Thursday, March 28, 2013

Springtime: When plants and allergies come back to life.

Allergies develop when the immune system overreacts to substances in the environment, such as the pollen of trees, grasses, weeds, or mold spores. Allergy symptoms, triggered by the release of histamine in the body, include itching, sneezing, hives, and wheezing. Seasonal allergic rhinitis or "hay fever," is common this time of the year because of the amount of pollen in the air. Common hay fever symptoms are sneezing, stuffiness, runny nose, and watery eyes. Fortunately, there are a number of self-care measures that can help with springtime allergies.

Reducing pollen exposure. For seasonal allergies caused by plants and trees, it is best to try to stay indoors when pollen counts are high. Information on current pollen levels can be obtained from the National Allergy Bureau website. During allergy season, the best time for outdoor activities is after a rain, which helps clear pollen from the air. To reduce exposure to outdoor pollen, keep windows shut and the air conditioner on. Don't mow lawns or rake leaves because it stirs up pollen and molds. Avoid hanging sheets or clothes outside to dry. If you

work outside, wear a dust mask.

Keeping indoor air allergy-free. You won't be able to eliminate every allergen from your home, but you can reduce your exposure to them. Use a high-efficiency particulate air (HEPA) filter in the bedroom. Wood, tile or vinyl works best for floor surfaces since dust, mold, and pollen can be removed more thoroughly than with carpet. Use of mattress and pillow covers can decrease the exposure to dust mites, since many hay fever sufferers are also allergic to dust mites. Indoor pets should be bathed regularly and kept off of the bed. Remove clothes you've worn outside. Bathe and shampoo hair daily before going to bed to remove pollen from hair and skin.

Over-the-counter (OTC) Antihistamines. All antihistamines, whether OTC or prescription, work by blocking the release of histamine in the body. They are best used when taken prior to the development of symptoms, not after symptoms are present. OTC antihistamines include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec).

Cromolyn sodium (NasalCrom) Nasal spray. Like antihistamines, this OTC nasal spray prevents the release of histamine and helps with nasal symptoms of hay fever. It is most effective when taken before symptoms start and may need to be used several times a day.

Nasal irrigation. Several studies have demonstrated the effectiveness of nasal irrigation in reducing symptoms of allergic rhinitis. Nasal irrigation can be performed with a neti pot, bulb syringe or squeeze bottle to flush out nasal passages with saline (salt) solution. There have been some reports of infection caused by contaminated neti pots. To prevent this, it is important to wash the irrigation device after each use and allow it to air dry.

Decongestants. Decongestants, such as pseudoephedrine (e.g. Sudafed), help with symptoms of nasal congestion but do not treat the underlying allergic reaction. Decongestants should not be taken long-term because they may affect blood pressure or urination. Decongestant nasal sprays such as Afrin or Neosynephrine should not be used for more than 3 or 4 days at a time for allergies in order to avoid rebound nasal congestion.

Herbal remedies. Butterbur (Petasites hybridus, 500 mg per day) – appears to have some effectiveness in preventing seasonal allergy symptoms. Two small studies demonstrated that an extract of butterbur was as effective as the antihistamines, Zyrtec or Allegra. As with medications, herbal products have side effects and can interact with other medications or supplements.

When self-care measures fail. There are a number of treatments for managing seasonal allergy symptoms available by prescription or on doctor's recommendation. These include:
  • Nasal steroids, fluticasone (Flonase), budesonide (Rhinocort), mometasone (Nasonex) and triamcinolone (Nasacort).
  • Prescription antihistamines, desloratadine (Clarinex) and the nasal spray azelastine (Astelin),
  • Leukotriene modifiers. Montelukast (Singulair) is a prescription tablet taken to block the action of leukotrienes — immune system chemicals that cause allergy symptoms such as excess mucus production.
  • Allergen immunotherapy ("allergy shots"). Testing to determine specific allergens responsible for symptoms is necessary prior to undergoing desensitizing injections.

Monday, March 25, 2013

Alternatives to Colonoscopy

Colorectal cancer is the second leading cause of cancer-related deaths for men and women in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it. For some time it has been known that the earlier that colon cancer is detected, the better the survival rate. For example, when colon cancer is diagnosed at an early stage, the five-year survival rate is 90 percent, as compared to a five-year survival rate of only 10 percent when diagnosis is delayed until the later stages. Additionally, the earlier the diagnosis, the less invasive and dangerous the treatment becomes.

Most medical authorities, including the United States Preventive Medicine Task Force and the American Cancer Society, recommend that screening for colon cancer begin at age 50. People in high-risk groups, including African Americans, individuals with a family history of colon cancer, and someone with a personal history of inflammatory bowel disease (e.g. ulcerative colitis), usually start their screening at an earlier age.

There are a number of ways to screen for colon cancer. Colonoscopy is the method that is considered to be the best. Colonoscopy involves the insertion of a flexible instrument with a camera (colonoscope) into the rectum and allows the entire colon to be visualized. A major advantage of colonoscopy is that if abnormal growths are found, they can be removed during the screening. If no abnormalities are found, colonoscopy usually does not need to be repeated for another 10 years.

There is no question but that colonoscopy represents the "gold standard" in colon cancer screening. Because of the expense, inconvenience, and potential for complications, however, many people shy away from being screened with this method. Fortunately, alternatives to colonoscopy, while not as definitive in confirming or ruling out colon cancer, are capable of making the diagnosis or of indicating the need for further evaluation.

Fecal Occult Blood Tests (FOBT) is a test for blood in the stool that is "hidden", or not apparent as typical bright red blood. Occult blood may be an early sign of colon cancer or its predecessor, colon polyps. There are two types of FOBT. One uses a chemical known as guaiac to detect blood. The other, the fecal immunochemical test (FIT), uses antibodies to detect blood in the stool. Stool samples are collected at home and taken to the doctor or to a lab where they are checked for blood. If evidence of blood in the stool is detected, further evaluation, often involving an entire examination of the colon may be required. This test should be repeated each year.

Flexible Sigmoidoscopy is a screening test for colorectal cancer that is less invasive and has less risk of complications than colonoscopy. Sigmoidoscopy involves examination of the lower colon using a thin, flexible tube-like instrument, called a sigmoidoscope. Since the sigmoidoscope is considerably shorter (about 2 feet) than a colonoscopy, less than half of the colon is inspected with this procedure. Nevertheless, studies have demonstrated that sigmoidoscopy, when repeated every five years and coupled with annual stool tests for blood, is effective in reducing the rates of new cases and deaths due to colorectal cancer.

Two tests recommended by the American Cancer Society, but still under consideration by the U.S. Preventive Services Task Force for screening people at average risk for developing colon cancer, are the Double-Contrast Barium Enema and Virtual Colonoscopy. Double-contrast barium enema, also known as air-contrast barium enema, is a radiological procedure where the inner lining of the colon is coated with radioactive barium. X-rays are then obtained that highlight the inner lining of the colon and assist in the detection of abnormalities such as the presence of colon polyps or cancer. To perform virtual colonoscopy, a tube is inserted through the anus and carbon dioxide gas is used to expand the rectum and colon. Once the colon is dilated, computerized tomography (CT scan) is performed to look at the lining of the colon and for abnormal growths. Because of the required bowel prep and other measures used to improve the accuracy of this test, these tests may not be any more acceptable than colonoscopy. Additionally, if anything unusual is found during the test, a colonoscopy is typically required. Another drawback to these tests are that Medicare and private health insurance plans may not pay for them for screening purposes.

March is National Colorectal Cancer Awareness Month. If you are of an appropriate age, are in a high risk group, or are due for a repeat screening, take the time this month to talk to your doctor about colon cancer screening. With the knowledge that, to a large degree, colon cancer is a preventable disease, it only makes sense.

Monday, March 18, 2013

Dangers Inside the Home!!!

People like to think of their home as a safe haven, a place where they can feel comfortable and secure. But our homes can pose risks to our well-being also. The ground on which houses stand, the materials from which they're constructed, as well as the mechanical systems designed to improve our comfort all have a bearing on the safety of our homes.

Radon is formed by the natural radioactive decay of                        uranium in rock, soil, and water. It is colorless, odorless, and tasteless. Unless you tested for it, you would have no idea of its presence or its amount. The US Environmental Protection Agency has determined that most radon exposure occurs from the radon gas that moves up through the ground and into the home where it can build up to dangerous levels. It is found in all 50 states, although the amount of radon in the soil depends on soil chemistry, which varies widely from one location to the next. Radon gas decays into radioactive particles that enter the lungs when breathing. The energy released by these particles is capable of damaging the lungs and in some instances can lead to the development of lung cancer. Only cigarette smoking is more closely tied to the development of lung cancer. The amount of radon in the home can be determined with the use of in-home testing devices. Free test kits are sometimes available from local or county health departments or from your state American Lung Association. Methods to mitigate exposure to radon are available for home new construction as well as for older homes.

Volatile organic compounds (VOCs) Many building materials and products we have in our homes release or "off-gas" VOCs. Acetone, formaldehyde, benzene, and toluene are a few of the chemicals contained in these gases. Common construction materials capable of emitting VOCs include particle board, plywood, insulating foam, carpets, paints, sealing caulks, and vinyl floors. Products used in the home such as adhesives, air fresheners, cleaning agents, cosmetics, and moth balls can also cause elevated levels of VOCs. The different chemicals comprising VOCs each have their own toxicity and potential for causing adverse health effects. Temporary effects of VOCs include eye, nose, or throat irritation, allergic skin reactions, dizziness, headaches, and nausea. Even more concerning are long-term risks including cancer, and damage to the liver, kidney and brain produced by certain VOCs. The following suggestions will help to reduce your exposure to VOCs:
  • Responsibly discard any partially full containers of old or unneeded chemicals or paints. Find out if your local government or any organization in your community sponsors special days for the collection of toxic household wastes.

  • VOCs are concentrated in the home, increase ventilation when using products that emit VOCs. In some cases, VOC emitting items may need to be removed from the home.

  • Keep exposure to cancer-causing VOCs to a minimum. These include benzene (from tobacco smoke, stored fuels and paint supplies, and automobile emissions), methylene chloride (from paint strippers, adhesive removers, and aerosol spray paints), and perchloroethylene (used in dry cleaning).

  • Formaldehyde is one of the few indoor air pollutants that can be measured using a home test kit. If an elevated formaldehyde level is detected, identify, and if possible, remove the source.
Carbon Monoxide (CO) is a highly poisonous gas that is formed when carbon-containing substances (gas, oil, kerosene, wood, or charcoal) are burned with insufficient amounts of air. Automobiles, space heaters, ranges, ovens, stoves, furnaces, fireplaces, water heaters, and gas clothes dryers are all common sources of carbon monoxide production. Dangerous levels of CO can build up if appliances are not working or vented properly, leading to CO poisoning. Each year in the U.S., thousands of Emergency Room visits and hundreds of deaths result from accidental CO poisoning. At moderate levels, the symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. Higher levels of CO inhalation can result in loss of consciousness and death. Since carbon monoxide is a clear, colorless gas, it can be very difficult to detect without the use of CO detector. In addition to installation of CO detectors near sleeping areas and on every level of the home, the Centers for Disease Control offers the following suggestions to help prevent CO poisoning:
  • Have your fuel-burning appliances (oil and gas furnaces, gas water heaters, gas ranges and ovens, gas dryers, gas or kerosene space heaters, fireplaces, and wood stoves) inspected by a professional at the beginning of every heating season.

  • Choose appliances that vent their fumes to the outside and make sure that they've been properly installed.

  • Read and follow instruction manuals that accompany fuel-burning devices.

  • Don't idle the car in a garage, even if the garage door is open

  • Don't use a gas oven to heat your home, even for a short time.

  • Don't use a charcoal grill indoors, even in a fireplace.

  • Don't sleep in any room with an unvented gas or kerosene space heater

  • Don't ignore symptoms, particularly if more than one person is experiencing them.

Peanut allergy, an increasingly common sensitivity

Eight types of food account for over 90% of allergic reactions in affected individuals: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Of these, the one most capable of producing a severe allergic reaction is peanuts. It has been estimated that approximately 400,000 school-aged children in the United States have a peanut allergy. Of particular concern is that up to one third of these children with peanut allergy are at risk of developing a life-threatening allergic reaction known as anaphylaxis.                       

It is no coincidence that over the past few years we are hearing more about peanut allergy. The Centers for Disease Control (CDC) reports that the prevalence of food allergies in children under the age of 18 increased between the years 1997 and 2007 by 18%. By some reports, the number of children with peanut allergy has tripled during this same time period.

What causes peanut allergy? Allergic reactions occur when the body’s immune system senses that something that we come in contact with, such as proteins in certain foods, could be harmful. As a defense mechanism, eating an allergenic food triggers the production of a type of antibody known as IgE. When the body is again challenged with that food, IgE antibodies are mobilized to “fight” the foreign protein. One of the effects of this defense is the release of a symptom-producing chemical called histamine. In addition to eating peanuts or peanut-containing foods, other avenues of exposure include inhaling aerosols containing peanuts (peanut flour or cooking spray), cross contact from food being exposed to peanuts during processing, and skin contact.

What are the symptoms of peanut allergy? Peanut allergy symptoms are primarily due to the effects of histamine on the skin, circulatory, respiratory, and gastrointestinal systems. These symptoms include wheezing, swelling in the face and throat, hives, and vomiting. In severe instances, anaphylaxis, with constriction of the airways and a severe drop in blood pressure (shock) can develop.

How is a peanut allergy diagnosed? Peanut allergy is most often suspected from the reaction that eating peanuts produces. To confirm the diagnosis, skin or blood testing may be used. In skin testing, a small amount of an extract of the food suspected of being allergic is introduced beneath the skin with a small needle. In the case of an allergy to that food, redness or swelling will develop at the site of the skin prick. Blood testing for allergies involves measuring the amount of IgE antibodies in the blood stream to particular foods. For example, an elevated IgE antibody level to peanuts strongly suggests a peanut allergy.

What is the treatment for peanut allergy? The only way to confidently avoid an allergic reaction to peanuts is by strictly avoiding exposure to peanuts or peanut-containing products. When exposure occurs inadvertently, treatment is based on the severity of the reaction. For mild reactions (hives, wheezing without respiratory distress, mild swelling, etc.) taking an antihistamine (e.g. Benadryl) may be adequate. For more severe allergic reactions, self-injection with epinephrine or treatment in an Emergency Department may be required. Parents of children with peanut allergies and allergic individuals capable of injecting themselves should carry an epinephrine auto injector (EpiPen, Twinject).

Are there other foods that should be avoided besides peanuts? In addition to peanuts or products that obviously contain peanuts, individuals with peanut allergy should avoid products with the statements, “may contain peanuts” or "produced in a facility that also processes nuts" on their labels. Other risky foods for someone with peanut allergy to eat include cookies and baked goods, candy, ice cream, and ethnic foods such as Chinese, Mexican, Thai, and Indian. Additionally, although peanuts are legumes, most closely related to soybeans and lentils, up to half of individuals with a peanut allergy also react to at least one tree nut (walnut, pecans, cashews, etc.).

Peanut butter and jelly sandwiches have been a staple for generations of American children. The increasing prevalence of peanut allergy, however, is making this a potentially dangerous food choice. The good news is that it appears that around 20% of children with peanut allergy will eventually “outgrow” their sensitivity. Promising also is desensitization therapy that is currently being performed by certain Allergists. By giving gradually increasing doses of peanut protein with careful monitoring for allergic reactions, desensitization has helped children to overcome their allergy to peanuts.

Friday, March 1, 2013

Why should I finish my antibiotics when I'm feeling better?

Many uncomplicated bacterial illnesses such as strep throat or ear infections respond quickly after starting treatment with antibiotics. This can lead to people failing to complete the entire course of prescribed treatment. Why then, considering the expense and risk of side effects, should we heed the common medical advice to complete an entire course of prescribed antibiotic treatment? In short, the two primary reasons why an entire course of a prescribed antibiotic should be taken are:
  1. Failure to take antibiotics in the proper dosage, or for as long as prescribed, runs the risk that the infection will not be adequately treated, leading to a persistent or recurrent infection.

  2. By not taking the entire course of antibiotics, resistant bacteria may develop that no longer respond to common antibiotics. This has the potential to turn easily treatable infections into serious ones.
Inadequate treatment: Taking antibiotics for the full duration prescribed is the best way to assure that harmful bacteria causing the infection are completely eradicated. Shortening the course of treatment may only wipe out the least dangerous bacteria while allowing the less sensitive bacteria to survive. This risks a recurrence of the infection, which can sometimes be even more difficult to treat.

Scientific studies are continuously being conducted to determine the minimal period of time necessary to take antibiotics for various bacterial infections. Doctors use this information in recommending the dosage and length of treatment. While some antibiotics must be taken for 10 days or more, others are approved for a shorter course of treatment. For example, in the case of an uncomplicated urinary tract infection, the antibiotic course may be as short as three days. These recommendations occasionally change based on the development of new antibiotics or on the results of additional research.

Development of resistant organisms: According to the Centers for Disease Control and Prevention (CDC), virtually all significant bacterial infections in the world are becoming resistant to antibiotics. Stopping treatment early is one of the factors responsible for this. With inadequate treatment, bacteria undergo changes in their DNA that makes them no longer susceptible to common antibiotics. This can lead to the need for stronger, more expensive antibiotics, or in some instances, resorting to surgical treatment for what once was an easily treated infection. Other factors contributing to the development of resistant bacteria include prescribing antibiotics for inappropriate reasons, as well as taking antibiotics for a longer period of time than recommended.

Obviously, health care providers have a major responsibility to make sure that antibiotics are prescribed appropriately. Additionally, the CDC recommends that consumers of medical care follow these recommendations in order to improve treatment outcomes and to avoid complications from antibiotic use:
  • Take antibiotics exactly as the doctor prescribes. Do not skip doses. Complete the prescribed course of treatment, even when you start feeling better.

  • Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Antibiotics treat specific types of infections. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

  • Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.

  • Do not ask for antibiotics when your doctor thinks you do not need them. Remember antibiotics have side effects. When your doctor says you don't need an antibiotic, taking one might do more harm than good.

  • Prevent infections by practicing good hand hygiene and getting recommended vaccines.