Friday, January 25, 2013

What to Do If You Have the Flu

Flu season is in full swing this year, with thousands of Americans suffering from its symptoms. The Centers for Disease Control (CDC) has estimated that an average of 36,000 people in the U.S. die from influenza or from its complications each year. Influenza is particularly hard on the elderly, people with a weakened immune system, children, and those with chronic illnesses, such as emphysema and diabetes.

Several weeks ago, a Health Tip went out encouraging everyone 6 months or older to receive the flu immunization. As expected, most of this year's flu cases have occurred in those who were not vaccinated. Unfortunately, getting a flu shot does not guarantee that you will not get the flu. While immunization remains the most effective way of preventing the flu, recent statistics from the CDC indicates that the effectiveness of the vaccine this year is 62%. This means that if you received the vaccine you are about 60 percent less likely to get the flu, but not completely immune.

How do you know if you have the flu? Mild cases of the flu can be similar to a common cold, but typically, the flu is much more severe. Muscle aches, severe fatigue, cough and headache predominate over common cold symptoms of runny nose and sore throat. Characteristic of the flu also is fever (100-102 degrees F) that can last for three to four days. Of particular concern in those who contract the flu are its complications, including bronchitis and pneumonia, which are responsible for the majority of flu-related hospitalizations and deaths.

What you can do for the flu? Most people with the flu end up being miserable for a few days, but recover on their own. A number of non-prescription medications, while not treatments for the virus itself, can help with flu symptoms. Over-the-counter medications and self-care measures include:
  1. Limiting activity and getting plenty of rest.

  2. Staying hydrated by drinking water, sports drinks or electrolyte replacement fluids.

  3. Gargling salt water (1 : 1 ratio) or using throat lozenges for sore throat.

  4. Taking acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Advil®, Motrin®, others) for fever or muscle aches.

  5. Taking decongestants (Claritin-D, Sudafed, others) can ease discomfort from stuffy nose, sinuses, ears, and chest.

  6. Using cough medicine or cough drops for temporary relief from coughing.
It is important that aspirin be avoided in anyone under the age of 18 with the flu because of its association with Reye syndrome, a condition affecting the nervous system and liver. In most people, medical attention or antiviral drugs are generally not required.

When should someone seek medical attention? People at increased risk of serious flu-related complications, including young children, elderly persons, pregnant women and people with chronic illnesses, such as diabetes, should contact their medical provider with the first signs of an influenza infection. Emergency warning signs in children include difficulty breathing, bluish skin color, extreme irritability, inability to keep food or liquids down, and high fever. Adults with shortness of breath, confusion, chest or abdominal pain, and persistent vomiting should receive urgent medical care. Someone in whom flu symptoms improve initially but later develop worsening cough and fever may have a bacterial infection and should receive medical attention.

What is the doctor able to do? Antiviral medications are modestly effective in shortening the duration of the flu and may help to avoid complications. For these to work effectively, however, it is important to start treatment within 48 hours of the development of symptoms. Below are antiviral medications approved for treating adults and children one year and older:
  1. oseltamivir (Tamiflu)

  2. zanamivir (Relenza)

  3. amantadine (Symmetrel)

  4. rimantadine (Flumadine)
In December 2012, the U.S. Food and Drug Administration expanded the approved use of oseltamivir for treating children between the ages of 2 weeks to one year. Antibiotics used for bacterial infections, such as Ampicillin, Keflex, Cipro, etc., are not used to treat uncomplicated cases of the flu. These may be required, however, with certain flu-related complications, such as pneumonia or ear infections.

When can I return to work or school? The Centers for Disease Control recommends that people recovering from the flu stay at home for at least 24 hours after their fever is gone. While at home, flu victims should avoid contact with others in the household to keep them from getting sick. Also, frequent hand washing will help to keep from infecting others.

Monday, January 21, 2013

Recurrent Heartburn - reflux….or allergy?

As most people know, heartburn has nothing to do with the heart. It is typically caused by gastric reflux, the regurgitation of acid from the stomach into the lower portion of the esophagus (the tube that connects the mouth to the stomach). The name comes from the similarity in symptoms between reflux symptoms and those of a heart attack.

Many people experience occasional heartburn, triggered by a disagreeable food such as coffee, alcohol, tomatoes, spicy foods, or chocolate. Some people, however, have a chronic form of heartburn known as gastroesophageal reflux disease (GERD). In GERD, the sphincter (valve) that prevents the reflux of stomach acid into the esophagus does not function properly. While occasional heartburn is more of a nuisance, GERD can be a much more serious problem. Treatment for GERD typically involves taking antacids to neutralize stomach acid or acid blockers to reduce acid production on a regular basis.

Recently, a new cause for persistent heartburn has been recognized. This condition is known as eosinophilic esophagitis (EE) and is thought to have an allergic or immunologic cause. "Eosinophilic" refers to eosinophils, a type of white blood cell that accumulates in the esophagus in this condition. "Esophagitis" means that the esophagus has become inflamed, in part due to the accumulation of eosinophils. EE can cause all of the same symptoms as classic GERD but does not respond as well (or at all) to standard GERD treatments.

Most cases of EE have been diagnosed since the year 2000, with more cases being diagnosed each year. The increased incidence is primarily related to increased awareness and recognition of this disease. EE is thought to be allergy-related based on the presence of eosinophils which are often seen in increased numbers in other "allergic" conditions, such as asthma, eczema, and hay fever.

Since EE is much less common than GERD, making the diagnosis first requires suspicion as to its presence. Factors that increase the likelihood that someone has EE includes: 1) the presence of other allergic problems, such as asthma or eczema, 2) a family history of allergic conditions, and 3) a poor response to treatment with measures used for GERD. Another major distinguishing feature is that unlike GERD, difficulty swallowing or having food hang up occurs commonly.

Currently, diagnosis is made by taking tissue biopsies during endoscopy (esophagogastroduodenoscopy or EGD). This involves placing a tube-like instrument that contains a light and camera into the esophagus. Areas of the esophagus that are narrowed, red, or contain white spots are suggestive of EE and would be biopsied. The biopsy specimens are then inspected with a microscope looking for the presence and number of eosinophils. In the absence of other conditions, such as esophageal cancer, a high number of eosinophils in the tissue confirms the diagnosis of EE.

As with GERD, medication to reduce stomach acid production (Protonix, Nexium, Prilosec, Previcid, etc.) helps with EE symptoms. In the past, many people with EE required balloon dilation of the esophagus because of areas of narrowing (strictures) that were causing food to hang up. Most of these individuals had not specifically been diagnosed with EE but were thought to have strictures due to chronic reflux of stomach acid. More recently, with the information that this condition could be allergic in nature, treatment has changed dramatically. Along with medications to reduce acid production, dietary therapy and treatment with corticosteroid medication are currently being used.

Since EE can be related to a food allergy, skin or blood testing for sensitivity to common dietary allergens, such as dairy products, eggs, wheat, nuts, and fish is usually performed. If sensitivity to one or more of these foods is detected, they should be removed from the diet. A second dietary intervention involves an elimination diet. This requires the removal of foods that most commonly cause allergy symptoms (shellfish, eggs, wheat, etc.) from the diet. Assuming symptoms improve, foods are added back into the diet one at a time while monitoring for symptom recurrence. If a certain food appears to be causing symptoms, it may need to be permanently removed from the diet. Environmental allergens, such as pollens, molds, cat, dog and dust mite allergens may also be related to the development of EE.

Corticosteroid medications, similar to prednisone, are also effective for treating EE. Flovent (fluticasone propionate), an inhaled medication used in treating asthma, is the most commonly used steroid in this condition. Rather than inhaling the medication, however, it is swallowed. This helps to decrease the build-up of white blood cells in the walls of the esophagus and reduce inflammation.

If you have allergies and GERD, particularly if difficulty swallowing is a major feature, it may be a good idea to consult your doctor or discuss with an eDoc about the possibility that your symptoms are due to this recently recognized condition.

Monday, January 14, 2013

Enjoying your skiing vacation

Most of the sources that provide information on preparing for ski season focus on building physical endurance and strengthening specific muscles groups. I certainly have no arguments with a gradually increasing cardiovascular exercise program that incorporates some interval training, particularly for those in whom skiing represents a one or two week vacation. Likewise, strengthening exercises, focusing on the quadriceps (front of the thigh) muscles, hamstring (back of the thigh) muscles, and “core” muscles (abdominals, lower back, etc.) will also help with being able to perform what for most people is an infrequent and not altogether familiar activity.

As someone who averages around 60 days on various types of skis each winter, however, I would like to offer a little different perspective on how best to prepare for and enjoy a ski area vacation.

1) Prepare yourself physically. As mentioned previously, preparing yourself through physical activity, both aerobic and strength training, will help you to be able ski more proficiently and to avoid post-exercise soreness. Many articles that you read about exercises to prepare for ski season have merit. A couple of the better articles can be found here and here.

2) Respect the altitude. Particularly during the holiday season and spring break, most people at my local ski area are “flatlanders”, living thousands of feet lower than the base elevation of 10,700 ft. It is virtually impossible to travel from near sea-level to this elevation without experiencing some symptoms of altitude sickness. Not to mention the effect of altitude on physical exertion in an environment with a reduced partial pressure of oxygen. While it can take several weeks to acclimatize to a higher elevation, after just a few days, the body becomes more efficient at extracting oxygen from the air and physical performance improves. Altitude-related symptoms can include difficulty sleeping, dizziness or light-headedness, headache, fatigue, loss of appetite, nausea, rapid heart rate, and shortness of breath. Any of these can be accentuated by overexertion, dehydration or alcohol consumption. Most can be lessened by a more gradual increase in elevation or by moderating activity levels during the first few days at altitude.

3) Don’t try to squeeze every minute out of your daily ski pass. Lift tickets are usually cheaper if purchased on a multi-day basis. Many ski areas also offer a “buddy pass” program where someone with a season pass can buy a friend a discounted lift ticket. One gas station in my town even offers a coupon for a 2-for-one pass just for filling up your gas tank. When looking into lodging near ski areas, check to see if discounted passes are included. With a little work, you can almost always figure out a way to avoid paying full rate. The importance of this is that if you spend a little less for your ticket, you will be less likely to feel compelled (as I used to) to ski from the time the lifts open until after the lifts close. Six or seven hours of skiing for someone who is not used to skiing can be extremely fatiguing, leading to a higher risk of injury toward the end of the day. During the first couple of days of a skiing vacation, periodically assess how you are feeling and performing. If you start falling more often and your performance becomes sloppy, you are getting tired, and it’s time to take a break or stop for the day.

4) Learn from a professional. One of the most alarmingly entertaining activities that I observe while riding up the ski lift are friends or family members of a novice skier or boarder attempting to provide instruction. Not only can this lead to resentment between teacher and learner, some of the techniques that I see demonstrated are not only incorrect, but in some cases downright dangerous. Although it may seem incongruous, one of the most important things that a ski instructor can teach is how to fall safely. Statistics have shown that most injuries to the anterior cruciate ligament (ACL) of the knee occur from improper technique, particularly during falls. Learning from a certified instructor will keep you from developing bad habits, accelerate your skiing ability, and help you to avoid injuries.

5) Plan your days to maximize enjoyment. Be sure that your equipment is ready (bindings adjusted, boots fitted, skis tuned, etc.) in advance. Study the ski area map in advance to determine the terrain that best suits your abilities. The last thing that a beginner skier wants to do is find themselves at the top of a double black diamond run with no other way down! If you aim for getting in the first wave of skiers for the day, you will enjoy less ski traffic on the slopes and often the best snow of the day. Ski for a couple of hours and then take a break. Since most people start skiing mid-morning, you should find the lodge relatively quiet at this time. Then you can be back out on the slopes before the lunch mob hits. Take another break mid-afternoon, in order to avoid fatigue toward the end of the day.

6) Eat and drink to maintain your energy and hydration. As mentioned previously, going to a higher elevation can lead to dehydration. Make a conscious effort to drink enough liquids to stay well hydrated. Keeping your urine volume high and its color clear is one way of accomplishing this. If you drink alcoholic beverages, save them for an “apr├Ęs ski” activity. There is absolutely nothing about alcohol that will improve your skiing technique, lower your risk of injury, or enhance your persona on the slopes. Since the price of food in ski lodges can be astronomical you may want to bring your own food or snacks. Most ski areas will have a “sack lunch” area with tables to accommodate this. You may want to also keep an energy bar or two in your pocket to eat on the lift if you need an energy boost.

7) Dress appropriately. While fashion often reigns over practicality when it comes to skiing attire, proper clothing choices will enhance your comfort on the slopes considerably. Most people know by now to dress in layers for the cold, with "wicking" fabrics next to the skin. The outermost layer (both top and bottom) should ideally be both windproof and breathable, such as Gortex fabric. A well-fitting helmet serves both as an essential piece of safety equipment and as an insulating layer for the head. Many skiers wear a balaclava under the helmet to keep the neck and ears even warmer. One of the most underappreciated articles of ski clothing is a neck gaiter. These seal the top of your jacket to keep wind out and can be pulled up over the mouth or nose when riding up the lift. Assuming an equal amount of insulation and similar fabric covering, mittens are warmer than gloves.

Most ski areas in the country are reporting excellent conditions this winter. A little preparation will go a long way to enhancing your enjoyment of your skiing vacation.

Friday, January 4, 2013

Understanding Food Product Dating

Everyone has seen the dates posted on various food products - "Use-By …", "Best-By …", "Sell-By …". What do these different categories of food dating mean and are there exceptions to these designations?

With the exception of infant formula, food dating is not required by the Federal government. Several states, however, impose dating requirements on some foods to assure that they remain safe and are consumed at optimal times.

"Open Dating" refers to the calendar dates that are seen on food products. The three most common of these dates are:
  • "Sell-By" date
  • "Use-By" date
  • "Best if Used By (or Before)"
"Sell-By" date is perhaps the most important of the dating designations. It tells the store how long to keep the product up for sale. Food should not be purchased if this date has expired. Once at home, food past the "Sell-By" date may be able to be consumed safely for varying lengths of time, depending on the type of food (poultry, eggs, canned meats, etc.) and the way that the food was processed (sealed at plant, fresh, or uncooked).

"Use-By" date is established by the manufacturer of the product and refers to when the food is best eaten. The quality of the product is thought to decline after the "Use-By" date, but it does not always mean that the product is unsafe or should be discarded. If the food has been handled property and refrigerated at 40 degrees F or below, most foods remain safe for a period of time, even past the "Use-By" date. An exception to this is baby formula which should not be purchased or used after this date.

"Best if used by" date is similar to the "Use-By" date. It is recommended by the manufacturer for best flavor or quality. It is not a purchase or safety date.

In addition to calendar dating, "Closed" or "coded" dating may be used, particularly in foods in cans or boxes that can be stored for longer periods of time. This enables manufacturers to rotate their stock as well as to locate their products in the event of a recall. According to the U.S. Department of Agriculture (USDA), "In general, high-acid canned foods such as tomatoes, grapefruit and pineapple will retain best quality on the shelf for 12 to 18 months; low-acid canned foods such as meat, poultry, fish and most vegetables will retain best quality on the shelf for 2 to 5 years — if the can remains in good condition and has been stored in a cool, clean, dry place."

Obviously, food product dating alone is not always the best guide for determining when a food if safe to consume. Use of the dating criteria, along with the following guidelines, however, will help insure food safety:
  1. Purchase foods prior to the "Sell-By" or "Use-By" date.
  2. If the food is perishable, refrigerate or freeze promptly.
  3. Most foods with a "Use-By" date should be consumed prior to the expiration of that date.
  4. Eggs purchased prior to their "Sell-By" or "EXP" date, and kept refrigerated will maintain their quality for 3 to 5 weeks.
  5. Infant formula should not be purchased or used past the "Use-By" date.
  6. Foods that have a "Sell-By" date or no date should be cooked or frozen following guidelines from the USDA.
  7. Once a perishable product has been handled and frozen properly, the expiration date can be disregarded.
In spite of the dating designation, food that smells bad, tastes bad, or looks bad probably is bad and should not be eaten. Typically, these changes are related to spoilage bacteria that can cause foodborne illness. Remember that, when in doubt . . . throw it out!