, or have stress? The question is, what can we do about it? Do the following:

1. Exercise – regular exercise; intentional exercise. Walking at work is great, but that is your body’s new normal, though every little bit helps. Up the ante! Burn off those chemicals that your body accumulates while stressed. And, with exercise, your body puts out endorphins. Endorphins are those “feel good” chemicals that are released into your blood stream by your brain, and that you want to have!! They make you; well, feel better—and can help decrease stress!

2. Yoga – it can help relax you, and you will learn deep breathing exercises, which can be used daily. It also puts out another feel-good chemical, serotonin, which helps lower cortisol, one of those chemicals that increase when stressed.

3. Eat a well balanced diet, if you need help with this, let us know. You have to give the body the fuel it needs to manage the stresses in your life!

4. Herbal supplements and teas are always a good ‘go to’. Both Chamomile and Lemon Grass tea have demonstrated benefit, but can cause drowsiness. Try making a cup of tea your daily activity. No multi-tasking but drinking a relaxing cup of tea. Enjoy the stress relief from the affects of the tea, and for taking a moment of time for yourself.

5. Make time for sleep. It is important!

6. Consider seeing a therapist. If you feel you need a medicine to help manage your stress and anxiety, you may be right! But, don’t forget the counseling to go along with it. I much prefer that my patients learn how to deal with the stress and anxiety in life, than to have to take medications, with their potential side effects.  

7. Take medications, if you have to. Think about what your future holds, in the area of stress. The problems in our lives will never go away. We will always have them. Do you want to commit yourself to a lifetime of dependency on medication to deal with these stressors? Or would you prefer to learn how to manage those stressors? If you feel the need to take prescription medicine in the short term, don’t forget that therapy can help you learn how to manage the stress for the long term!

Mindfulness and your health

By Ns1ghter Provider: Joseph Accursio MD

Let’s talk philosophically for a few minutes. Believe it or not, your ideas about healthcare profoundly impact the way you go about your daily life. Your health plays an undeniable and immediate role in your function at work, at home, during exercise…in everything that you do. And that’s why it is so important for us to change the way we think about health and healthcare. 


If you follow health news in any form or fashion, you’ve likely seen the latest buzzword, which gains increasing popularity everyday – the word is “mindfulness.” There are many definitions and attachments to this word because it’s the latest thing. But what exactly is mindfulness? And how can you use it to improve your health and performance? 
Boiled down to the simplest definition, mindfulness can be explained in two words – PAY ATTENTION! This sounds rather silly, but in hindsight, evidence of people not paying attention to what their body is telling them and how they’re feeling is quite common. Let me give you some examples: 


• The holidays roll around. You hear constantly around the office that people have “put on a few pounds” over the holidays and they just have get back in the gym to take that weight off. But every year, it’s a few more pounds MORE than it was last year.
• Life gets busy. Responsibilities temporarily increase and the time to prepare and eat meals takes a back seat to convenience. You swear that you’ll get back to “eating right” sooner or later, but before you know it, a LONG amount of time has passed and you’re still eating from a drive thru window. You’ve been more tired “lately” and just can’t seem to catch up.
• How often have you heard or made the statement about “getting back in shape”? Whether due to things noted above or another life circumstance, it’s pretty common to hear people discuss returning to a prior state of health. In most cases, people have been so “out of shape” for so long, that returning to the mythical “in-shape” is unlikely. 


These examples are not meant to be all inclusive, but to bring awareness to the fact that we generally only pay attention to our health when something has gone wrong and has been affecting us in significant ways.


Here is the core idea behind mindfulness, which is again, paying regular attention to your health. If we gave as much thought to our health as we did to so many electronic devices, we would have a lot less problems and be much better off for it. Ironically, this is the best use of fit-bit type devices. Though research has been less that stellar regarding fit-bit use, they do provide a conscious reminder of how much we move and other indications of health and wellness. 


Admittedly, paying attention to something that’s so obvious and easy to forget is an exercise in discipline. The discipline of reorganizing priorities. The first step to change and the initial period required to ingrain a positive habit is the most difficult. Here are some suggestions to help you achieve a better health awareness or mindfulness:
1. To start with, you’ll have to write this down! Make sticky notes, program your phone with alarms, keep a journal…whatever it is that helps you to remember. DO IT! BE DILIGENT! There is little in your day that is more valuable than your overall health.
2. You will need a support system. As human beings, change is extraordinarily difficult without external support. We simply don’t have it in us to make big changes without help. Recruit some help! People who are invested in you – close family or friends. Even better, people in whom you are invested, and will undertake a journey of health consciousness alongside you. Support is CRUCIAL to success!
3. Don’t be afraid to fail. You will fail. Often. That’s the way of it. But don’t see failures as the end. See them as a small challenge that is overcome by the next success. Keep at it! As the maxim goes, success is 90% perspiration and 10% inspiration. THERE’S NO SUBSTITUTE FOR WORKING AT IT!