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Tag: Health

  • This Week in Health: Restless Legs Syndrome

    This Week in Health: Restless Legs Syndrome

    Restless Legs Syndrome

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    Overview

    Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.

    Restless legs syndrome, also known as Willis-Ekbom disease, can begin at any age and generally worsens as you age. It can disrupt sleep, which interferes with daily activities.

    Causes

    Often, there’s no known cause for RLS. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine, which sends messages to control muscle movement.

    Heredity

    Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

    Pregnancy

    Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women get RLS for the first time during pregnancy, especially during their last trimester. However, symptoms usually disappear after delivery.

    Risk factors

    RLS can develop at any age, even during childhood. The disorder is more common with increasing age and more common in women than in men.

    RLS usually isn’t related to a serious underlying medical problem. However, it sometimes accompanies other conditions, such as:

    • Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.
    • Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods, or repeatedly donate blood, you may have iron deficiency.
    • Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in your blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
    • Spinal cord conditions. Lesions on the spinal cord as a result of damage or injury have been linked to RLS. Having had anesthesia to the spinal cord, such as a spinal block, also increases the risk of developing RLS.

    Symptoms

    The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS include:

    • Sensations that begin after rest. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
    • Relief with movement. The sensation of RLS lessens with movement, such as stretching, jiggling your legs, pacing or walking.
    • Worsening of symptoms in the evening. Symptoms occur mainly at night.
    • Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.

    Diagnosis & Treatment

    Initial Diagnosis

    Your doctor will take your medical history and ask for a description of your symptoms. A diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

    • You have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations.
    • Your symptoms start or get worse when you’re resting, such as sitting or lying down.
    • Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
    • Your symptoms are worse at night.
    • Symptoms can’t be explained solely by another medical or behavioral condition.

    Advanced Diagnosis

    Your doctor may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes for your symptoms.

    In addition, your doctor may refer you to a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn’t require a sleep study.

    Initial Treatment

    Lifestyle and home remedies

    Making simple lifestyle changes can help alleviate symptoms of RLS:

    • Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
    • Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.
    • Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get at least seven hours of sleep nightly.
    • Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it or working out too late in the day may intensify symptoms.
    • Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate, coffee, tea and soft drinks, for a few weeks to see if this helps.
    • Consider using a foot wrap. A foot wrap specially designed for people with RLS puts pressure under your foot and may help relieve your symptoms.

    Advanced Treatment

    Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of RLS. Correcting an iron deficiency may involve receiving iron supplementation orally or intravenously. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.

    Medications

    Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

    • Medications that increase dopamine in the brain. These medications affect levels of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.

      Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.

    • Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS.
    • Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples include tramadol (Ultram, ConZip), codeine, oxycodone (Oxycontin, Roxicodone, others) and hydrocodone (Hysingla ER, Zohydro ER).
    • Muscle relaxants and sleep medications. These drugs help you sleep better at night, but they don’t eliminate the leg sensations, and they may cause daytime drowsiness. These medications are generally only used if no other treatment provides relief.

    It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

    Primary Source: Mayo Clinic

  • This Week in Health: Skin Cancer

    This Week in Health: Skin Cancer

    End of Summer

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    Three Main Types of Skin Cancer

    Basil Cell Carcinoma
    Squamous Cell Carcinoma
    Melanoma

    Overview

    Skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumors. The main types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma.  Merkel cell carcinoma (MCC) is a less common but very aggressive form that has seen increasing numbers of cases.

    The two main causes of skin cancer are the sun’s harmful ultraviolet (UV) rays and the use of UV tanning machines. The good news is that if skin cancer is caught early, your dermatologist can treat it with little or no scarring and high odds of eliminating it entirely. Often, the doctor may even detect the growth at a precancerous stage, before it has become a full-blown skin cancer or penetrated below the surface of the skin

     

    Diagnosis & Treatment

    Diagnosis

    Any new or unusual skin growths should be examined by a dermatologist.

    Biopsies can confirm a diagnosis.

    Treatment

    When caught early, most skin cancers such as BCC and SCC can be removed via minimally invasive surgical excision.

    If the lesion has become large, or is a more aggressive form such as melanoma, much larger areas of surrounding tissue may need to be removed. This can produce significant scarring and deformity.

    Melanoma in particular can often metastasize (spread to other organs of the body), and may require even more aggressive forms of treatment such as immunotherapy, chemotherapy, and radiation therapy

    Prevention

    Prevention and early intervention are the most important aspect of skin cancer treatment.

    • Wear UV blocking sunscreen
    • Avoid extended exposure to the sun
    • Examine your skin routinely
    • See a dermatologist annually for a professional skin exam

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Plantar Fasciitis

    This Week in Health: Plantar Fasciitis

    Plantar Fasciitis

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    Overview

    Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

    Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

    Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis

    Causes

    Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia. Sometimes the development of a bone spur on the heel (calcaneal spur) can contribute to the inflammation, although the cause remains unclear in many cases of plantar fasciitis, and often these spurs remain completely asymptomatic

    Diagnosis & Treatment

    Initial Diagnosis

    Plantar fasciitis is typically diagnosed based on your medical history and physical examination. During the exam, your doctor will check for areas of tenderness in your foot. The location of your pain can help determine its cause.

    Advanced Diagnosis

    Usually no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure another problem, such as a stress fracture, is not causing you pain.

    Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

    Initial Treatment

    Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.

    Medications

    Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may ease the pain and inflammation caused by plantar fasciitis.

    Therapies

    Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

    • Physical therapy. A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
    • Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.
    • Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

    Advanced Treatment

    Injections

    Injecting steroid medication into the tender area can provide temporary pain relief. Multiple shots aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound imaging, platelet-rich plasma obtained from the patient’s own blood can be injected to promote tissue healing.

    Extracorporeal shock wave therapy

    In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. Some studies show promising results, but it hasn’t been shown to be consistently effective.

    Ultrasonic tissue repair

    This minimally invasive technology was developed in part by Mayo Clinic doctors. It uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. Using ultrasound energy, the probe tip vibrates rapidly to break up the damaged tissue, which is then suctioned out.

    Surgery

    Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

    Prevention

    To reduce the pain of plantar fasciitis, try these self-care tips:

    • Maintain a healthy weight. Carrying extra weight can put extra stress on your plantar fascia.
    • Choose supportive shoes. Buy shoes with a low to moderate heel, thick soles, good arch support and extra cushioning. Don’t walk barefoot.
    • Don’t wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet.
    • Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
    • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day. Icing can help reduce pain and inflammation.
    • Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

    Primary Source: Mayo Clinic

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • HEALTH: Computer Ergonomics

    HEALTH: Computer Ergonomics

    Ergonomic Tips for Computer Users

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    Overview

    Ergonomics is the study of the relationship between people, their work tasks, and their physical work environment. It attempts to reduce strain, fatigue, and injuries by improving product design and workspace arrangement. The goal is a comfortable, relaxed posture.

    Many people spend hours a day in front of a computer without thinking about the impact on their bodies. They physically stress their bodies daily without realizing it by extending their wrists, slouching, sitting without foot support and straining to look at poorly placed monitors.

    These practices can lead to cumulative trauma disorders or repetitive stress injuries, which create a life-long impact on health. Symptoms may include pain, muscle fatigue, loss of sensation, tingling and reduced performance.

    Compare These Two Workstations

    Adapt Your Workspace

    Posture And Positioning

    • Maintain good posture when working at the keyboard. Utilize a chair with back support. 
    • Keep your feet supported on the floor or on a footrest when you work to reduce pressure on your lower back
    • Avoid twisting or bending your trunk or neck. Frequently used items should be positioned directly in front of you and angled upward on a copyholder when working. 
    • Keep your shoulders relaxed with your elbows close to your sides.
    • Avoid resting your elbows on the hard surface or edge of your table. Pads can be used to protect your elbows if necessary.
    • Elbows should be positioned at 100 to 110 degrees when working in order to keep a relaxed position at the keyboard. This could require a slight negative tilt (front of keyboard higher than back) when working in upright positions. If reclined in your chair, the keyboard could be at a positive angle to maintain this relaxed position.
    • Your wrists should be in a neutral or straight position when keying or using a pointing device or calculator. Wrist rests can assist you in maintaining a neutral position when used properly during pauses. Float your arms above the keyboard and wrist rest when keying. Avoid planting your wrists on the table or wrist rest. This can result in bending the wrists either up and down or side to side.
    • Take breaks. These breaks can be brief and should include stretches for optimal results. If possible, take a one or two-minute break every 15 to 20 minutes, or a five-minute break every hour. Every few hours, get up, move around, and do an alternative activity.

    Laptop Considerations

    Laptop computers are not ergonomically designed for prolonged use. The monitor and keyboard are so close together that they cannot both be in good positions at the same time. For prolonged use, it’s best to add a separate monitor and keyboard. The laptop can be planced on books so the top of the screen is at eye level, then use an external keyboard so that your elbows can rest at 90° by your side. 

    Don’t be THIS guy

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Oh My Aching Head

    This Week in Health: Oh My Aching Head

    Migraine Headaches

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    Introduction

    Migraine management is a weighty topic to cover in this segment, so – in the interests of keeping it manageable – this will be just a brief summary. 

    I chose this topic today to highlight the fact that – after decades of a stagnant treatment algorithm – several new treatment strategies have emerged in the last couple of years, and these have become game-changers for many.

    This piece will focus on classic (with aura) and common (without aura) migraine management. There are several other uniques classifications of migraine, such as cluster migraines, but they are beyond the scope of this article.

    Overview

    Migraine is a leading cause of disability worldwide. Approximately 15% of Americans experience migraines. Most people who have migraines feel that people who do not have them often underestimate their condition. Migraines affect people’s quality of life and ability to participate in work, family, and social events. 

    Migraine is a common episodic disorder, the hallmark of which is a disabling headache generally associated with nausea, and/or light and sound sensitivity. It can also become a chronic condition, defined as: greater than 15 headache days per month, lasting greater than 4 hours and sometimes for multiple days per episode.

    Some people even develop chronic daily migraine headaches.

    Symptoms and Causes

    A migraine can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days, and the pain can be so severe that it interferes with your daily activities.

    For some people, a warning symptom known as an aura occurs before or with the headache. An aura can include visual disturbances, such as flashes of light or blind spots, or other disturbances, such as tingling on one side of the face or in an arm or leg and difficulty speaking.

    Though migraine causes aren’t fully understood, genetics and environmental factors appear to play a role.

    Changes in the brainstem, and its interactions with the trigeminal nerve (a major pain pathway), might be involved. So might imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system.

    Researchers are studying the role of serotonin in migraines. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).

    There are a number of migraine triggers, including:

    • Hormonal changes in women
    • Drinks – including alcohol (especially wine) and caffeine
    • Stress
    • Sensory stimuli
    • Sleep changes
    • Physical factors
    • Weather changes
    • Medications
    • Foods
    • Food additives

    Diagnosis & Treatment

    Initial Diagnosis

    If you have migraines or a family history of migraines, a doctor trained in treating headaches will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.

    Advanced Diagnosis

    If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:

    • MRI. An MRI scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. 
    • CT scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain.

    Treatment

    Migraine treatment involves acute (abortive) and preventive (prophylactic) therapy. Patients with frequent attacks usually require both. Measures directed toward reducing migraine triggers are also generally advisable.

    Acute treatment aims to reverse, or at least stop, the progression of a headache that has started. Preventive treatment, which is given even in the absence of a headache, aims to reduce the frequency and severity of the migraine attack, make acute attacks more responsive to abortive therapy, and perhaps also improve the patient’s quality of life.

    Acute (abortive)

    • Reduce migraine triggers
    • Non-pharma treatment devices
      • Cerena TMS (with some limits)
      • vNS
      • REN
    • NSAIDs
    • Ergots
    • Triptans
    • CGRP antagonists
      • Ubrelvy
      • Nurtec ODT
    • Ditans (5-HT1F agonists)
      • Reyvow

    Preventive (prophylactic)

    • Antiepileptics

    • Antidepressants

    • Antihypertensives

    • Botulinum toxin

    • Calcitonin gene-related peptide (CGRP) inhibitors
      • Aimovig 
      • Ajovy 
      • Emgality 
      • Vyepti

    The treatments listed in red are relatively new and have added additional valuable avenues toward migraine relief.

    Here is an excellent reference article that provides more detailed information: Migraine Headache Treatment and Management

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • Health: Hotter than Hell?

    Health: Hotter than Hell?

    Heat Exhaustion & Heat Stroke

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    Overview

    Prolonged or intense exposure to hot temperatures can cause heat-related illnesses such as heat exhaustion, heat cramps, and heat stroke (also known as sun stroke). As your body works to cool itself under extreme or prolonged heat, blood rushes to the surface of your skin. As a result, less blood reaches your brain, muscles, and other organs. This can interfere with both your physical strength and your mental capacity, leading, in some cases, to serious danger.

    Heat-related illness can strike anyone. But chronic alcoholics, the elderly, the young, the obese, and individuals whose immune systems may be compromised are at greater risk, as are individuals taking certain drugs, such as antihistamines, antipsychotic medications, and cocaine. High humidity also increases the risk of heat illness because it interferes with the evaporation of sweat, your body’s way of cooling itself. The reasons that people have heat related illnesses can be broken into two main categories: 

    • Exercise-associated heat exhaustion or heat stroke and
    • Non-exertional classic heat stroke

    Heat exhaustion, heat cramps, and heat stroke all occur when your body cannot cool itself adequately. But each is slightly different.

    Heat cramps can strike when the body loses excessive amounts of fluids and salt. This deficiency, accompanied by the loss of other essential nutrients such as potassium and magnesium, typically occurs during heavy exertion.

    Heat exhaustion occurs when the body loses larger amounts of water and salt through excessive sweating, particularly through hard physical labor or exercise. This loss of essential fluids can disturb circulation and interfere with brain function. Individuals who have heart, lung, or kidney problems or are on low-sodium diets may be particularly susceptible to heat exhaustion.

    Heat stroke, the most serious of the heat-related illnesses, occurs when the body suffers from long, intense exposure to heat and loses its ability to cool itself. In prolonged, extreme heat, the part of the brain that normally regulates body temperature malfunctions. There is a decreases in the body’s ability to sweat and, therefore, cool down. Those who have certain medical conditions that decrease the body’s ability to sweat — such as scleroderma or cystic fibrosis — may be at greater risk of developing heat stroke

    Source: WebMD

    Symptoms

    Heat Cramps: 

    • Severe, sometimes disabling, cramps that typically begin suddenly in the hands, calves, or feet
    • Hard, tense muscles

    Heat Exhaustion:

    • Fatigue
    • Nausea
    • Headache
    • Excessive thirst
    • Muscle aches and cramps
    • Drenching sweats, often accompanied by cold, clammy skin or a sensation of prickly skin
    • Confusion or anxiety
    • Weakness
    • Slowed or weakened heartbeat
    • Dizziness
    • Fainting
    • Agitation

    Heat Stroke:

    • Nausea and vomiting
    • Headache
    • Dizziness or vertigo
    • Fatigue
    • Hot, flushed, dry skin
    • Rapid heart rate
    • Dry skin
    • Profound sweating
    • Shortness of breath
    • Decreased urination
    • Blood in urine or stool
    • Increased body temperature (104 degrees to 106 degrees F)
    • Confusion, delirium, or loss of consciousness
    • Convulsions

    Diagnosis & Treatment

    Diagnosis

    Observation or experience of any of the above symptoms

    Initial Treatment

    • Heat stroke: Call 911 if any heat stroke symptoms are present.
    • Heat exhaustion and heat cramps: If symptoms get worse or do not improve in an hour, call 911.

    Advanced Treatment

    Heat stroke

    The best treatment for heat stroke is immediate cooling in an ice bath. It takes ice and water to efficiently cool the body. Do not delay. If heat stroke occurs at a location where an ice bath is not possible, move the individual to a cool area if indoors or a cool, shady area if outdoors. Loosen or remove the person’s clothing. Have the person lie down and slightly elevate the feet. Cool the person as quickly as possible. Wet the person’s skin with cool water, place cool cloths or ice all over the body, spray the person with a garden hose or soak the person’s clothes with cold water. Check the person’s temperature and continue these efforts until his/her temperature is 101°F or lower. Do NOT give the person fluids to drink. Continue your efforts until medical help arrives.

    Heat exhaustion

    While waiting for medical help, move the individual to a cool area if indoors or to a cool, shady area if outdoors. Give the person cool water to drink in small sips. Cool head, face, and neck with cold ice packs, cold cloths or cold water. When symptoms improve, take the individual to a clinic or emergency room to be seen by a nurse or doctor.

    Heat cramps

    Heat cramps usually can be treated by rest and fluids. The person should stop the activity and rest in a cool place. Have him/her drink apple or grape juice or a sports drink in small sips every 15 to 20 minutes. He or she should rest for several hours before going back to work or exercise.

    Prevention

    Everyone should take these steps to prevent heat-related illnesses, injuries, and death during hot weather:

    • Stay in an air-conditioned indoor location as much as you can.
    • Drink plenty of fluids even if you don’t feel thirsty.
    • Schedule outdoor activities carefully.
      • Wear loose, lightweight, light-colored clothing and sunscreen.
      • Pace yourself.
    • Take cool showers or baths to cool down.
    • Check on a friend or neighbor and have someone do the same for you.
    • Never leave children or pets in cars.
    • Check the local news for health and safety updates.

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Vitamin D deficiency

    This Week in Health: Vitamin D deficiency

    Vitamin D Deficiency

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    Overview

    Vitamin D isn’t a single chemical – in fact, technically it’s not actually a vitamin at all – but rather a group of fat-soluble hormones responsible for enhancing intestinal absorption of calcium, iron, magnesium, phosphate, and zinc.

    Your body makes vitamin D when direct sunlight (specifically UV rays) converts a chemical in your skin into an active form of the vitamin. Calcium, the primary component of bone, can only be absorbed by your body when vitamin D is present. 

    You can also get Vitamin D through dietary intake. Though not found in many foods, it can be obtained through ingestion of fortified milk, fortified cereal, and fatty fish such as salmon, mackerel and sardines.

    In addition to bone health, getting enough vitamin D may also play a role in  protecting against the following conditions (and increasing vitamin D levels may help to treat them). These conditions can include:

    • Heart disease and high blood pressure.
    • Diabetes.
    • Infections and immune system disorders.
    • Falls in older people.
    • Some types of cancer, such as colon, prostate and breast cancers.
    • Multiple sclerosis.

    Persons commonly at risk for vitamin D deficiency include those with inadequate sun exposure, limited oral intake via diet, or impaired intestinal absorption (as seen with Crohn’s disease, Celiac disease, or in those who have had weight loss surgery).

    Other factors that contribute to vitamin D deficiency:

    • Age: The skin’s ability to make vitamin D lessens with age.
    • Mobility: People who are homebound or are rarely outside (for example, people in nursing homes and other facilities) are not able to use sun exposure as a source of vitamin D.
    • Skin color: high-melanin (dark) skin is less able to make vitamin D than low-melanin (fair) skin.
    • Medications:
      • Laxatives.
      • Steroids (such as prednisone).
      • Cholesterol-lowering drugs (such as cholestyramine and colestipol).
      • Seizure-control drugs (such as phenobarbital and phenytoin).
      • A tuberculosis drug (rifampin).
      • A weight-loss drug (orlistat).

    Symptoms

    Severe lack of vitamin D in children causes rickets, showing up as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is rare in developed countries due to fortification of milk and other foods with Vitamin D

    Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:

    • Fatigue.
    • Bone pain.
    • Muscle weakness, muscle aches, or muscle cramps.
    • Mood changes, like depression.

    Diagnosis & Treatment

    Diagnosis

    A simple serum (blood) level can be drawn – most commonly the  25-hydroxyvitamin D, known as 25(OH)D for short.

    A “normal” level varies depending on the lab’s reference values, but is generally considered to be 32 to 100 ng/ml.

    Treatment

    Adequate intake:  

    Vitamin D consists of 2 bioequivalent forms. 

    Vitamin D2, also known as ergocalciferol, is obtained from dietary vegetable sources and oral supplements. 

    Vitamin D3, also known as cholecalciferol, is obtained primarily from skin exposure to ultraviolet B (UVB) radiation in sunlight, but can also be obtained via ingestion of food sources such as oily fish and variably fortified foods (milk, juices, margarines, yogurts, cereals, and soy), and oral supplements. 

    Supplements:

    D2 – Can be had via prescription from your health provider

    D3 – better absorbed than D2, this is typically an over the counter supplement

    How much you would require depends on your serum level.

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • Health: What’s Bugging You?

    Health: What’s Bugging You?

    What’s Bugging You?

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    Since it is summer, and many of us are spending time outdoors, it is time we turn our attention to the things that can “getcha” and cause illness, that aren’t the Covid-19 virus

    Overview

    Insect-borne diseases are viral and bacterial illnesses that pass to humans either from insect (bug) bites or by the deposition of their feces/larvae on the skin. The most common insects that pass on disease are mosquitoes, ticks, sand flies, house flies, fleas and bedbugs. For example, mosquitoes are known for spreading the Zika virus, Yellow Fever, and Malaria. Ticks are known to spread Lyme disease and Rocky Mountain spotted fever.

    Risk Factors

    You increase your risk of being infected by an insect when you are in areas where they gather. This would include tall grass, bushes, spots near still water (ponds), and places around the globe with heavy outbreaks. It can also include your home and living spaces if you fail to clean and maintain them, especially in the case of fleas and bedbugs.

    Many Known Culprits

    Mosquitoes

    In North America, the most common mosquito-born diseases are:

    • West Nile Virus
    • Zika
    • Dengue fever
    • Malaria (rare in the US)

    Their flight can be more or less noisy; their bite is not always painful. Half of all mosquito bites occur through clothing. Only the females bite – they draw blood from their victims in order to nourish their eggs. Male mosquitoes generally do not buzz and are completely harmless.

    Ticks

    In North America, the most common tick-borne diseases are:

    •  Lyme disease
    • Meningoencephalitis 
    • Spotted Fevers

    Tick bites result from contact with grassland. This risk is generally restricted to certain well-defined regions. Once the ticks are on the skin, they migrate towards the major skin folds (groin, armpits) where they implant themselves. They do not begin to feed until 12 to 24 hours have passed and so the risk of infection is low if they are quickly removed. It is best to use tweezers or some other precision implement to remove them rather than fingers – if the tick has begun to feed, avoid puncturing its body during removal.

    Flies, Midges

    In North America most fly-borne illnesses are from the common house fly, and are transmitted by some form of fecal contamination of food or water, either directly or indirectly, These include:

    • Typhoid Fever
    • Cholera
    • Shigella
    • E. coli
    Bedbugs

    A common bedbug-borne illness is also transmitted by the bug’s feces, not the bite. Bedbugs feed at night on their sleeping victims. A bedbug infestation can be incredibly difficult to remove: if you discover them in your home, prepare to discard your bed and bedding at a minimum, and you will likely need to fumigate your entire house.

    • American Trypanosomiasis (Chagas’ Disease)
    Fleas, Lice

    Lice transmit different bacterial infections: 

    • bartonellosis (Trench fever),
    • borrelliosis (relapsing fever)
    • certain types of rickettsiosis 

    Rat fleas are a vector for:

    • Plague

    Symptoms of insect-borne diseases

    Symptoms will vary depending upon the type of insect that has bitten you. Common symptoms of insect borne diseases can include:

    • fever
    • chills
    • headache
    • sore muscles
    • skin rash
    • nausea
    • stomach pain

    More serious symptoms can include:

    • difficulty breathing
    • the feeling that your throat is closing
    • swelling of your lips, tongue, or face
    • chest pain
    • a racing heartbeat that lasts more than a few minutes
    • dizziness
    • vomiting

    Diagnosis & Treatment

    Initial Diagnosis

    Your doctor can typically diagnose an insect-borne disease with a physical exam, a review of your symptoms, and a look at your recent travel destinations.

    Advanced Diagnosis

    Lab tests (blood and urine) can diagnose certain insect-borne diseases.

    Initial Treatment = PREVENTION

    There are many actions you can take to reduce the threat of being infected by an insect. You should:

    • Stay out of tall grass and bushes.
    • Dress in long pants, long sleeves, and a hat if you must be in tall grass and bushes. Tuck your pants into long, white socks.
    • Wear light-colored clothing. This makes it easier to spot insects.
    • Use bug spray that contains the ingredient DEET.
    • Examine your skin and scalp when you get back in to check for bugs or bites. Always shower with plenty of soap after being in the outdoors. Ideally don’t go into areas known to be insect hotspots alone; you and your companion(s) can check each other for attached insects.
    • Pay attention to outbreaks through the travel health notices posted by the Centers for Disease Control and Prevention (CDC). If you can, avoid travel to those places during outbreaks.

    Advanced Treatment

    Various treatments exist for these diseases

    1. Medications (usually antibiotics, or in the case of malaria, antibiotics and quinine).  These can be used for both treatment of active disease as well as prophylaxis when going into an endemic area

      • Lyme Disease
      • Spotted fevers
      • Malaria 

    2. Symptomatic support – treating the fevers, rashes, and aches

      • Meningoencephalitis
      • Dengue fever
      • West Nile virus
      • Yellow Fever

    3. Preventive Vaccines

      • Meningoencephalitis
      • Yellow fever
      • Studies underway for Dengue fever and West Nile disease

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Insomnia

    This Week in Health: Insomnia

    Insomnia – or why the hell can’t I sleep?

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    Overview

    Insomnia is a common sleep disorder in which sufferers find it hard to fall asleep, or stay asleep long enough.

    Exactly how much sleep is enough is subjective, but most adults need seven to eight hours a night.

    Many adults will experience short-term (acute) insomnia, which lasts for days or weeks, at some point in their lives; usually the result of acute stress or trauma. But some people have long-term (chronic) insomnia that lasts for a month or more. 

    Insomnia symptoms may include:

    • Difficulty falling asleep at night
    • Repeatedly waking up during the night
    • Waking up too early
    • Not feeling well-rested after a night’s sleep
    • Daytime tiredness or sleepiness
    • Irritability, depression or anxiety
    • Fatigue related issues such as the inability to focus
    • Ongoing worries about sleep

    Complications of insomnia may include:

    • Lower performance on the job or at school
    • Slowed reaction time while driving and a higher risk of accidents
    • Mental health disorders, such as depression, an anxiety disorder, or substance abuse
    • Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease

    Many Possible Reasons for Insomnia

    Insomnia may be the primary problem, but it may also be the result of other conditions.

    Common causes of chronic insomnia include:

    • Stress. 
    • Travel or work schedule. 
    • Poor sleep habits. 
    • Eating too much late in the evening. 

    Chronic insomnia is usually a result of stress, life events, or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

    Additional common causes of insomnia include:

    • Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
    • Medications. 
      • certain antidepressants 
      • medications for asthma or blood pressure. 
      • Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products 
    • Medical conditions.
      • chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
    • Sleep-related disorders.
      • Sleep apnea 
      • Restless legs syndrome 
    • Caffeine, nicotine and alcohol. 

    Insomnia and aging

    Insomnia becomes more common with age. As you get older, you may experience:

    • Changes in sleep patterns. 
    • Changes in activity. 
    • Changes in health. 
    • More medications

    Diagnosis & Treatment

    Diagnosis

    • Physical exam. 
    • Sleep habits review. 
    • Sleep study. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

    Initial Treatment

    Prevention

    Good sleep habits can help prevent insomnia and promote sound sleep:

    • Keep your bedtime and wake time consistent from day to day, including weekends.
    • Stay active — regular activity helps promote a good night’s sleep.
    • Check your medications to see if they may contribute to insomnia.
    • Avoid or limit naps.
    • Avoid or limit caffeine and alcohol, and don’t use nicotine.
    • Avoid large meals and beverages before bedtime.
    • Make your bedroom comfortable for sleep and only use it for sex or sleep.
    • Create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music.

    Advanced Treatment

    Cognitive behavioral therapy for insomnia

    • Stimulus control therapy.  Remove factors that condition your mind to resist sleep. 
    • Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises 
    • Sleep restriction. Avoid naps
    • Remaining passively awake.  Getting in bed and trying to stay awake rather than expecting to fall asleep.
    • Light therapy. To adjust your internal clock

    Prescription medications

    Examples include:

    • Eszopiclone (Lunesta)
    • Ramelteon (Rozerem)
    • Zaleplon (Sonata)
    • Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

    Prescription sleeping pills can have side effects, such as causing daytime grogginess and increasing the risk of falling, or they can be habit-forming.

    Over-the-counter sleep aids

    • Antihistamines
    • Melatonin supplements

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • HEALTH: Let’s Talk About our Aching Joints

    HEALTH: Let’s Talk About our Aching Joints

    Joint Pain

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    With Many Potential Sources

    The most common of these is Osteoarthritis.

    Others include (but are not limited to): Rheumatoid Arthritis, Sprains, Tendinitis, Bursitis, Dislocation, Gout, Lyme Disease, Fibromyalgia, Avascular Necrosis, and Metastatic Cancer.

    For the purposes of this post, we will be focusing on Osteoarthritis 

    Overview

    Osteoarthritis (OA) is the most common form of arthritis. It affects over 32.5 million US adults.

    Some people call it degenerative joint disease, or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.

    With the onset of OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly, and get worse over time. OA can cause pain, stiffness, and swelling, and – in more severe cases – it can reduce joint function to the point of disability: some chronic sufferers are no longer able to do daily tasks or work.

    Symptoms generally include:

    • Persistent joint pain.
    • Stiffness.
    • Decreased range of motion (or flexibility).
    • Swelling.

    Risk factors for OA include:

    • Injury 
    • Overuse—defined as heavy or repetitive stress on a particular joint.
    • Age
    • Gender—Women are more likely to develop OA than men, especially after age 50.
    • Obesity—extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. Obesity may also have metabolic effects that increase the risk of OA.
    • Genetics—OA is hereditary; further, having OA in one joint increases the risk factors for other joints.
    • Race— Some Asian populations have lower risk for OA.

    See Also: This Week in Health: Low Back Pain

    Diagnosis & Treatment

    Initial Diagnosis

    Basic history and physical exam is the starting point.

    X-rays are invaluable in identifying changes in the internal bone structure and/or joint space narrowing consistent with OA.

    Serum lab studies can rule out any systemic inflammatory conditions (such as rheumatoid arthritis, etc).

    Advanced Diagnosis

    MRI imaging can identify any muscle, cartilage, ligament, or tendon injuries that might contribute to the condition.

    Initial Treatment

    • Increasing physical activity.
    • Physical therapy with muscle strengthening exercises.
    • Weight loss.
    • Medications, including over-the-counter pain relievers and prescription drugs.
      •  Non-steroidal anti-inflammatory drugs (NSAIDS) – both oral and topical
      • EDIT to add: Supplements! (see comments below)
    • Supportive devices such as crutches or canes

    Advanced Treatment

    • Bracing
    • Corticosteroid injections
    • For knees, viscosupplementation injections
    • Nerve Blocks and radiofrequency ablation (RFA) (for spine joints, knees, and sacroiliac joints)
    • Experimental stem cell injections
    • Opioids (to be considered carefully, with risk stratification and close monitoring)
    • CBD products, both oral and topical, have some anecdotal evidence of benefit, but should only be used with full disclosure to one’s MD, and in accordance with State laws.
    • Surgery
      • Arthroscopic “clean-up”
      • Total or partial joint replacements

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

    Edited by: WhiteKnightLeo