Wednesday, January 25, 2017

Why Does My Eyelid Twitch?

Eye twitching, or blepharospasm, is a condition that generates a number of questions among our clients. "Blepharo" means eyelid and "spasm" refers to an uncontrolled muscle contraction. There are benign as well as serious causes of blepharospasm. Today's Health Tip will look at the two most common types.
Simple Eyelid Twitch
Typically, with a simple eyelid twitch, the upper lid blinks and you can't make it stop. Usually, this affects only one eye with the lid twitching every few seconds.  This is the most common and least serious type of blepharospasm. Although there is no definite cause, its occurrence seems to be associated with fatigue, stress, lack of sleep and use of alcohol, tobacco or caffeine. Once these spasms begin, they may continue off and on for a few days and then disappear as quickly as they began. People who experience this find it very annoying and in some cases frightening. This type of eyelid twitching requires no treatment although getting plenty of rest, and reducing stress and caffeine consumption seems to help.

Benign Essential Blepharospasm (BEB)
A second, much less common type of eyelid twitching is called Benign Essential Blepharospasm (BEB). "Benign" indicates the condition is not life threatening and "essential" is a medical term meaning "of unknown cause." It is estimated that there are at least 50,000 cases of blepharospasm in the United States, with up to 2000 new cases diagnosed annually. This type of blepharospasm usually involves both eyes, causing the eyelids to close involuntarily. In BEB, abnormal nerve impulses develop in a vicious cycle, producing the spasms. BEB may also be seen in those with conditions that result in irritation of the surface of the eye (cornea) or the membranes lining the eyelids (conjunctiva). This type of blepharospasm may become a chronic, progressively worsening process, and can even become incapacitating.

In most cases, doctors are able to diagnose BEB from the clinical appearance of the patient. There are no laboratory or imaging studies that are specific to the condition. Since light sensitivity is a common trigger for BEB, one of the treatment measures involves the use of tinted glasses to block ultraviolet rays.  For mild cases, medications may be tried initially.  Drugs with the highest percentages of favorable patient responses include the tranquilizer lorazepam and Artane, a medication used in the treatment of Parkinson's disease.

Botulinum (BOTOX®) injections have now become the most commonly recommended treatment for BEB with up to 95% of patients reporting significant improvement. Injection in very small quantities into the muscles around the eyes will relax the spasm. The injection works for several months, but will slowly wear off and usually needs to be repeated. In patients who do receive adequate relief of their spasms with BOTOX® injections, surgical intervention may be considered. Surgical treatment for BEB involves severing the involved muscles around the eye.

When Should I See a Doctor?  As mentioned, most cases of eyelid twitching are benign and related to lifestyle issues such as fatigue and caffeine consumption.  Reasons to consult a physician include: 1) twitching lasting longer than a week, 2) spasm involving other facial muscles, 3) drooping of the eyelid, and 4) redness, swelling or discharge from the eye.

Sources for article:

Eyelid Spasms from Kellogg Eye Center, University of Michigan
Eye twitching from Mayo Foundation for Medical Education and Research
Eyelid twitch from Medline Plus

Wednesday, January 18, 2017

What works for cellulite (and what does not)?

First of all, let's be clear: cellulite is fat.  Cellulite is not a medical term, but a term that was coined in European salons and spas to describe deposits of dimpled fat found on the thighs and buttocks of up to 90% of women.  Cellulite occurs primarily in women, rather than in men, because of the configuration of fibrous bands that separates fat cells into compartments.  In women, this connective tissue has a honeycomb configuration, rather than the crisscross pattern in men, which allows fat to protrude, creating the characteristic "cottage-cheese" pattern. Cellulite development also appears to be under the influence of hormonal factors, with most cellulite developing in the post-adolescent period.

A recent internet search for "cellulite treatment" revealed thousands of entries.  Special washcloths, loofah sponges, creams and gels to "dissolve" cellulite, vitamin and herbal supplements,  massagers,  rollers,  body wraps,  toning lotions,  electrical muscle stimulation, vibrating machines, "enzyme" injections, liposuction, and massage are just a few of the treatments that are touted at these sites.  Despite a prolific number of treatments, there has been scant research performed to evaluate most of these and only a tiny number have received approval from the U.S. Food and Drug Administration (FDA). Let's look at some of the treatments that work and some that don't.

Weight Loss.  Reduction in body fat can have a beneficial effect on the appearance of cellulite. This makes sense when you consider that having less surplus fat makes it less likely to protrude through the connective tissue.  Of course, this is best done through healthy means such as a sensible c
alorie restricted diet and exercise.  Weight loss is not always successful, however, as genetics also has a major bearing on whether or not cellulite develops.  Even women of ideal weight can have cellulite.

Cardiovascular exercise and weight training.  There is some evidence that along with weight loss, a program that includes cardiovascular exercise (walking, jogging, cycling, etc.) and strength training can help improve the appearance of cellulite.  The cardio portion is best done for 30-40 minutes, 3-4 times per week. The strength training program should include calisthenics-type exercises involving the use of small dumbbells, ankle weights or resistance bands.

Liposuction is falling out of favor as a treatment for cellulite. While this surgical treatment does remove fat, it does not remove cellulite specifically.  In fact liposuction can worsen the appearance of cellulite in cases in which large amounts of fat are removed.

Endermologie is a FDA-approved treatment for cellulite which allows for deep   tissue mobilization with the use of a hand-held machine to knead the skin between rollers.  Up to 14 sessions, at significant expense, may be required to see results.  Unfortunately, these results are usually short-lived and follow-up treatments are usually required.

What's new?  Two of the more recently FDA-approved treatments for cellulite involve a "miminally invasive" technique to sever the fibrous bands beneath the skin that cause the characteristic appearance of cellulite.  The first, marketed under the name, Cellulaze, involves the use of a small laser that is inserted under the patient's skin. Laser energy is used to "melt" fat under the skin and release the fibrous bands that pull down on the skin.  A second system called Cellfina uses a needle-like instrument to "cut" the fibrous bands.  Both procedures require the use of a local anesthetic since small incisions have to be made to introduce instruments beneath the skin.  These procedure can be performed on an outpatient basis and generally only require a single treatment. The results are reported to last a year or more.  Both of these forms of treatment are expensive and are most appropriately used after trying less invasive measures, such as weight loss and exercise.

Buyer Beware.   Body wraps, electric muscle stimulators, bowel cleansers, herbal extracts, mesotherapy (a technique in which substances are injected into layers of fat and connective tissue under the skin), creams or gels to "dissolve" cellulite, most massaging devices, and any "anti-cellulite pills" are ineffective and a huge waste of money.

Genetics and statistics indicate that most women will develop cellulite.  Its appearance, however, can be improved by avoiding excess weight and exercising regularly.  If more than this is needed, by all means stick with a method that has proven results.
Sources for article:
Cellulite, Causes and Treatment from WebMD
Cellulite from Mayo Foundation for Medical Education and Research

Wednesday, January 11, 2017

Talking to your children about school violence

By definition, school violence is youth violence that occurs on school property, on the way to or from school, or during a school sponsored event.  School violence can take on a number of different forms including weapon use, bullying, fighting, and electronic aggression.  Statistically, most youth violence has involved persons between the ages of 10 and 24, although the pattern is shifting to involve even younger individuals.
Although any death occurring in the school setting is unacceptable, deaths occurring in the school setting are rare.  Of all youth homicides, less than 3% of these occurred at school.

More common than deaths, however, are non-fatal victimizations that occur in the school setting. In 2014, the CDC reported 486,400 occurrences of non-fatal school violence. A 2015 national survey of youth in grades 9-12 found the following:
  • 7.8% reported being in a physical fight on school property during the 12 months prior to the survey
  • 5.6% reported that they did not go to school on one or more days in the 30 days prior to the survey because the felt unsafe at school or on their way to or from school
  •  4.1% reported carrying a weapon (gun, knife or club) on school property on one or more days in the 30 days before the survey
  • 6.0% reported being threatened or injured with a weapon on school property one or more times in the 12 months before the survey
  • 20.2% reported being bullied on school property and 15.5% reported being bullied electronically during the 12 months before the survey.
Sobering statistics such as these make it clear that there are legitimate concerns among students regarding school-related violence.  Many youths struggle to understand why anyone would do such a thing and question their safety at school. Even though there are no easy answers when addressing these concerns, it is important that parents be able to provide sound, rational advice when addressing their fears and anxieties.

Here are several suggestions offered by the non-profit organization, Mental Health America, to help guide parents through difficult discussions with their children about school violence:
  • Encourage children to talk about their concerns and to express their feelings. They may not understand the term "violence" but can talk to you about being afraid or a classmate who is mean to them.
  • Talk honestly about your own feelings regarding school violence. It is important for children to recognize they are not dealing with their fears alone.
  • Validate the child's feelings. Do not minimize a child's concerns. Let him/her know that serious school violence is not common, which is why incidents such as Columbine and Conyers, Georgia attract so much media attention. Stress that schools are safe places. In fact, recent studies have shown that schools are more secure now than ever before.
  • Empower children to take action regarding school safety. Encourage them to report specific incidents (such as bullying, threats or talk of suicide) and to develop problem solving and conflict resolution skills.
  • Discuss the safety procedures that are in place at your child's school.
  • Create safety plans with your child. Help identify which adults (a friendly secretary, trusted teacher or approachable administrator) your child can talk to if they feel threatened at school.
  • Ensure that your child knows how to reach you (or another family member or friend) in case of crisis during the school day. Remind your child that they can talk to you anytime they feel threatened.
  • Recognize behavior that may indicate your child is concerned about returning to school. Younger children may react to school violence by not wanting to attend school or participate in school-based activities. Teens and adolescents may minimize their concerns outwardly, but may become argumentative, withdrawn, or allow their school performance to decline.
  • Keep the dialogue going and make school safety a common topic in family discussions rather than just a response to an immediate crisis. Open dialogue will encourage children to share their concerns.
  • Seek help when necessary. If you are worried about a child's reaction or have ongoing concerns about his/her behavior or emotions, contact a mental health professional at school or at your community mental health center. Your local Mental Health Association or the National Mental Health Association's Information Center can direct you to resources in your community.
While there are no statistics to indicate that physical violence in the school setting is increasing, there is concern that electronic bullying, also known as cyberbullying, or online social cruelty may be on the rise.

With the widespread increase in electronic communication among today's youth, this is an issue that deserves ongoing attention.

Sources for article:
About School Violence from the Centers for Disease Control
Talking To Kids About School Safety from Mental Health America
Checklist to Help Prevent Violence in Schools from the National PTA

If you have any questions about school violence , please log into your account and send us your question. We are here to help.

Wednesday, January 4, 2017

Obstructive Sleep Apnea

The Greek word "apnea" means "without breath".  In sleep apnea, there is an involuntary cessation of breathing that occurs while sleeping.  These pauses in breathing can last anywhere from 10 seconds to as much as a minute.  Snoring is also a common feature of sleep apnea.  While snoring can just be a nuisance, snoring associated with sleep apnea can signal a serious medical condition. If left untreated, sleep apnea can lead to the development of high blood pressure, heart failure, memory problems, and can increase the chance of having driving accidents due to excessive fatigue.

How does OSA develop?  The most common type of sleep apnea is called Obstructive Sleep Apnea (OSA).  This occurs when soft tissue in the back of the throat collapses during sleep, blocking off the airway. OSA is usually seen in overweight individuals.  Other risk factors for the development of OSA include: a large neck, a recessed chin, smoking, and alcohol use.  A typical patient with OSA will snore loudly after falling asleep. The snoring is then interrupted by silent periods during which no breathing takes place (apnea).  These apneic episodes are then followed by sudden efforts to breathe. The result is disturbed sleep, leading to excessive daytime drowsiness.

How is OSA diagnosed?    Most people with OSA will be unaware of their snoring or episodes of apnea. The predominant symptom will be excessive daytime drowsiness.  The snoring and apnea episodes are usually reported by a family member. The American Sleep Apnea Association has published a questionnaire known as the Snore Score.  A positive response to any one of the following questions points to the possibility of someone having obstructive sleep apnea:
  1. Are you a loud and/or regular snorer?
  2. Have you ever been observed to gasp or stop breathing during sleep?
  3. Do you feel tired or groggy upon awakening, or do you awaken with a headache?
  4. Are you often tired or fatigued during the waking hours?
  5. Do you fall asleep sitting, reading, watching TV or driving?
  6. Do you often have problems with memory or concentration? 
Other symptoms that can be associated with OSA include morning headaches, weight gain, attention deficits and memory loss. The diagnosis is usually confirmed after monitoring for apneic episodes in a sleep laboratory.

How is OSA treated?     Fortunately, there are a number of treatments available for OSA, depending on the severity and underlying causes.  These treatment options include:
  • Avoidance of alcohol and medications that relax the airway and/or reduce respiratory drive.
  • Weight loss is highly effective in obese individuals by reducing excess fat around the neck which is constricting the airway.
  • Positional therapy, i.e., avoiding sleeping on the back (for adults)
  • Oral appliances designed to keep the airway open.
  • Surgery (the most common procedure is called uvulopalatopharyngoplasty which removes excess tissue that is blocking the airway). 
  • Continuous positive airway pressure (CPAP)
The American Academy of Sleep Medicine recommends the use of an oral appliance as a first line treatment for patients with mild to moderate OSA.  In many patients, however, CPAP is the most effective treatment method.  It works by blowing pressurized air into the person's airway at a high enough pressure to keep the airway from collapsing.  A relatively new surgical procedure known as the Pillar Procedure has been found to be helpful in mild-to-moderate OSA. This procedure involves the placement of flexible implants into the soft palate to keep it from relaxing and blocking the airway.  For more on Obstructive Sleep Apnea, visit the American Sleep Apnea Association.

Sources for article: 

What Is Sleep Apnea? from the National Heart, Lung, and Blood Institute
Test Yourself from the American Sleep Apnea Association
Pillar Procedure from the Mayo Foundation for Medical Education and Research

If you have any questions about Obstructive Sleep Apnea, please log into your account and send us your question. We are here to help.